Background: The importance of psychological reactions in modifying oral health behaviors and salivary immunity has been shown previously, but few studies assessed whether psychological reactions are associated with caries in populations. Thus, the aim of this study was to examine the association of depressive symptoms with untreated caries using a hierarchal approach. Methods: In this cross-sectional study, a random sample of 390 South Brazilians aged 60 years or more was evaluated using a structured questionnaire assessing sociodemographic, behavior, health and depressive symptoms (Geriatric Depression Scale) data. Oral examinations were carried out in order to assess: (1) dental status, using the DMFT index; (2) dental plaque, using the Visible Plaque Index, and (3) unstimulated saliva flow, using the spit method. A hierarchical model based on the framework of caries was carried out to assess whether depressive symptoms were associated with prevalent untreated dental caries (or D >0). Results: Depressive symptoms, number of teeth and plaque accumulation were significant predictors of caries with respect to the D >0 outcome. Conclusion: Our findings suggest that depressive symptoms may act as determinants of caries, adding to the body of knowledge supporting the importance of psychological reactions in oral health/disease processes.