This study aimed to evaluate the impact of COVID-19 on the oral health of adults with a nationwide online cross-sectional questionnaire survey. The COVID-19 epidemic is a global health crisis, unlike any in modern history [12], which severely affects physical and mental health [13, 14]. Although the epidemic seems to be temporarily contained in China, it is still spreading worldwide. Experts from WHO warned of the second outbreak of this epidemic, and this virus may never entirely go away [15]. In this manner, the present study not only contributes to a comprehensive understanding of the impact of COVID-19 on oral health in China but may also provide additional advice for oral health maintenance during the epidemic for residents in other regions as well as for post-epidemic dental treatment.
The results of our survey show that the epidemic did affect psychological status and change living habits. We found that the participants in Wuhan tended to be more affected than those in other places in China. This finding is reasonable because Wuhan was the earliest epicentre of this epidemic. People in Wuhan may have suffered more from stress and other negative emotions. Previous studies have evaluated the mutual impact of psychological emotions and oral health [16,17,18]. In our study, the significantly higher prevalence of oral problems among participants in Wuhan may also be proof of this mutual correlation.
Toothbrushing frequency did not significantly differ between the participants of different regions and age groups. Notably, 73.09% of the total participants brushed their teeth twice or more a day. In 2015, the fourth national oral health survey was conducted in China. According to the results of that survey, 47.8% of the 35–44-year-old group and 30.6% of the 55–64-year-old group brushed their teeth twice or more a day [19, 20]. Although the age groups differed, the result could be a reference to indicate that the majority of the participants in the present survey had good oral hygiene behaviour. This result may be related to the fact that people might pay more attention to oral healthcare because of the inability to seek timely dental treatment. Educational background and socioeconomic status may also be factors influencing oral health behaviours. These factors require a more detailed questionnaire design and analysis in future research.
Compared with other common chronic diseases, the highest proportion of participants with a history of oral diseases felt that the original disease had worsened during the epidemic. This outcome illustrates the specificity of dental treatment in that the majority of oral problems can only be solved by professional dental procedures. Most dental institutions cannot provide regular dental services amidst the epidemic, leading to the worsening of existing oral problems.
Gingival bleeding, bad breath and oral ulcers were the three most common oral problems the study population encountered amid the epidemic. All three oral problems are associated with oral hygiene [21,22,23,24], and psychological status has been proven to be an important risk factor for oral ulcers [25]. To study the relationship between oral hygiene habits and oral disease further, we found that the prevalence of common oral diseases was the lowest among participants who brushed their teeth twice or more a day. All these findings suggest the importance of good oral hygiene behaviours and mental states in reducing the occurrence of oral diseases.
Inadequate dental services and reluctance to go outside made tolerance the most popular choice for the participants facing oral problems. People chose to stay home as much as possible because of the official recommendation and fear of the epidemic. This finding is in accordance with the results of a previous study showing significantly reduced dental emergency patients in Beijing in February 2020 [26].
Forty percent of the participants worried about inadequate dental services, which may have increased uneasiness and anxiety during the epidemic. Thus, we can see that more than half of the participants tended to pay more attention to oral healthcare after the epidemic. This result suggests that COVID-19 may raise public awareness about oral health while posing a great threat to people’s lives and health.
More than 70% of the participants understood that oral treatment may lead to the spread of infections. This response reflected people’s concerns about the transmission of this serious virus, and most people had correct knowledge. We found that more than 70% of the participants expressed concerns about the safety of dental treatment, and more participants in Wuhan were concerned compared with other places, which is also in accordance with the aforementioned finding that participants in Wuhan were more affected by the epidemic.
Despite this concern, 92.30% of the participants surveyed said they would go to dental institutions when facing dental problems after the epidemic. This response is an important message that reminds us of the importance of avoiding nosocomial infections in the post-epidemic period. Several studies have provided guidelines for the provision of dental care both during and after the epidemic, including the screening and assessment of patients, prevention of infection, hand hygiene, and personal protective equipment [27,28,29]. These guidelines remain to be further improved and evaluated. The most important thing is to abide strictly by the relevant regulations and guidelines during regular dental procedures; thus, both the patients and the dentists will be protected and safe.
