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

Abstract

Introduction The aims of this study were to determine the associations between psychological wellbeing, and the frequency of tooth brushing and presence of oral ulcers during the COVID-19 pandemic; and to identify the mediating roles of psychological distress (general anxiety and depression) and perceived social support in the paths of observed associations. Methods This cross-sectional study recruited 996 adults in Nigeria between June and August 2020. Data collected through an online survey included outcome variables (decreased frequency of tooth brushing and presence of oral ulcers), explanatory variable (psychological wellbeing), mediators (general anxiety symptoms, depression symptoms and perceived social support) and confounders (age, sex at birth, educational and employment status). Multivariate logistic regression was used to determine the risk indicators for the outcome variables. A path analysis was conducted to identify the indirect effect of mediators on the association between the outcome and explanatory variables. Results Of the 966 respondents, 96 (9.9%) reported decreased tooth-brushing frequency and 129 (13.4%) had oral ulcers during the pandemic. The odds of decreased tooth-brushing during the pandemic decreased as the psychological wellbeing increased (AOR: 0.87; 95% CI: 0.83–0.91; p < 0.001) and as generalized anxiety symptoms increased (AOR: 0.92; 95% CI: 0.86–0.98; p = 0.009). The odds of having an oral ulcer was higher as the generalized anxiety symptoms increased (AOR: 1.15; 95% CI: 01.08–1.21; p < 0.001). Only generalized anxiety (indirect effect: 0.02; 95% CI: 0.01–0.04; P = 0.014) significantly mediated the relationship between wellbeing and tooth-brushing accounting for approximately 12% of the total effect of wellbeing on decreased toothbrushing. Generalized anxiety (indirect effect 0.05; 95% CI: − 0.07–0.03; P < 0.001) also significantly mediated the relationship between wellbeing and presence of oral ulcer accounting for 70% of the total effect of wellbeing on presence of oral ulcer. Depressive symptoms and perceived social support did not significantly mediate the associations between psychological wellbeing, decreased frequency of tooth brushing and the presence of oral ulcers. Conclusion Patients who come into the dental clinic with poor oral hygiene or oral ulcers during the COVID-19 pandemic may benefit from screening for generalized anxiety and psychological wellbeing to identify those who will benefit from interventions for mental health challenges.

Psychological Impact of COVID-19 in the Setting of Dentistry: A Review Article

“…Comparing the results of the studies using validated and non-validated questionnaires, there were differences in the percentage of dentists suffering from anxiety, with higher frequencies in those studies carried out with non-validated questionnaires (ranging from 7.1 to 71% with validated questionnaires [ 71 , 83 ] vs. 25.6 to 89% with non-validated questionnaires [ 64 , 81 ]). This was also observed in the studies that analysed adult patients under general treatment (ranging from 4.5 to 5.1% with validated questionnaires [ 100 , 108 ] vs. 9.5 to 62.4% with non-validated questionnaires [ 76 , 133 ]). Similarly, studies analyzing the percentage of patients presenting fear reported higher values with validated questionnaires (from 45 to 45.7% [ 100 , 120 ]) than with the non-validated ones (62.4 to 63.6% [ 115 , 133 ]).…”

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

“…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 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 ].…”

Peruvian children toothbrushing during the COVID-19 pandemic

“…16 On the other hand, Folayan et al reported that in the COVID-19 pandemic, one tenth of the adult individuals evaluated reported having reduced the regularity with which they brushed their teeth; likewise, the interruption of this healthy habit would be linked to the development of disorders such as anxiety and decreased psychological well-being. 17 From the aforementioned, it can be derived that the modification of such an important daily routine due to such complex scenarios as a health emergency would influence the deterioration of oral hygiene maintenance.…”