Next Article in Journal
Job Mobility and Subjective Well-Being among New-Generation Migrant Workers in China: The Mediating Role of Interpersonal Trust
Next Article in Special Issue
COVID-19 Impact on Public Dental Healthcare in Bosnia and Herzegovina: Current Situation and Ongoing Perspectives
Previous Article in Journal
Hemodynamic Responses to Resistance Exercise with Blood Flow Restriction Using a Practical Method Versus a Traditional Cuff-Inflation System
Previous Article in Special Issue
Differences in Oral Lesions Associated with Tobacco Smoking, E-Cigarette Use and COVID-19 Infection among Adolescents and Young People in Nigeria
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
IJERPH
Volume 19
Issue 18
10.3390/ijerph191811550
ijerph-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Associations between Emotional Distress, Sleep Changes, Decreased Tooth Brushing Frequency, Self-Reported Oral Ulcers and SARS-Cov-2 Infection during the First Wave of the COVID-19 Pandemic: A Global Survey

by
Morenike Oluwatoyin Folayan
1,2,*,
Roberto Ariel Abeldaño Zuniga
1,3,
Oliver C. Ezechi
1,4,
Brandon Brown
1,5,
Annie L. Nguyen
1,6,
Nourhan M. Aly
1,7,
Passent Ellakany
1,8,
Ifeoma E. Idigbe
1,9,
Abeedha Tu-Allah Khan
1,10,
Folake Barakat Lawal
1,11,
Mohammed Jafer
1,12,
Balgis Gaffar
1,13,
Bamidele Olubukola Popoola
1,14,
Mir Faeq Ali Quadri
1,15,
Jorma I. Virtanen
1,16,
Joanne Lusher
1,17 and
Maha El Tantawi
1,7
1
Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria
2
Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife 220282, Nigeria
3
Post Graduate School, University of Sierra Sur, Oaxaca 70805, Mexico
4
Department of Clinical Sciences, Nigerian Institute of Medical Research, Lagos 100001, Nigeria
5
Department of Social Medicine, Population and Public Health, Riverside School of Medicine, University of California, Riverside, CA 92501, USA
6
Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
7
Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria 21544, Egypt
8
Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
9
Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos 100001, Nigeria
10
Department of Biological Sciences, Faculty of Science, Superior University Lahore, Main Raiwind Road Punjab, Lahore 54590, Pakistan
11
Department of Periodontology and Community Dentistry, University of Ibadan and University College Hospital, Ibadan 200132, Nigeria
12
Preventive Dental Sciences Department, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia
13
Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman bin Faisal University, Dammam 31441, Saudi Arabia
14
Department of Child Oral Health, University of Ibadan, Ibadan 200132, Nigeria
15
Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA 98105, USA
16
Faculty of Medicine, University of Turku, 20014 Turku, Finland
17
Provost’s Group, Regent’s University London, London NW1 4NS, UK
 
add Show full affiliation list
 
remove Hide full affiliation list
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2022, 19(18), 11550; https://doi.org/10.3390/ijerph191811550
Submission received: 18 August 2022 / Revised: 10 September 2022 / Accepted: 10 September 2022 / Published: 14 September 2022
(This article belongs to the Special Issue Second Edition of COVID-19: A Public Health Approach for Health Professionals)
Review Reports Versions Notes

Abstract

:
This study assessed the association between emotional distress, sleep changes, decreased frequency of tooth brushing, and self-reported oral ulcers, and the association between COVID-19 status and decreased frequency of tooth brushing. Using a cross-sectional online survey, data were collected from adults in 152 countries between July and December 2020. Binary logistic regression analyses were conducted to determine the associations between dependent (decreased frequency of tooth brushing, oral ulcers, change in sleep pattern) and independent (tested positive for COVID-19, depression, anxiety, frustration/boredom, loneliness, anger, and grief/feeling of loss) variables after adjusting for confounders (age, sex, level of education, employment status). Of the 14,970 participants data analyzed, 1856 (12.4%) tested positive for COVID-19. Respondents who reported feeling depressed (AoR: 1.375), lonely (AoR: 1.185), angry (AoR: 1.299), and experienced sleep changes (AoR:1.466) had significantly higher odds of decreased tooth brushing frequency. Respondents who felt anxious (AoR: 1.255), angry (AoR: 1.510), grief/sense of loss (AoR: 1.236), and sleep changes (AoR: 1.262) had significantly higher odds of oral ulcers. Respondents who tested positive for COVID-19 had significantly higher odds of decreased tooth brushing frequency (AoR: 1.237) and oral ulcers (AoR: 2.780). These findings highlight that the relationship between emotional distress and oral health may intensify during a pandemic.

1. Introduction

Poor oral health is a risk factor for general health [1]. A significant risk factor for systemic diseases is dental plaque. Plaque accumulation induces the development of periodontal diseases and the dissemination of bacteria into the bloodstream. The dissemination of bacteria results in pro-inflammatory events by atheroma formation, maturation, and exacerbation [2,3]. Periodontitis (inflammation of the soft tissue and the bone supporting the tooth) is a risk factor for several major illnesses, including type 2 diabetes, coronary artery disease, cerebral vascular disease, rheumatoid arthritis, chronic obstructive pulmonary disease, pneumonia, chronic kidney disease, cognitive impairment, obesity, metabolic syndrome, and cancer [4,5,6]. Periodontitis can also be non-dental biofilm induced [7].
Frequent tooth brushing effectively reduces the accumulation of plaque and calculus in humans [8]. Poor tooth brushing and plaque accumulation are also risk factors for dental caries [9,10]. Like periodontal diseases, dental caries can lead to the dissemination of bacteria that increase the risk for impaired growth, cardiovascular disease, head and neck cancer, and diseases of the immune system and kidney [11].
The frequency of tooth brushing is lower in people dealing with psychological distress [12], such as depression [13] and suicidal ideation [14], and psychological well-being during a crisis like the COVID-19 pandemic is associated with a decrease in tooth brushing frequency [15]. Psychological distress can be caused by emotional stress like loneliness [16], dental anxiety [17], frustration or boredom [18], anger [19], grief, or feeling of loss [20]. These factors are associated with oral diseases.
Emotions regulate human behavior and moderate responses to stressful situations [21,22,23]. This, in turn, can affect oral health outcomes [24]. Sleep regulates emotions and the quality and amount of sleep influence how an individual reacts to events, thereby affecting general well-being [25]. Sleep problems have been featured commonly during the COVID-19 pandemic and are associated with higher levels of psychological distress [26]. Oral health and sleep quality are intrinsically linked [27]. However, little is known about how sleep quantity is associated with tooth brushing habits.
Nevertheless, psychological distress and sleep disorders are risk factors for oral ulcers [28,29]. COVID-19-induced psychological distress and sleep disorders may be associated with recurrent aphthous ulcers due to elevated levels of salivary cortisol or reactive oxygen species in the saliva [28]. One study reported associations between psychological distress, sleep disorders experienced during the COVID-19 pandemic, reduced tooth brushing frequency, and the presence of oral ulcers [30].
Also, SARS-CoV-2 infects human cells using the ACE2 receptors found in the upper respiratory tract and the epithelial cells lining the salivary gland ducts. The virus can also be found on the dorsum of the tongue, and tooth brushing, along with other oral hygiene methods, may reduce the viral load in the oral cavity [31,32,33,34,35]. However, little is known about this plausible association between tooth brushing and COVID-19.
This study tried to address some of these gaps in understanding the relationship between oral health and COVID-19. We assessed the association between COVID-19-induced emotional distress, sleep changes, reduced tooth brushing frequency, and the presence of self-reported oral ulcers. The study also assessed the association between decreased tooth brushing frequency and testing positive for COVID-19.

2. Materials and Methods

This study is part of a large cross-sectional multi-country study that collected data from 152 countries between July and December 2020 using an online platform (Survey Monkey®) that generated a convenient sample of 21,206 adults. The survey was designed to determine the impact of COVID-19 on the mental health and wellness of adults using a questionnaire that was validated for global use [36]. The overall Content Validity Index of the questionnaire was 0.83.

2.1. Ethical Consideration

Ethical approval was obtained from the Human Research Ethics Committee at the Institute of Public Health of the Obafemi Awolowo University Ile-Ife, Nigeria (HREC No: IPHOAU/12/1557). Additional ethical approval was obtained from India (D-1791-uz and D-1790-uz), Saudi Arabia (CODJU-2006F), Brazil (CAAE N° 38423820.2.0000.0010), and the United Kingdom (13283/10570). Study participants provided consent before participating in the online survey.

2.2. Recruitment of Study Participants

Participants were recruited through respondent-driven sampling. The survey link, created using an online survey tool (Survey Monkey®), was posted on social media groups (Facebook, Twitter, and Instagram), network email lists, and WhatsApp groups. Participants were included if they were above 18 years of age, could understand the survey language, and could access the survey using an electronic device and an internet connection. Respondents were required to provide details about their sociodemographic profile, medical health profile, oral health status, pandemic stress level, and the impact of COVID-19 on their daily life.

2.3. Study Procedure

The survey was preceded by a brief introduction explaining the purpose of the study, assuring participants of their voluntary participation and confidentiality of their data. Before proceeding, participants were required to check a box that indicated consent. The questionnaire took, on average, 11 min to complete and was administered in English. Multiple best-practice procedures were performed to increase the data quality of the survey [37,38]. Each participant could only complete a single questionnaire through IP address restrictions, though they could edit their answers freely until they chose to submit. Full details of the methodology can be found elsewhere [39,40,41].

2.4. Control Variables

Sociodemographic Variables

The confounding sociodemographic variables were age in years, sex at birth (male, female, others), the highest level of education attained (none, primary, secondary, college/university), and employment status (employed, unemployed, student, retiree).

2.5. Dependent Variables

Oral Health

Two indicators of oral health status were determined using two questions: did the frequency of tooth brushing change during the lockdown with the options of ‘Yes (increased)’, ‘Yes (decreased)’ and ‘No change’; and did you have oral ulcers during the lockdown with the option responses of ‘yes’ or ‘no’.

2.6. Independent Variables

2.6.1. COVID-19 Status

This was determined by asking respondents if they had tested positive for COVID-19. The response options were ‘yes’ or ‘no’.

2.6.2. Emotional Distress

Respondents were asked to indicate if they had experienced any of the ten listed emotions during the pandemic. The list included depression, anxiety, frustration or boredom, loneliness, anger, grief, or feeling of loss. Respondents were required to tick a checkbox against any emotions they experienced during the pandemic.

2.6.3. Sleep Changes

Respondents were asked to indicate if they had experienced a change (sleeping more, sleeping less or other changes from normal) or no change in sleep pattern. Each respondent was required to check a response box that indicated if they had experienced a change in sleep pattern during the pandemic. For this study’s statistical analysis, the responses were dichotomized into sleeping changes present (sleeping more, sleeping less, other changes from normal) and sleeping disorders absent (no change in the sleeping pattern).

2.7. Data Analyses

Raw data were downloaded, cleaned, and imported to SPSS version 23.0 (IBM Corp., Armonk, NY, USA) for analysis. Where appropriate, chi-square tests and t-tests were used to assess the associations between the dependent, independent, and confounding variables. Inferential analyses were conducted using binary logistic regression analysis models and adjusting for confounding variables (sociodemographic variables). Adjusted odds ratios (AoR) for the binary logistic regression model and 95% confidence intervals (CI) were calculated. Statistical significance was set at <0.05.

3. Results

As shown in Table 1, 14,970 participants provided complete data for analysis. The mean (standard deviation) age of the participants was 34.58 (12.7) years, 9328 (62.3%) were females, 1636 (10.9%) reported a decrease in tooth brushing frequency during the lockdown, and 1760 (11.8%) reported having oral ulcers. Also, 1856 (12.4%) tested positive for COVID-19, 4394 (29.4%) felt frustrated or bored, 2416 (16.1%) were depressed, 4262 (28.5%) anxious, 2760 (18.4%) lonely, 1841 (12.3%) felt angry; and 1546 (10.3%) felt grief or had a feeling of loss. Finally, 4715 (31.5%) reported sleep changes.
Significantly more respondents who were younger (p < 0.001), students (p < 0.001), felt frustrated or bored (p < 0.001), anxious (p < 0.001), depressed (p < 0.001), lonely (p < 0.001), angry (p < 0.001), grief or sense of loss (p < 0.001), had sleep changes (p < 0.001) and tested positive for COVID-19 (p < 0.001) reported a decrease in the frequency of tooth brushing during the lockdown. Also, significantly fewer people with no formal education (p < 0.001) reported decreased tooth brushing frequency during the lockdown.
Similarly, significantly more respondents who were younger (p < 0.001), had primary school education (p < 0.001), were students (p < 0.001), felt frustrated or bored (p < 0.001), anxious (p < 0.001), depressed (p < 0.001), lonely (p < 0.001), angry (p < 0.001), grief or sense of loss (p < 0.001), had sleep changes (p < 0.001) and tested positive for COVID-19 (p < 0.001) reported having oral ulcers during the lockdown. Also, significantly fewer females (p < 0.001) and people who had no formal education (p < 0.001) reported having oral ulcers during the lockdown.
Table 2 shows that respondents with primary school level of education (AoR: 1.414; 95% CI: 1.034–1.934; p = 0.030), students (AoR:1.449; 95% CI: 1.217–1.724; p < 0.001), those who reported feeling depressed (AoR:1.375; 95% CI: 1.185–1.596; p < 0.001), lonely (AoR: 1.185; 95% CI: 1.025–1.369; p = 0.022), angry (AoR:1.299; 95% CI: 1.107–1.525; p = 0.001), had sleep changes (AoR: 1.466; 95% CI: 1.303–1.650; p < 0.001) and tested positive for COVID-19 (AoR:1.237; 95% CI: 1.069–1.433; p = 0.004), had higher odds of reporting a decrease in tooth brushing frequency during the pandemic. On the contrary, older respondents (AoR:0.984; 95% CI: 0.978–0.990; p < 0.001) had lower odds of reporting a decrease in tooth brushing frequency during the pandemic when there was a lockdown.
Respondents with primary school level of education (AoR: 2.619; 95% CI: 2.011–3.411; p < 0.001)), those employed (AoR: 1.441; 95% CI: 1.221–1.701; p < 0.001), retired (A0R: 1.876; 95% CI: 1.305–2.697; p = 0.001), those who reported feeling anxious (AoR: 1.255; 95% CI: 1.106–1.423; p < 0.001), angry (AoR: 1.510; 95% CI: 1.293–1.763; p < 0.001), grief or a sense of loss (AoR: 1.236; 95% CI: 1.047–1.460; p = 0.013), had sleep changes (AoR: 1.262; 95% CI: 1.122–1.419; p < 0.001) and tested positive for COVID-19 (AoR: 2.780; 95% CI: 2.460–3.141; p < 0.001), had higher odds of reporting oral ulcers during the pandemic. On the contrary, older respondents (AoR: 0.977; 95% CI: 0.971–0.982; p < 0.001) had lower odds of decreased tooth brushing during the pandemic

4. Discussion

According to the present findings, COVID-19-induced emotional distress and sleep changes were associated with decreased frequency of tooth brushing and an increased risk for oral ulcers during the lockdown. The types of emotional distress associated with a decrease in the frequency of tooth brushing were not always associated with a higher risk of oral ulcers. While depression, loneliness, and anger were associated with a decrease in the frequency of tooth brushing, anxiety, anger, and grief or sense of loss were associated with a higher risk of oral ulcers. There was also a significant association between frequency of tooth brushing, presence of oral ulcers, and testing positive for COVID-19.
This study provides a global perspective on the likely impact of COVID-19 lockdowns on oral health and the possible impact of the pandemic on oral and systemic health-related behaviors. The study, however, had a few limitations. It was a cross-sectional study, and data were skewed to those with higher educational levels due to the non-probability sampling technique conducted using an online platform that inadvertently excluded populations less able to access or use online services [42]. Non-probability sampling techniques were appropriate during the pandemic when reduced physical contact and human movement regulations were in place. The large sample size compensates for some of the limitations of the non-probability sampling by allowing for a more precise estimate of effects, which provides a reduced margin for error and an increase in the generalizability of the study findings due to the cosmopolitan nature of this study [43,44].
The findings suggest that depression, loneliness, and anger may result in negative lifestyle modifications associated with a lack of willpower [45,46]. Depression may lead to adopting poor health behaviors; consequently, in this case, a decrease in tooth brushing. Loneliness, described as the subjective experience of social isolation, is also associated with adopting adverse health behaviors such as poor diet, physical inactivity, and problematic smoking and alcohol intake [47,48,49,50,51,52,53]. Anger is also associated with poor health behaviors [54]. The present study provides first-time evidence that a negative oral health behavior associated with the pandemic, decreased frequency of tooth brushing, may be associated with loneliness and anger.
On the other hand, anxiety, anger, grief, or a sense of loss may result in disorders of the body’s physiology that may lead to oral ulcers. Suggested disorders associated with anxiety include a transitory rise in salivary cortisol and reactive oxygen species in the saliva [55]. In the same context, grief is associated with dysregulation of the immune function resulting in the elevation in inflammation-related health problems [56,57,58,59,60,61,62], one of which is recurrent oral ulcers [63,64].
The current study’s findings implicate anger in both behavior and physiobiological changes. A prior study indicated that anger reprioritizes neural and physiological resources that negatively affect behavior and physiological changes. That is, anger decreases liking judgments and enhances avoidance behaviors, negatively affecting health behavior. [65,66]. Anger may have moderated the association between sleep changes, decreased tooth brushing frequency, and increased risk of oral ulcers during the lockdown. Sleep changes are associated with poor health outcomes [67,68], causing functional deficits, increased cortisol secretion, and abnormal growth hormone metabolism [69]. Anger may have also caused oral ulcers through the same physiological process as sleep. However, the moderating effect of anger on the association between sleep changes and decreased tooth brushing may be less direct. Sleep deprivation is associated with anger, irritability, aggression, and short temper, as well as mood swings, leading to decreased motivation and positive health behavior [70]. These are postulations that need to be studied further.
The findings of this current study also highlighted a negative effect of COVID-19-associated emotional distress and sleep changes on oral health with respect to tooth brushing frequency and oral ulcers. Prior studies indicated that aphthous, hemorrhagic, and necrotic oral ulcers were associated with COVID-19 [71,72]. Previous studies also suggested that the pandemic is associated with a higher risk of reduced tooth brushing frequency [15,73,74]. This raises concern over the long-term impact of the pandemic on people at risk of periodontal-induced health risks [7]. The finding of this study suggests possible pathways for the observed results: COVID-19-induced emotional distress and sleep changes may be linked to a decrease in the frequency of tooth brushing and an increased risk for oral ulcers during the lockdown. These study findings suggest the need for reinforcing information about the importance of tooth brushing during pandemic situations and the necessity to support individuals with emotional distress with oral hygiene practice. Such support would assist in preventing physiological detriment caused by poor oral health during a pandemic.
In addition, the current study suggests a possible link between a reduction in the frequency of tooth brushing and testing positive for COVID-19. There are speculations on this association between tooth brushing andSARS-CoV-2 infection risk, with oral hygiene practices reducing this risk [75]. Though the current study is unable to determine the direction of this association, the present finding suggests a plausibility that needs to be explored further.

5. Conclusions

In conclusion, COVID-19-associated emotional distress and disrupted sleep patterns were associated with a reduction in tooth brushing frequency and the presence of oral ulcers, possibly through physiobiological and behavioral pathways. It would be worthwhile for further studies to substantiate this initial observation of plausibility that decreased tooth brushing frequency may be associated with an increased risk of SARS-CoV-2 infection.

Author Contributions

M.O.F.; methodology, M.O.F., R.A.A.Z., O.C.E., B.B., A.L.N., N.M.A., P.E., I.E.I., A.T.-A.K., F.B.L., M.J., B.G., B.O.P., M.F.A.Q., J.I.V., J.L. and M.E.T.; validation, M.O.F., M.E.T., B.B., O.C.E., A.L.N. and N.M.A.; formal analysis, R.A.A.Z.; investigation, N.M.A.; data curation, N.M.A.; writing—original draft preparation, M.O.F.; writing—review and editing, M.O.F., R.A.A.Z., O.C.E., B.B., A.L.N., N.M.A., P.E., I.E.I., A.T.-A.K., F.B.L., M.J., B.G., B.O.P., M.F.A.Q., J.I.V., J.L. and M.E.T.; project administration, M.O.F., M.E.T., B.B., O.C.E., A.L.N. and N.M.A. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Institute of Public Health Research Ethics Committee (HREC No: IPHOAU/12/1557).

Informed Consent Statement

Written informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data presented in this study are available on request from the corresponding author. The data are not publicly available due to ongoing data analysis from the dataset.

Acknowledgments

We acknowledge the time and efforts of study participants. We also acknowledge the efforts of other members of the MEHEWE who contributed to the data collection.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Sabbah, W.; Folayan, M.O.; El Tantawi, M. The link between oral and general health. Int. J. Dent. 2019, 2019, 7862923. [Google Scholar] [CrossRef] [PubMed]
  2. Corredor, Z.; Suarez-Molina, A.; Fong, C.; Cifuentes-C, L.; Guauque-Olarte, S. Presence of periodontal pathogenic bacteria in blood of patients with coronary artery disease. Sci. Rep. 2022, 12, 1241. [Google Scholar] [CrossRef] [PubMed]
  3. Dhadse, P.; Gattani, D.; Mishra, R. The link between periodontal disease and cardiovascular disease: How far we have come in last two decades? J. Indian Soc. Periodontol. 2010, 14, 148–154. [Google Scholar] [CrossRef] [PubMed]
  4. Tonetti, M.S.; van Dyke, T.E.; Working Group 1 of the Joint EFP/AAP Workshop. Periodontitis and atherosclerotic cardiovascular disease: Consensus report of the joint EFP/AAP workshop on periodontitis and systemic diseases. J. Periodontol. 2013, 84 (Suppl. 4), S24–S29. [Google Scholar] [CrossRef] [PubMed]
  5. Winning, L.; Linden, G. Periodontitis and systemic disease. BDJ Team 2015, 2, 15163. [Google Scholar] [CrossRef]
  6. Linden, G.J.; Herzberg, M.C.; Working Group 4 of Joint EFP/AAP Workshop. Periodontitis and systemic diseases: A record of discussions of working group 4 of the joint EFP/AAP workshop on periodontitis and systemic diseases. J. Clin. Periodontol. 2013, 40 (Suppl. 14), S20–S23. [Google Scholar] [CrossRef]
  7. Caton, J.G.; Armitage, G.; Berglundh, T.; Chapple, I.L.C.; Jepsen, S.; Kornman, K.S.; Mealey, B.L.; Papapanou, P.N.; Sanz, M.; Tonetti, M.S. A new classification scheme for periodontal and peri-implant diseases and conditions—Introduction and key changes from the 1999 classification. J. Clin. Periodontol. 2018, 45 (Suppl. 20), S1–S8. [Google Scholar] [CrossRef]
  8. Löe, H. Oral hygiene in the prevention of caries and periodontal disease. Int. Dent. J. 2000, 50, 129–139. [Google Scholar] [CrossRef]
  9. Pita-Fernández, S.; Pombo-Sánchez, A.; Suárez-Quintanilla, J.; Novio-Mallón, S.; Rivas-Mundiña, B.; Pértega-Díaz, S. Clinical relevance of tooth brushing in relation to dental caries. Aten. Primaria 2010, 42, 372–379. [Google Scholar] [CrossRef]
  10. Kumar, S.; Tadakamadla, J.; Johnson, N.W. Effect of toothbrushing frequency on incidence and increment of dental caries: A systematic review and meta-analysis. J. Dent. Res. 2016, 95, 1230–1236. [Google Scholar] [CrossRef] [Green Version]
  11. Ling, Z.; Tao, H. Dental caries and systemic diseases. In Dental Caries; Xuedong, Z., Ed.; Springer: Berlin/Heidelberg, Germany, 2016. [Google Scholar] [CrossRef]
  12. Pohjola, V.; Nurkkala, M.; Virtanen, J.I. Psychological distress, oral health behaviour and related factors among adolescents: Finnish school health promotion study. BMC Oral Health 2021, 21, 6. [Google Scholar] [CrossRef] [PubMed]
  13. Anttila, S.; Knuuttila, M.; Ylöstalo, P.; Joukamaa, M. Symptoms of depression and anxiety in relation to dental health behavior and self-perceived dental treatment need. Eur. J. Oral Sci. 2006, 114, 109–114. [Google Scholar] [CrossRef] [PubMed]
  14. Folayan, M.O.; Tantawi, M.E.; Oginni, O.; Oziegbe, E.; Mapayi, B.; Arowolo, O.; Adeniyi, A.A.; Sam-Agudu, N.A. Oral health practices and oral hygiene status as indicators of suicidal ideation among adolescents in Southwest Nigeria. PLoS ONE 2021, 16, e0247073. [Google Scholar] [CrossRef] [PubMed]
  15. Folayan, M.O.; Ibigbami, O.I.; Oloniniyi, I.O.; Oginni, O.; Aloba, O. Associations between psychological wellbeing, depression, general anxiety, perceived social support, tooth brushing frequency and oral ulcers among adults resident in Nigeria during the first wave of the COVID-19 pandemic. BMC Oral Health 2021, 21, 520. [Google Scholar] [CrossRef]
  16. Rouxel, P.; Heilmann, A.; Demakakos, P.; Aida, J.; Tsakos, G.; Watt, R.G. Oral health-related quality of life and loneliness among older adults. Eur. J. Ageing 2016, 14, 101–109. [Google Scholar] [CrossRef]
  17. Zinke, A.; Hannig, C.; Berth, H. Psychological distress and anxiety compared amongst dental patients—Results of a cross-sectional study in 1549 adults. BMC Oral Health 2019, 19, 27. [Google Scholar] [CrossRef]
  18. Brooks, S.K.; Webster, R.K.; Smith, L.E.; Woodland, L.; Wessely, S.; Greenberg, N.; Rubin, G.J. The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet 2020, 395, 912–920. [Google Scholar] [CrossRef]
  19. Humber, N.; Emsley, R.; Pratt, D.; Tarrier, N. Anger as a predictor of psychological distress and self-harm ideation in inmates: A structured self-assessment diary study. Psychiatry Res. 2013, 210, 166–173. [Google Scholar] [CrossRef]
  20. Joaquim, R.M.; Pinto, A.L.; Guatimosim, R.F.; de Paula, J.J.; Costa, D.S.; Diaz, A.P.; da Silva, A.G.; Pinheiro, M.I.; Serpa, A.L.; Miranda, D.M.; et al. Bereavement and psychological distress during COVID-19 pandemics: The impact of death experience on mental health. Curr. Res. Behav. Sci. 2021, 2, 100019. [Google Scholar] [CrossRef]
  21. Ylöstalo, P.; Ek, E.; Knuuttila, M. Coping and optimism in relation to dental health behaviour—A study among Finnish young adults. Eur. J. Oral Sci. 2013, 111, 477–482. [Google Scholar] [CrossRef]
  22. Gross, J.J. The emerging field of emotion regulation: An integrative review. Rev. Gen. Psychol. 1998, 2, 271–279. [Google Scholar] [CrossRef]
  23. Bowman, G.S. Emotions and illness. J. Adv. Nurs. 2001, 34, 256–263. [Google Scholar] [CrossRef] [PubMed]
  24. Settineri, S.; Rizzo, A.; Liotta, M.; Mento, C. Clinical psychology of oral health: The link between teeth and emotions. SAGE Open 2017, 7, 2158244017728319. [Google Scholar] [CrossRef]
  25. Vandekerckhove, M.; Wang, Y.L. Emotion, emotion regulation and sleep: An intimate relationship. AIMS Neurosci. 2017, 5, 1–17. [Google Scholar] [CrossRef]
  26. Alimoradi, Z.; Broström, A.; Tsang, H.W.H.; Griffiths, M.D.; Haghayegh, S.; Ohayon, M.M.; Lin, C.Y.; Pakpour, A.H. Sleep problems during COVID-19 pandemic and its’ association to psychological distress: A systematic review and meta-analysis. EClinicalMedicine 2021, 36, 100916. [Google Scholar] [CrossRef]
  27. Copeland, D. Sleep Disorders and Oral Health: What’s the Connection? Dentistry IQ. 15 June 2022. Available online: https://www.dentistryiq.com/personal-wellness/article/14278124/sleep-disorders-and-oral-health-whats-the-connection. (accessed on 5 August 2022).
  28. Ajmal, M.; Ibrahim, L.; Mohammed, N.; Al-Qarni, H. Prevalence and psychological stress in recurrent aphthous stomatitis among female dental students in Saudi Arabia. Clujul Med. 2018, 91, 216–221. [Google Scholar] [CrossRef]
  29. Tohidinik, H.R.; Rodríguez, A.; Regueira-Méndez, C.; Takkouche, B. Sleep quality and risk of recurrent aphthous ulcers: A Spanish cohort study. Oral Dis. 2021, 1–9. [Google Scholar] [CrossRef]
  30. Brandão, T.B.; Gueiros, L.A.; Melo, T.S.; Prado-Ribeiro, A.C.; Nesrallah, A.C.F.A.; Prado, G.V.B.; Santos-Silva, A.R.; Migliorati, C.A. Oral lesions in patients with SARS-CoV-2 infection: Could the oral cavity be a target organ? Oral Surg. Oral Med. Oral Pathol. Oral Radiol. 2021, 131, e45–e51. [Google Scholar] [CrossRef]
  31. Liu, L.; Wei, Q.; Alvarez, X.; Wang, H.; Du, Y.; Zhu, H.; Jiang, H.; Zhou, J.; Lam, P.; Zhang, L.; et al. Epithelial cells lining salivary gland ducts are early target cells of severe acute respiratory syndrome coronavirus infection in the upper respiratory tracts of rhesus macaques. J. Virol. 2011, 85, 4025–4030. [Google Scholar] [CrossRef] [Green Version]
  32. To, K.K.-W.; Tsang, O.T.-Y.; Yip, C.C.-Y.; Chan, K.-H.; Wu, T.-C.; Chan, J.M.C.; Leung, W.-S.; Chik, T.S.-H.; Choi, C.Y.-C.; Kandamby, D.H.; et al. Consistent detection of 2019 novel coronavirus in saliva. Clin. Infect. Dis. 2020, 71, 841–843. [Google Scholar] [CrossRef]
  33. Peng, X.; Xu, X.; Li, Y.; Cheng, L.; Zhou, X.; Ren, B. Transmission routes of 2019-nCoV and controls in dental practice. Int. J. Oral Sci. 2020, 12, 9. [Google Scholar] [CrossRef] [PubMed]
  34. Chen, N.; Zhou, M.; Dong, X.; Qu, J.; Gong, F.; Han, Y.; Qiu, Y.; Wang, J.; Liu, Y.; Wei, Y.; et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet 2020, 395, 507–513. [Google Scholar] [CrossRef]
  35. Wang, W.K.; Chen, S.Y.; Liu, I.J.; Chen, Y.C.; Chen, H.L.; Yang, C.F.; Chen, P.J.; Yeh, S.H.; Kao, C.L.; Huang, L.M.; et al. Detection of SARS-associated coronavirus in throat wash and saliva in early diagnosis. Emerg. Infect. Dis. 2004, 10, 1213–1219. [Google Scholar] [CrossRef] [PubMed]
  36. El Tantawi, M.; Folayan, M.O.; Nguyen, A.; Aly, N.M.; Ezechi, O.; Uzochukwu, B.S.C.; Alaba, O.; Brown, B. Validation of a COVID-19 mental health and wellness survey questionnaire. BMC Public Health 2022, 22, 1509. [Google Scholar] [CrossRef]
  37. Van Selm, M.; Jankowski, N.W. Conducting online surveys. Qual. Quant. 2006, 40, 435–456. [Google Scholar] [CrossRef]
  38. King, D.B.; O’Rourke, N.; DeLongis, A. Social media recruitment and online data collection: A beginner’s guide and best practices for accessing low-prevalence and hard-to-reach populations. Can. Psychol. 2014, 55, 240–249. [Google Scholar] [CrossRef]
  39. Nguyen, A.L.; Brown, B.; Tantawi, M.E.; Ndembi, N.; Okeibunor, J.; Mohammed, A.; Folayan, M.O. Time to scale-up research collaborations to address the global impact of COVID-19—A commentary. Health Behav. Policy Rev. 2021, 8, 277–280. [Google Scholar] [CrossRef]
  40. Folayan, M.O.; Ibigbami, O.; Brown, B.; El Tantawi, M.; Uzochukwu, B.; Ezechi, O.C.; Aly, N.M.; Abeldaño, G.F.; Ara, E.; Ayanore, M.A.; et al. Differences in COVID-19 preventive behavior and food insecurity by HIV status in Nigeria. AIDS Behav. 2022, 26, 739–751. [Google Scholar] [CrossRef]
  41. Folayan, M.O.; Ibigbami, O.; El Tantawi, M.; Brown, B.; Aly, N.M.; Ezechi, O.; Abeldaño, G.F.; Ara, E.; Ayanore, M.A.; Ellakany, P.; et al. Factors associated with financial security, food security and quality of daily lives of residents in Nigeria during the first wave of the COVID-19 pandemic. Int. J. Environ. Res. Public Health 2021, 18, 7925. [Google Scholar] [CrossRef]
  42. Oyeboade, J.A. Socio-Economic Status, Peer Pressure and Use of Social Media by Undergraduate Students in University of Ibadan, Ibadan, Oyo State, Nigeria. Libr. Philos. Pract. 2017, 1495. Available online: http://digitalcommons.unl.edu/libphilprac/1495 (accessed on 5 August 2022).
  43. Hargittai, E. Potential biases in big data: Omitted voices on social media. Soc. Sci. Comput. Rev. 2020, 38, 10–24. [Google Scholar] [CrossRef]
  44. Andridge, R.; Valliant, R. Inference from probability and nonprobability samples. In Handbook of Computational Social Science; Routledge: Oxfordshire, UK, 2021; pp. 158–180. [Google Scholar]
  45. Clayborne, Z.M.; Colman, I. Associations between depression and health behaviour change: Findings from 8 cycles of the Canadian community health survey. Can. J. Psychiatry 2019, 64, 30–38. [Google Scholar] [CrossRef] [PubMed]
  46. Stanton, R.; To, Q.G.; Khalesi, S.; Williams, S.L.; Alley, S.J.; Thwaite, T.L.; Fenning, A.S.; Vandelanotte, C. Depression, anxiety and stress during COVID-19: Associations with changes in physical activity, sleep, tobacco and alcohol use in Australian adults. Int. J. Environ. Res. Public Health 2020, 17, 4065. [Google Scholar] [CrossRef] [PubMed]
  47. Rico-Uribe, L.A.; Caballero, F.F.; Olaya, B.; Tobiasz-Adamczyk, B.; Koskinen, S.; Leonardi, M.; Haro, J.M.; Chatterji, S.; Ayuso-Mateos, J.L.; Miret, M. Loneliness, social networks, and health: A cross-sectional study in three countries. PLoS ONE 2016, 11, e0145264. [Google Scholar] [CrossRef]
  48. Kearns, A.; Whitley, E.; Tannahill, C.; Ellaway, A. Loneliness, social relations and health and wellbeing in deprived communities. Psychol. Health Med. 2015, 20, 332–334. [Google Scholar] [CrossRef]
  49. Stickley, A.; Koyanagi, A.; Roberts, B.; Richardson, E.; Abbott, P.; Tumanov, S.; McKee, M. Loneliness: Its correlates and association with health behaviours and outcomes in nine countries of the former Soviet Union. PLoS ONE 2013, 8, e67978. [Google Scholar]
  50. Locher, J.L.; Ritchie, C.S.; Roth, D.L.; Baker, P.S.; Bodner, E.V.; Allman, R.M. Social isolation, support, and capital and nutritional risk in an older sample: Ethnic and gender differences. Soc. Sci. Med. 2005, 60, 747–761. [Google Scholar] [CrossRef]
  51. Ramlagan, S.; Peltzer, K.; Phaswana-Mafuya, N. Social capital and health among older adults in South Africa. BMC Geriatr. 2013, 13, 100. [Google Scholar] [CrossRef]
  52. Shiovitz-Ezra, S.; Litwin, H. Social network type and health-related behaviors: Evidence from an American national survey. Soc. Sci. Med. 2012, 75, 901–904. [Google Scholar] [CrossRef]
  53. Watt, R.G.; Heilmann, A.; Sabbah, W.; Newton, T.; Chandola, T.; Aida, J.; Sheiham, A.; Marmot, M.; Kawachi, I.; Tsakos, G. Social relationships and health related behaviors among older US adults. BMC Public Health 2014, 14, 533. [Google Scholar] [CrossRef]
  54. Staicu, M.L.; Cuţov, M. Anger and health risk behaviors. J. Med. Life 2010, 3, 372–375. [Google Scholar] [PubMed]
  55. Albanidou-Farmaki, E.; Poulopoulos, A.K.; Epivatianos, A.; Farmakis, K.; Karamouzis, M.; Antoniades, D. Increased anxiety level and high salivary and serum cortisol concentrations in patients with recurrent aphthous stomatitis. Tohoku J. Exp. Med. 2008, 214, 291–296. [Google Scholar] [CrossRef] [PubMed]
  56. Seiler, A.; Murdock, K.W.; Fagundes, C.P. Impaired mental health and low-grade inflammation among fatigued bereaved individuals. J. Psychosom. Res. 2018, 112, 40–46. [Google Scholar] [CrossRef] [PubMed]
  57. Buckley, T.; Morel-Kopp, M.C.; Ward, C.; Bartrop, R.; McKinley, S.; Mihailidou, A.S.; Spinaze, M.; Chen, W.; Tofler, G. Inflammatory and thrombotic changes in early bereavement: A prospective evaluation. Eur. J. Prev. Cardiol. 2012, 19, 1145–1152. [Google Scholar] [CrossRef] [PubMed]
  58. Gerra, G.; Monti, D.; Panerai, A.E.; Sacerdote, P.; Anderlini, R.; Avanzini, P.; Zaimovic, A.; Brambilla, F.; Franceschi, C. Long-term immune-endocrine effects of bereavement: Relationships with anxiety levels and mood. Psychiatry Res. 2003, 121, 145–158. [Google Scholar] [CrossRef]
  59. Cohen, M.; Granger, S.; Fuller-Thomson, E. The association between bereavement and biomarkers of inflammation. Behav. Med. 2015, 41, 49–59. [Google Scholar] [CrossRef]
  60. Fagundes, C.P.; Murdock, K.W.; LeRoy, A.; Baameur, F.; Thayer, J.F.; Heijnen, C. Spousal bereavement is associated with more pronounced ex vivo cytokine production and lower heart rate variability: Mechanisms underlying cardiovascular risk? Psychoneuroendocrinology 2018, 93, 65–71. [Google Scholar] [CrossRef]
  61. Seiler, A.; von Känel, R.; Slavich, G.M. The psychobiology of bereavement and health: A conceptual review from the perspective of social signal transduction theory of depression. Front. Psychiatry 2020, 11, 565239. [Google Scholar] [CrossRef]
  62. Katrinli, S.; Oliveira, N.C.S.; Felger, J.C.; Michopoulos, V.; Smith, A.K. The role of the immune system in posttraumatic stress disorder. Transl. Psychiatry 2022, 12, 313. [Google Scholar] [CrossRef]
  63. Zwiri, A.M. Anxiety, depression and quality of life among patients with recurrent aphthous ulcers. J. Contemp. Dent. Pract. 2015, 16, 112–117. [Google Scholar] [CrossRef]
  64. Wang, K.; Ding, L.; Yang, C.; Hao, X.; Wang, C. Exploring the relationship between psychiatric traits and the risk of mouth ulcers using bi-directional mendelian randomization. Front. Genet. 2020, 11, 608630. [Google Scholar] [CrossRef]
  65. Marsh, A.A.; Ambady, N.; Kleck, R.E. The effects of fear and anger facial expressions on approach- and avoidance-related behaviors. Emotion 2005, 5, 119–124. [Google Scholar] [CrossRef] [PubMed]
  66. Murphy, S.T.; Zajonc, R.B. Affect, cognition, and awareness—Affective priming with optimal and suboptimal stimulus exposures. J. Personal. Soc. Psychol. 1993, 64, 723–739. [Google Scholar] [CrossRef]
  67. Grandner, M.A.; Jackson, N.J.; Izci-Balserak, B.; Gallagher, R.A.; Murray-Bachmann, R.; Williams, N.J.; Patel, N.P.; Jean-Louis, G. Social and behavioral determinants of perceived insufficient sleep. Front. Neurol. 2015, 6, 112. [Google Scholar] [CrossRef] [PubMed]
  68. Grandner, M.A.; Patel, N.P.; Gehrman, P.R.; Perlis, M.L.; Pack, A.I. Problems associated with short sleep: Bridging the gap between laboratory and epidemiological studies. Sleep Med. Rev. 2010, 14, 239–247. [Google Scholar] [CrossRef] [PubMed]
  69. Copinschi, G. Metabolic and endocrine effects of sleep deprivation. Essent. Psychopharmacol. 2005, 6, 341–347. [Google Scholar]
  70. Saghir, Z.; Syeda, J.N.; Muhammad, A.S.; Balla Abdalla, T.H. The amygdala, sleep debt, sleep deprivation, and the emotion of anger: A possible connection? Cureus 2018, 10, e2912. [Google Scholar] [CrossRef]
  71. Erbaş, G.S.; Botsali, A.; Erden, N.; Arı, C.; Taşkın, B.; Alper, S.; Vural, S. COVID-19-related oral mucosa lesions among confirmed SARS-CoV-2 patients: A systematic review. Int. J. Dermatol. 2022, 61, 20–32. [Google Scholar] [CrossRef]
  72. Wu, Y.H.; Wu, Y.C.; Lang, M.J.; Lee, Y.P.; Jin, Y.T.; Chiang, C.P. Review of oral ulcerative lesions in COVID-19 patients: A comprehensive study of 51 cases. J. Dent. Sci. 2021, 16, 1066–1073. [Google Scholar] [CrossRef]
  73. Matsuyama, Y.; Aida, J.; Takeuchi, K.; Koyama, S.; Tabuchi, T. Dental pain and worsened socioeconomic conditions due to the COVID-19 pandemic. J. Dent. Res. 2021, 100, 591–598. [Google Scholar] [CrossRef]
  74. Brondani, B.; Knorst, J.K.; Tomazoni, F.; Cósta, M.D.; Vargas, A.W.; Noronha, T.G.; Mendes, F.M.; Ardenghi, T.M. Effect of the COVID-19 pandemic on behavioural and psychosocial factors related to oral health in adolescents: A cohort study. Int. J. Paediatr. Dent. 2021, 31, 539–546. [Google Scholar] [CrossRef] [PubMed]
  75. González-Olmo, M.J.; Delgado-Ramos, B.; Ruiz-Guillén, A.; Romero-Maroto, M.; Carrillo-Díaz, M. Oral hygiene habits and possible transmission of COVID-19 among cohabitants. BMC Oral Health 2020, 20, 286. [Google Scholar] [CrossRef] [PubMed]
Table
Table 1. Factors associated with decreased tooth brushing frequency and self-reported oral ulcers during the lockdown in the first wave of the COVID-19 pandemic in 152 countries (N = 14,970).
Table 1. Factors associated with decreased tooth brushing frequency and self-reported oral ulcers during the lockdown in the first wave of the COVID-19 pandemic in 152 countries (N = 14,970).
Variables Total N = 14,970Tooth Brushing Decreased during the LockdownChi-Square Test p ValueSelf-Reported Oral Ulcers during the LockdownChi-Square Test
p Value
Yes No YesNo
N = 1636N = 13,334N = 1760N = 13,210
10.9%89.1%11.8%88.2%
n (%)n (%)n (%)n (%)
** Age34.58
(SD 12.7)		31.20
(SD 12.1)		34.99
(SD 12.8)		* < 0.00132.15
(SD 11.35)		34.90
(SD 12.9) 		* < 0.001
Sex at birth
Male5544 (37.0)593 (10.7)4951 (89.3) 739 (13.3)4805 (86.7)
Female9328 (62.3)1025 (11.0)8303 (89.0)5.9131004 (10.8)8324 (89.2)* 25.048
Others 98 (0.7)18 (18.4)80 (81.6)0.05217 (17.3)81 (82.7)<0.001
Educational level
No formal education305 (2.0)22 (7.2)283 (92.8) 33 (10.8)272 (89.2)
Primary376 (2.5)49 (13.0)327 (87.0)* 22.49681 (21.5)295 (78.5)* 36.367
Secondary2709 (18.1)356 (13.1)2353 (86.9)<0.001324 (12.0)2385 (88.0)<0.001
College/university11,580 (77.4)1209 (10.4)10,371 (89.6) 1322 (11.4)10,258 (88.6)
Employment status
Employed8305 (55.5)736 (8.9)7569 (91.1) 990 (11.9)7315 (88.1)
Unemployed3736 (25.0)238 (10.1)2113 (89.9)* 163.641217 (9.2)2134 (90.8)* 27.938
Student578 (3.9)617 (16.5)3119 (83.5)<0.001500 (13.4)3236 (86.6)<0.001
Retiree 2351 (15.7)45 (7.8)533 (92.2) 53 (9.2)525 (90.8)
Frustration or boredom
Yes4394 (29.4)596 (13.6)3798 (86.4)* 44.377611 (13.9)3783 (86.1)* 27.673
No 10,576 (70.6)1040 (9.8)9536 (90.2)<0.0011149 (10.9)9427 (89.1)<0.001
Anxiety
Yes4262 (28.5)579 (13.6)3683 (86.4)* 43.201656 (15.4)3606 (84.6)* 75.886
No10,708 (71.5)1057 (9.9)9651 (90.1)<0.0011104 (10.3)9604 (89.7)<0.001
Depression
Yes2416 (16.1)408 (16.9)2008 (83.1)* 105.092388 (16.1)2028 (83.9)* 54.411
No12,554 (83.9)1228 (9.8)11,326 (90.2)<0.0011372 (10.9)11,182 (89.7)<0.001
Loneliness
Yes2760 (18.4)435 (15.8)2325 (84.2)* 81.177417 (15.1)2343 (84.9)* 36.645
No12,210 (81.6)1201 (9.8)11,009 (90.2)<0.0011343 (11.0)10,867 (89.0)<0.001
Anger
Yes1841 (12.3)312 (16.9)1529 (83.1)* 78.120351 (19.1)1490 (80.9)* 108.087
No13,129 (87.7)1324 (10.1)11,805 (89.9)<0.0011409 (10.7)11,720 (89.3)<0.001
Grief or feelings of loss
Yes1546 (10.3)229 (14.8)1317 (85.2)* 26.717279 (18.0)1267 (82.0)* 65.742
No13,424 (89.7)1407 (10.5)12,017 (89.5)<0.0011481 (11.0)11,943 (89.0)<0.001
Sleep changes
Yes4715 (31.5)704 (14.9)4011 (85.1)* 113.277695 (14.7)4020 (85.3)* 59.048
No10,255 (68.5)932 (9.1)9323 (90.9)<0.0011065 (10.4)9190 (89.6)<0.001
Tested positive to COVID-19
Yes1856 (12.4)256 (13.8)1600 (86.2)* 17.860470 (25.3)1386 (74.7)* 375.858
No13,114 (87.6)1380 (10.5)11,734 (89.5)<0.0011290 (9.8)11,824 (90.2)<0.001
** t-test conducted, SD: Standard Deviation, * statistically significant.
Table
Table 2. The binary logistic regression analysis determines the risk indicators for the decreased frequency of tooth brushing and the presence of self-reported oral ulcers during the first wave of COVID-19 in 152 countries (N = 14,970).
Table 2. The binary logistic regression analysis determines the risk indicators for the decreased frequency of tooth brushing and the presence of self-reported oral ulcers during the first wave of COVID-19 in 152 countries (N = 14,970).
Variables Decreased
Tooth Brushing Frequency		Self-Reported Oral Ulcers
Present
AoR; 95% CI
(p Values)		AoR; 95% CI
(p Values)
Age* 0.984; 0.978–0.990 (p < 0.001)* 0.977; 0.971–0.982 (p < 0.001)
Sex at birth
Male0.658; 0.386–1.121; (p = 0.124)0.880; 0.506–1.532 (p = 0.651)
Female0.599; 0.353–1.018; p = 0.058)0.674; 0.388–1.171 (p = 0.162)
Others 1.0001.000
Educational level
No formal education0.765; 0.489–1.198, (p = 0.242)1.268; 0.863–1.864 (p = 0.226)
Primary* 1.414; 1.034–1.934, (p = 0.030)* 2.619; 2.011–3.411 (p < 0.001)
Secondary1.029; 0.900–1.177, (p = 0.672)1.006; 0.876–1.156 (p = 0.930)
College/university1.0001.000
Employment status
Employed0.965; 0.818–1.135 (p = 0.656)* 1.441;1.221–1.701 (p < 0.001)
Student* 1.449; 1.217–1.724 (p < 0.001)1.199; 0.998–1.442 (p = 0.053)
Retiree 1.225; 0.839–1.789 (p = 0.294)* 1.876; 1.305–2.697 (p = 0.001)
Unemployed1.0001.000
Frustration or boredom
Yes0.959; 0.843–1.090 (p = 0.522)0.918; 0.809–1.042 (p = 0.187)
No 1.0001.000
Anxiety
Yes1.081; 0.948–1.233 (p = 0.246)* 1.255; 1.106–1.423 (p < 0.001)
No1.0001.000
Depression
Yes* 1.375; 1.185–1.596 (p < 0.001)1.015; 0.873–1.180 (p = 0.848)
No1.0001.000
Loneliness
Yes* 1.185; 1.025–1.369 (p = 0.022)0.970; 0.839–1.122 (p = 0.684)
No1.0001.000
Anger
Yes* 1.299; 1.107–1.525 (p = 0.001)* 1.510; 1.293–1.763 (p < 0.001)
No1.0001.000
Grief or feelings of loss
Yes0.922; 0.773–1.099 (p = 0.362)* 1.236; 1.047–1.460 (p = 0.013)
No1.0001.000
Sleep changes
Yes* 1.466; 1.303–1.650 (p < 0.001)* 1.262; 1.122–1.419 (p < 0.001)
No1.0001.000
Tested positive for COVID-19
Yes* 1.237; 1.069–1.433 (p = 0.004)* 2.780; 2.460–3.141 (p < 0.001)
No1.0001.000
* Statistically significant. AoR: Adjusted Odds Ratio, CI: Confidence Interval.
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Share and Cite

MDPI and ACS Style

Folayan, M.O.; Zuniga, R.A.A.; Ezechi, O.C.; Brown, B.; Nguyen, A.L.; Aly, N.M.; Ellakany, P.; Idigbe, I.E.; Khan, A.T.-A.; Lawal, F.B.; et al. Associations between Emotional Distress, Sleep Changes, Decreased Tooth Brushing Frequency, Self-Reported Oral Ulcers and SARS-Cov-2 Infection during the First Wave of the COVID-19 Pandemic: A Global Survey. Int. J. Environ. Res. Public Health 2022, 19, 11550. https://doi.org/10.3390/ijerph191811550

AMA Style

Folayan MO, Zuniga RAA, Ezechi OC, Brown B, Nguyen AL, Aly NM, Ellakany P, Idigbe IE, Khan AT-A, Lawal FB, et al. Associations between Emotional Distress, Sleep Changes, Decreased Tooth Brushing Frequency, Self-Reported Oral Ulcers and SARS-Cov-2 Infection during the First Wave of the COVID-19 Pandemic: A Global Survey. International Journal of Environmental Research and Public Health. 2022; 19(18):11550. https://doi.org/10.3390/ijerph191811550

Chicago/Turabian Style

Folayan, Morenike Oluwatoyin, Roberto Ariel Abeldaño Zuniga, Oliver C. Ezechi, Brandon Brown, Annie L. Nguyen, Nourhan M. Aly, Passent Ellakany, Ifeoma E. Idigbe, Abeedha Tu-Allah Khan, Folake Barakat Lawal, and et al. 2022. "Associations between Emotional Distress, Sleep Changes, Decreased Tooth Brushing Frequency, Self-Reported Oral Ulcers and SARS-Cov-2 Infection during the First Wave of the COVID-19 Pandemic: A Global Survey" International Journal of Environmental Research and Public Health 19, no. 18: 11550. https://doi.org/10.3390/ijerph191811550

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop