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This systematic review and meta-analysis investigated the potential links between clinically assessed oral health conditions and depressive symptoms in adults. Six databases were searched for observational studies examining dental caries, periodontal disease, or tooth loss through clinical examination, and depressive symptoms through validated instruments. Data extraction and quality assessment (JBI) were independently performed by two reviewers, and random-effects meta-analyses were conducted for compatible effect measures (OR), assessing heterogeneity. Out of 6.917 unique records, 20 studies were selected. The meta-analyses revealed increased odds of depression for patients who experienced tooth loss (pooled OR = 1.19, 95%CI: 1.09-1.30, I2 = 54.7%), supported by a dose-response gradient in subgroup analyses. Periodontal disease also increased the odds of depression (pooled OR = 1.59, 95%CI: 1.14-2.21, I2 = 0.0%). Conversely, depression as an exposure was associated with higher odds of dental caries (pooled OR = 1.20, 95%CI: 1.04-1.39, I2 = 0.0%), but not with periodontal disease. The relationship between oral and mental health seems to be condition-specific, with robust quantitative evidence indicating the importance of tooth loss in the development of depressive symptoms, which in turn increase the odds for dental caries, suggesting a possible feedback loop. Evidence for depression affecting periodontal status remains inconclusive.