The effect of coronavirus disease 2019 pandemic on oral health behavior of Turkish society

Document Type: Original Article


Assistant Professor, Department of Periodontology, School of Dentistry, Usak University, Usak, Turkey



BACKGROUND AND AIM: Coronavirus disease 2019 (COVID-19) has caused widespread public health concerns and has recently been declared a pandemic by the World Health Organization (WHO). Understanding behavioral responses and other precautionary behaviors related to the pandemic may help to improve public oral health behavior and information about community health risks. Studies are largely reliant on the monitoring of COVID-19 outcomes in clinical settings and health behavior responses to pandemics, but no research has sought to examine how individuals’ oral health behaviors are affected during the pandemic. In this context, the aim of this research is to determine whether Turkish individuals’ oral health behaviors changed during the pandemic.
METHODS: This population-based study was conducted in Usak, Turkey. A representative sample of individuals were recruited through three stage cluster sampling multistage cluster sampling method. It was designed to assess the public’s oral health response during the COVID-19 pandemic by using a three-part online questionnaire that contained 15 questions. The first part measured demographic data, the second part identified oral health behaviors, and the last part evaluated precautionary behaviors.
RESULTS: A total of 2589 individuals, 1584 (61.2%) women and 1005 (38.8%) men were included.The rate of individuals who brushed their teeth twice or more daily before the COVID-19 pandemic was 41.0%, and this proportion increased to 48.4% during the pandemic. The frequency of toothbrushing increased significantly during the pandemic (P < 0.05, chi-square test). A total of 600 (58.1%) smokers decreased smoking per day during the pandemic.
CONCLUSION: Within the limitations of this study, our results suggest that the COVID-19 pandemic is associated with beneficial changes in toothbrushing and smoking behaviors.


Main Subjects

  1. World Health Organization. Coronavirus disease 2019 (COVID-19): Situation Report -51 [Online]. [cited 2020 Mar 11]; Available from: URL:
  2. Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: A retrospective review of medical records. Lancet 2020; 395(10226): 809-15.
  3. Sabino-Silva R, Jardim ACG, Siqueira WL. Coronavirus COVID-19 impacts to dentistry and potential salivary diagnosis. Clin Oral Investig 2020; 24(4): 1619-21.
  4. Zhai P, Ding Y, Wu X, Long J, Zhong Y, Li Y. The epidemiology, diagnosis and treatment of COVID-19. Int J Antimicrob Agents 2020; 55(5): 105955.
  5. Meng L, Hua F, Bian Z. Coronavirus disease 2019 (COVID-19): Emerging and future challenges for dental and oral medicine. J Dent Res 2020; 99(5): 481-7.
  6. Seale H, McLaws ML, Heywood AE, Ward KF, Lowbridge CP, Van D, et al. The community's attitude towards swine flu and pandemic influenza. Med J Aust 2009; 191(5): 267-9.
  7. Ferguson N. Capturing human behaviour. Nature 2007; 446(7137): 733.
  8. Qian M, Wu Q, Wu P, Hou Z, Liang Y, Cowling B, et al. Psychological responses, behavioral changes and public perceptions during the early phase of the COVID-19 outbreak in China: A population based cross-sectional survey. medRxiv 2020. [In Press].
  9. Yeung NCY, Lau JTF, Choi KC, Griffiths S. Population responses during the pandemic phase of the influenza A(H1N1) pdm09 epidemic, Hong Kong, China. Emerg Infect Dis 2017; 23(5): 813-5.
10. de Zwart O, Veldhuijzen IK, Elam G, Aro AR, Abraham T, Bishop GD, et al. Perceived threat, risk perception, and efficacy beliefs related to SARS and other (emerging) infectious diseases: Results of an international survey. Int J Behav Med 2009; 16(1): 30-40.

11. Kok G, Jonkers R, Gelissen R, Meertens R, Schaalma H, de Zwart O. Behavioural intentions in response to an influenza pandemic. BMC Public Health 2010; 10(1): 174.

12. Ather A, Patel B, Ruparel NB, Diogenes A, Hargreaves KM. Coronavirus disease 19 (COVID-19): Implications for clinical dental care. J Endod 2020; 46(5): 584-95.

13. Taglioni F, Cartoux M, Dellagi K, Dalban C+, Fianu A, Carrat F, et al. The influenza A (H1N1) pandemic in Reunion Island: Knowledge, perceived risk and precautionary behaviour. BMC Infectious Diseases 2013; 13(1): 34.

14. Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med 2020; 8(4): 420-2.

15. Verelst F, Willem L, Beutels P. Behavioural change models for infectious disease transmission: A systematic review (2010-2015). J R Soc Interface 2016; 13(125): 20160820.

16. Wise T, Zbozinek TD, Michelini G, Hagan CC, Mobbs D. Changes in risk perception and self-reported protective behaviour during the first week of the COVID-19 pandemic in the United States. R Soc Open Sci 2020; 7(9): 200742.

17. Kay E, Shou L. A randomised controlled trial of a smartphone application for improving oral hygiene. Br Dent J 2019; 226(7): 508-11.

18. Khosravi M. Perceived risk of COVID-19 pandemic: The role of public worry and trust. Electron J Gen Med 2020; 17(4): em203.

19. Harper CA, Satchell LP, Fido D, Latzman RD. Functional fear predicts public health compliance in the COVID-19 pandemic. Int J Ment Health Addict 2020; 1-14. [Epub ahead of print].

20. Park CL, Russell BS, Fendrich M, Finkelstein-Fox L, Hutchison M, Becker J. Americans' COVID-19 stress, coping, and adherence to CDC guidelines. J Gen Intern Med 2020; 35(8): 2296-303.

21. Sibley CG, Greaves LM, Satherley N, Wilson MS, Overall NC, Lee CHJ, et al. Effects of the COVID-19 pandemic and nationwide lockdown on trust, attitudes toward government, and well-being. Am Psychol 2020; 75(5): 618-30.

22. Guo H, Zhou Y, Liu X, Tan J. The impact of the COVID-19 epidemic on the utilization of emergency dental services. J Dent Sci 2020. [Epub ahead of print].

23. Del Rio C, Malani PN. COVID-19-new insights on a rapidly changing epidemic. JAMA 2020; 323(14): 1339-40.

24. Jiang Y, Zhou X, Cheng L, Li M. the impact of smoking on subgingival microflora: From periodontal health to disease. Front Microbiol 2020; 11: 66.

25. Emanuel AS, Parish A, Logan HL, Dodd VJ, Zheng D, Guo Y. Dental visits mediate the impact of smoking on oral health. Am J Health Behav 2018; 42(1): 59-68.

26. Leite FRM, Nascimento GG, Baake S, Pedersen LD, Scheutz F, Lopez R. Impact of smoking cessation on periodontitis: A systematic review and meta-analysis of prospective longitudinal observational and interventional Studies. Nicotine Tob Res 2019; 21(12): 1600-8.

27. McClure JB, Bush T, Anderson ML, Blasi P, Thompson E, Nelson J, et al. oral health promotion and smoking cessation program delivered via tobacco quitlines: The oral health 4 life trial. Am J Public Health 2018; 108(5): 689-95.

28. Wong J, Goh QY, Tan Z, Lie SA, Tay YC, Ng SY, et al. Preparing for a COVID-19 pandemic: A review of operating room outbreak response measures in a large tertiary hospital in Singapore. Can J Anaesth 2020; 67(6): 732-45.

29. Lippi G, Henry BM. Active smoking is not associated with severity of coronavirus disease 2019 (COVID-19). Eur J Intern Med 2020; 75: 107-8.

30. Vecchio S, Ramella R, Drago A, Carraro D, Littlewood R, Somaini L. COVID19 pandemic and people with opioid use disorder: Innovation to reduce risk. Psychiatry Research 2020; 289: 113047.

31. Robichaud M, Dugas MJ. Negative problem orientation (Part I): Psychometric properties of a new measure. Behav Res Ther 2005; 43(3): 391-401.

32. Abdelrahman M. Personality traits, risk perception, and protective behaviors of Arab residents of Qatar during the COVID-19 Pandemic. Int J Ment Health Addict 2020; 1-12. [Epub ahead of print].

33. Lee M, You M. Psychological and behavioral responses in south korea during the early stages of coronavirus disease 2019 (COVID-19). Int J Environ Res Public Health 2020; 17(9).