Findings from the present systematic review showed a great heterogeneity among the studies and the summary effect measure of the meta-analysis cannot affirm an association between depression and periodontitis. Future studies with different designs in distinct populations should be conducted to investigate this association.

BAPD was associated with increased risk for periodontitis. Individuals with BPAD presented higher levels of A. actinomycetemcomitans and P. gingivalis, suggesting that periodontitis could be a co-morbidity frequently found in individuals with BAPD.

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Periodontitis, an inflammatory disease of periodontal tissues, is characterized by the progressive loss of support tissue and the insertion of teeth. It derives from the infection and interaction of specific bacterial species with host response components in susceptible individuals. A growing number of observational and epidemiological studies have been published, in the last decades, pointing to a possible association between stress, anxiety, and depression with the development and progression of periodontal diseases. One of the possible mechanisms of influence of stress and of the psychosocial factors, in the periodontal conditions, is the modification of the individual's behavior. The studies that assessed the association between stress, depression, and periodontal disease are numerous in different types of design, yet their data are still conflicting. Another recurrent serious condition of mental health, frequently associated with high rates of morbidity and mortality, is the bipolar affective disorder (BPAD). Although little investigated and with conflicting data, BPAD is a behavioral factor associated to the periodontal disease. In addition, little is known about its interference with the microbial and immunological response to periodontitis. The aim of this chapter is to describe the main scientific evidence of the association between BPAD and periodontitis.