Health changes during Covid-19: a nationwide study with dental students

Poly, Ane; Lopes, Laísa Inara Gracindo; Câmara, João Victor Frazão; Barreto, Suelem Chasse; Pereira, Gisele Damiana da Silveira

doi:10.11606/s1518-8787.2023057004666

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Original Article • Rev. Saúde Pública 57 • 2023 • https://doi.org/10.11606/s1518-8787.2023057004666 copy

Health changes during Covid-19: a nationwide study with dental students

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To assess the changes in stress levels, social behavior, dietary and parafunctional habits, oral hygiene, among other conditions perceived by dental students in Brazil during the Covid-19 pandemic and evaluated the correlations between stress level and other variables.

METHODS

An online questionnaire was developed and validated. Undergraduates enrolled in private and public dental schools were recruited by convenience sampling. Data were collected on the perceived changes regarding stress levels, financial and social characteristics, dietary habits, oral hygiene, health conditions, and parafunctional habits. Quantitative variables were expressed as absolute and relative frequencies. Wilcoxon test evaluated comparisons between perceived changes, and correlations between changes in stress levels and other variables were analyzed by Spearman correlation (α = 0.05).

RESULTS

A total of 638 dental students, mean age of 22.95 ± 4.10 years, participated in the study. During the pandemic, the reported stress levels increased while household income decreased (p < 0.05). Late dinners and mindless eating increased in frequency, whereas oral hygiene decreased (p < 0.05). Most of the health conditions and parafunctional habits assessed changed (p < 0.05). Perceived stress levels showed poor negative correlations with household income (r_S = −0.14), poor positive correlations with the pressure to contribute financially in the household (r_S = 0.19), and poor positive correlations with food choice frequency (r_S = 0.15) (p < 0.05).

CONCLUSIONS

Dental students reported perceived changes in stress levels, dietary habits, oral hygiene, health conditions, parafunctional habits, and social behavior. Moreover, the results showed poor correlations, as students with higher stress levels tended to have the lowest household income, feel pressured to contribute financially in the household, and present a high meal intake frequency.

Students, Dental; Adaptation, Psychological; Health Behavior; Physical Distancing; COVID-19

Variable	n	%
1. Dental school year
1st year	101	15.8
2nd year	139	21.8
3rd year	148	23.2
4th year	162	25.4
5th year	88	13.8
2. Dental school region
North	14	2.2
Northeast	157	24.6
Midwest	22	3.5
Southeast	403	63.1
South	42	6.6
3. Gender
Female	514	80.6
Male	124	19.4
4. Age (years)
< 20	57	8.9
20–25	491	76.9
26–30	71	11.1
> 30	19	3.1
5. Main income shared by
1 person	45	7.1
2–3 persons	259	40.6
4–5 persons	298	46.7
> 5 persons	36	5.6

Variable	n	%
6. Monthly household income BEFORE the pandemic (consider a minimum wage of R$1,045):
(1) 1–4 minimum wages	307	48.1
(2) 5–9 minimum wages	195	30.6
(3) 10–14 minimum wages	93	14.6
(4) 15–19 minimum wages	25	3.9
(5) 20+ minimum wages	18	2.8
7. Monthly household income DURING the pandemic (consider a minimum wage of R$1,045):
(1) 1–4 minimum wages	348	54.6
(2) 5–9 minimum wages	181	28.4
(3) 10–14 minimum wages	69	10.8
(4) 15–19 minimum wages	27	4.2
(5) 20+ minimum wages	13	2.0
8. Do you feel pressured to help your family financially due to the pandemic?
Yes, my family pressures me, and I pressure myself	60	9.4
Yes, my family pressures me, but I do not pressure myself	1	0.2
Yes, I pressure myself, but my family does not pressure me	385	60.3
No	192	30.1
9. Stress levels BEFORE the pandemic:
(1) not stressed	31	4.9
(2) a little stressed	263	41.2
(3) moderately stressed	262	41.1
(4) very stressed	67	10.5
(5) extremely stressed	15	2.3
10. Stress levels DURING the pandemic:
(1) not stressed	3	0.5
(2) a little stressed	34	5.3
(3) moderately stressed	171	26.8
(4) very stressed	256	40.1
(5) extremely stressed	174	27.3
11. Meals eaten BEFORE the pandemic:
Breakfast
Yes	481	75.4
No	157	24.6
Morning snack
Yes	167	26.2
No	471	73.8
Lunch
Yes	622	97.5
No	16	2.5
Afternoon snack
Yes	445	69.7
No	193	30.3
Dinner
Yes	581	91.1
No	57	8.9
Late dinner
Yes	120	18.8
No	518	81.2
Mindless eating
Yes	224	35.1
No	414	64.9
12. Meals eaten DURING the pandemic:
Breakfast
Yes	451	70.7
No	187	29.3
Morning snack
Yes	154	24.1
No	484	75.9
Lunch
Yes	611	95.8
No	29	4.2
Afternoon snack
Yes	460	72.1
No	178	27.9
Dinner
Yes	552	86.5
No	86	13.5
Late dinner
Yes	167	26.2
No	471	73.8
Mindless eating
Yes	293	45.9
No	345	54.1
13. Food choice BEFORE the pandemic:
Sugar-rich foods with low tooth adhesion
Yes	281	44.0
No	357	56.0
Sugar-rich foods with high tooth adhesion
Yes	429	67.2
No	209	32.8
High-fat foods
Yes	376	58.9
No	262	41.1
Sausages
Yes	321	50.3
No	317	49.7
Acidic drinks
Yes	224	35.1
No	414	64.9
Tooth-staining foods
Yes	445	69.7
No	193	30.3
None of them
Yes	19	3.0
No	619	97.0
14. Food choice DURING the pandemic:
Sugar-rich foods with low tooth adhesion
Yes	192	30.1
No	446	69.9
Sugar-rich foods with high tooth adhesion
Yes	429	67.2
No	209	32.8
High-fat foods
Yes	329	51.6
No	309	48.4
Sausages
Yes	315	49.4
No	323	50.6
Acidic drinks
Yes	213	33.4
No	425	66.6
Tooth-staining foods
Yes	440	69.0
No	198	31.0
None of them
Yes	24	3.8
No	614	96.2
15. Food choice intake frequency BEFORE the pandemic:
(1) Never	15	2.4
(2) 1–2 times a week	243	38.1
(3) 3–4 times a week	253	39.7
(4) 5–6 times a week	73	11.4
(5) 7+ times a week	54	8.5
16. Food choice intake frequency DURING the pandemic:
(1) Never	15	2.4
(2) 1–2 times a week	156	24.5
(3) 3–4 times a week	257	40.3
(4) 5–6 times a week	122	19.1
(5) 7+ times a week	88	13.8
17. Usually, you eat the food choice selected:
Along with main meals	56	8.8
Right after meals	115	18.0
In the morning	35	5.5
In the afternoon	262	41.1
At the night	137	21.5
Before dawn	15	2.4
Never	18	2.8
18. Tooth brushing frequency BEFORE the pandemic:
(1) No brushing	0	0.0
(2) once a day	5	0.8
(3) twice a day	126	19.7
(4) 3 times a day	411	64.4
(5) 4+ a day	96	15.0
19. Tooth brushing frequency DURING the pandemic:
(1) No brushing	0	0.0
(2) once a day	28	4.4
(3) twice a day	178	27.9
(4) 3 times a day	332	52.0
(5) 4+ a day	100	15.7
20. Tooth brushing time BEFORE the pandemic:
(1) After meals and after snacks	81	12.7
(2) After meals but not after snacks	408	63.9
(3) After most meals but not all	147	23.0
(4) Not everyday	2	0.3
(5) Never	0	0.0
21. Tooth brushing time DURING the pandemic:
(1) After meals and after snacks	104	16.3
(2) After meals but not after snacks	326	51.1
(3) After most meals but not all	196	30.7
(4) Not everyday	12	1.9
(5) Never	0	0.0
22. Health conditions BEFORE the pandemic:
Gingivitis
Yes	83	13.0
No	555	87.0
TMJ pain
Yes	103	16.1
No	535	83.9
Tooth wear
Yes	38	6.0
No	600	94.0
Cold sensitivity
Yes	104	16.3
No	534	83.7
Aphthous ulcer
Yes	87	13.6
No	551	86.4
Traumatic oral ulcer
Yes	22	3.4
No	616	96.6
Herpes labialis
Yes	9	1.4
No	629	98.6
Headache
Yes	227	35.6
No	411	64.4
Gastroesophageal reflux
Yes	89	13.9
No	549	86.1
None of them
Yes	241	37.8
No	397	62.2
23. Health conditions DURING the pandemic:
Gingivitis
Yes	115	18.0
No	523	82.0
TMJ pain
Yes	196	30.7
No	442	69.3
Tooth wear
Yes	71	11.1
No	567	88.9
Cold sensitivity
Yes	130	20.4
No	508	79.6
Aphthous ulcer
Yes	108	16.9
No	530	83.1
Traumatic oral ulcer
Yes	37	5.8
No	601	94.2
Herpes labialis
Yes	14	2.2
No	624	97.8
Headache
Yes	334	52.4
No	304	47.6
Gastroesophageal reflux
Yes	141	22.1
No	497	77.9
None of them
Yes	144	22.6
No	494	77.4
24. Sleep changes due to the pandemic:
Less hours	162	25.4
No change	60	9.4
More hours at night	285	44.7
More hours at anytime (day or night)	91	14.3
More hours, almost the entire day	40	6.3
25. Parafunctional habits BEFORE the pandemic.
Onychophagia (nail biting)
Yes	157	24.6
No	481	75.4
Object biting
Yes	159	24.9
No	479	75.1
Bruxism
Awake clenching
Yes	122	19.1
No	516	80.9
Sleep clenching
Yes	134	21.0
No	504	79.0
Awake teeth grinding
Yes	23	3.6
No	615	96.4
Sleep teeth grinding
Yes	31	4.9
No	607	95.1
Dermatophagia (finger biting)
Yes	237	37.1
No	401	62.9
Lip biting
Yes	243	38.1
No	395	61.9
None of them
Yes	183	28.7
No	455	71.3
26. Parafunctional habits DURING the pandemic.
Onychophagia (nail biting)
Yes	154	24.1
No	484	75.9
Object biting
Yes	122	19.1
No	516	80.9
Bruxism
Awake clenching
Yes	197	30.9
No	441	69.1
Sleep clenching
Yes	195	30.6
No	443	69.4
Awake teeth grinding
Yes	49	7.7
No	589	92.3
Sleep teeth grinding
Yes	50	7.8
No	588	92.2
Dermatophagia (finger biting)
Yes	253	39.7
No	385	60.3
Lip biting
Yes	279	43.7
No	359	56.3
None of them
Yes	0	0.0
No	638	100.0
27. Alcohol consumption changes due to the pandemic:
Never	188	29.5
Stopped	33	5.2
Decreased	173	27.1
Equal	130	20.4
Started	15	2.4
Increased	99	15.5

Variable	Before		During		P value

	Median	Q₁–Q₃	Median	Q₁–Q₃
Monthly household income	2	1–2	1	1–2	< 0.0001^a
Stress levels	3	2–3	4	3–5	< 0.0001^a
Food choice frequency	2	1–2	2	2–3	< 0.0001^a
Tooth brushing frequency	4	4–4	4	3–4	< 0.0001^a
Tooth brushing time	2	2–2	2	2–3	0.0054^a

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E-mail: revsp@usp.br

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[1] Correspondence: João Victor Frazão Câmara University Hospital, Saarland University Clinic of Operative Dentistry, Periodontology and Preventive Dentistry Building 73 66421 Homburg/Saar, Germany E-mail: jvfrazao92@hotmail.com