Associations between psychological distress and untreated dental caries in conflict-affected Syrian adolescents: a cross-sectional study

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Introduction: Evidence regarding the oral health of internally displaced Syrian adolescents remains limited. This study evaluated oral health status and examined the association between psychological distress and untreated dental caries among adolescents living in conflict-affected areas of Syria. Methods: This cross-sectional study included 99 adolescents aged 12-17 years. Clinical oral examinations were performed according to World Health Organization (WHO) criteria. Psychological status was assessed using validated Arabic versions of the International Trauma Questionnaire (ITQ), Depression Anxiety Stress Scale-21 (DASS-21), and Epworth Sleepiness Scale (ESS). Associations between untreated dental caries, psychological status, and socio-demographic characteristics were evaluated using descriptive statistics and multivariable regression analyses. Results: The mean DMFT score was 8.42 ± 6.31, with untreated caries accounting for most of the disease burden (mean decayed teeth = 7.44 ± 6.58). Urgent dental treatment was required in 30.3% of participants. Poorer dentition status was significantly associated with rural displacement and lower parental educational level. Importantly, symptoms of post-traumatic stress disorder (PTSD), disturbances in self-organization (DSO), complex PTSD, depression, anxiety, stress, and sleep disturbances remained significantly associated with greater untreated dental decay after adjustment for residential location and parents' education level. Greater psychological symptom severity was associated with progressively higher decayed teeth scores. Conclusions: Conflict-affected Syrian adolescents exhibited a high burden of untreated dental disease and substantial unmet treatment needs. Although socioeconomic disadvantage was associated with poorer oral health, psychological distress remained significantly associated with greater untreated dental decay after adjustment for residential location and parental education. These findings support the integration of oral healthcare and psychosocial services to reduce oral health inequalities among adolescents living in conflict-affected settings.

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