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

doi:10.3390/ijerph191811550

. 2022 Sep 14;19(18):11550.

doi: 10.3390/ijerph191811550.

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

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}, Maha El Tantawi^{1

7}

Affiliations

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.

PMID: 36141821
PMCID: PMC9516999
DOI: 10.3390/ijerph191811550

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

Morenike Oluwatoyin Folayan et al. Int J Environ Res Public Health. 2022.

. 2022 Sep 14;19(18):11550.

doi: 10.3390/ijerph191811550.

Authors

Affiliations

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.

PMID: 36141821
PMCID: PMC9516999
DOI: 10.3390/ijerph191811550

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.

Keywords: COVID-19 pandemic; emotions; oral health; oral ulcers; sleep disorders.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Cited by

The Oral Lesion in the COVID-19 Patient: Is It True Oral Manifestation or Not?
Sarasati A, Agustina D, Surboyo MDC. Sarasati A, et al. Infect Drug Resist. 2023 Jul 4;16:4357-4385. doi: 10.2147/IDR.S411615. eCollection 2023. Infect Drug Resist. 2023. PMID: 37424667 Free PMC article. Review.
Hand and Oral Hygiene Practices of South Korean Adolescents Before and During the COVID-19 Pandemic.
Oh J, Lee M, Lee H, Yang H, Park J, Rahmati M, Koyanagi A, Smith L, Fond G, Boyer L, Kim MS, Lee SW, López Sánchez GF, Dragioti E, Woo HG, Yon DK. Oh J, et al. JAMA Netw Open. 2023 Dec 1;6(12):e2349249. doi: 10.1001/jamanetworkopen.2023.49249. JAMA Netw Open. 2023. PMID: 38147331 Free PMC article.
Evaluation of the daily routines and health behaviors of primary school children and their parents: what has changed with a pandemic?
Ceyhan D, Çakmak BK, Gürel FB. Ceyhan D, et al. BMC Oral Health. 2025 Jul 11;25(1):1145. doi: 10.1186/s12903-025-06202-z. BMC Oral Health. 2025. PMID: 40646522 Free PMC article.
Potential Causal Association between Depression and Oral Diseases: A Mendelian Randomization Study.
Zhang X, Jiang H, Zhang L, Li C, Chen C, Xing M, Ma Y, Ma Y. Zhang X, et al. Genes (Basel). 2023 Dec 8;14(12):2191. doi: 10.3390/genes14122191. Genes (Basel). 2023. PMID: 38137013 Free PMC article.
COVID-19's psychological toll on oral health: A cross-sectional study in Iranian adults.
Karimi M, Khami MR, Varmazyari S, Shamshiri AR, Hormozi M, M Aly N, Oluwátóyìn Foláyan MN. Karimi M, et al. PLoS One. 2024 Jul 19;19(7):e0307429. doi: 10.1371/journal.pone.0307429. eCollection 2024. PLoS One. 2024. PMID: 39028738 Free PMC article.

See all "Cited by" articles

References

1. Sabbah W., Folayan M.O., El Tantawi M. The link between oral and general health. Int. J. Dent. 2019;2019:7862923. doi: 10.1155/2019/7862923. - DOI - PMC - PubMed
1. 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. doi: 10.1038/s41598-022-05337-1. - DOI - PMC - PubMed
1. 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. doi: 10.4103/0972-124X.75908. - DOI - PMC - PubMed
1. 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. doi: 10.1902/jop.2013.1340019. - DOI - PubMed
1. Winning L., Linden G. Periodontitis and systemic disease. BDJ Team. 2015;2:15163. doi: 10.1038/bdjteam.2015.163. - DOI - PMC - PubMed

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Grants and funding

K01 AG064986/AG/NIA NIH HHS/United States

LinkOut - more resources

Full Text Sources
Medical
- MedlinePlus Health Information
Miscellaneous
- NCI CPTAC Assay Portal

[1] Sabbah W., Folayan M.O., El Tantawi M. The link between oral and general health. Int. J. Dent. 2019;2019:7862923. doi: 10.1155/2019/7862923. - DOI - PMC - PubMed

[2] Sabbah W., Folayan M.O., El Tantawi M. The link between oral and general health. Int. J. Dent. 2019;2019:7862923. doi: 10.1155/2019/7862923. - DOI - PMC - PubMed

[3] 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. doi: 10.1038/s41598-022-05337-1. - DOI - PMC - PubMed

[4] 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. doi: 10.1038/s41598-022-05337-1. - DOI - PMC - PubMed

[5] 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. doi: 10.4103/0972-124X.75908. - DOI - PMC - PubMed

[6] 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. doi: 10.4103/0972-124X.75908. - DOI - PMC - PubMed

[7] 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. doi: 10.1902/jop.2013.1340019. - DOI - PubMed

[8] 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. doi: 10.1902/jop.2013.1340019. - DOI - PubMed

[9] Winning L., Linden G. Periodontitis and systemic disease. BDJ Team. 2015;2:15163. doi: 10.1038/bdjteam.2015.163. - DOI - PMC - PubMed

[10] Winning L., Linden G. Periodontitis and systemic disease. BDJ Team. 2015;2:15163. doi: 10.1038/bdjteam.2015.163. - DOI - PMC - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Similar articles

Cited by

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous

Abstract

Conflict of interest statement

Similar articles

Cited by

References

MeSH terms

Related information

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous