Association Between Oral Behaviors and Symptoms of Anxiety and Depression in Romanian Adults Attending Private Dental Practices: A Cross-Sectional Observational Study.

Background/Objectives: Oral behaviors are increasingly considered relevant within the biopsychosocial framework of temporomandibular disorders, yet their relationship with emotional symptoms remains insufficiently characterized in general adult populations. This study investigated the association between the frequency of oral behaviors and the severity of anxiety and depression symptoms in adults. Methods: This observational, cross-sectional, multicenter study included 460 adults recruited from private dental practices. Oral behaviors were assessed using the Oral Behaviors Checklist (OBC-21), while anxiety and depression were evaluated using Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). Associations were examined using Spearman correlations and generalized linear models with negative binomial distributions, adjusted for age, sex, and area of residence. Results: OBC-21 scores were positively associated with GAD-7 (R = 0.469, p < 0.001) and PHQ-9 (R = 0.432, p < 0.001). In adjusted models, OBC-21 remained significantly associated with anxiety symptoms (IRR = 1.0292, 95% CI: 1.0187-1.0399, p < 0.001) and depressive symptoms (IRR = 1.0293, 95% CI: 1.0187-1.0400, p < 0.001). Male sex was associated with lower anxiety scores, while age and area of residence were not significant. GAD-7 and PHQ-9 scores were strongly correlated. Conclusions: In this sample of adults attending private dental practices, a higher frequency of oral behaviors was associated with increased anxiety and depression symptoms, independently of age, sex, and area of residence. These findings support the clinical relevance of assessing oral behaviors as part of a biopsychosocial evaluation in dental practice.