To distinguish the Oral hygiene practices performed by the patients of rural Jaipur before and during the two monthslockdown period and how it changed their oral health. A cross-sectional survey.

INTRODUCTION

The coronavirus or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ¹ is a virusrelated disease that can be transmitted through droplets of an infected person which affects the respiratory system of the infected person and may cause death in severe cases. The first case was detected in December 2019 in Wuhan, China with severe pneumonia and respiratory distress. Since then multiple cases were seen and many people died.²

The COVID-19 was announced as a pandemic on 11th March 2020 by the World Health Organization (WHO).^3,4 Lockdown was announced by many countries including India, which resulted in major economical downfall affecting the whole world. Nowadays, COVID-19 is a common topic for discussion among all of us, whether it be the increasing number of cases or the three months lockdown. Because of amidst COVID-19 lockdown most of us got time to spend with family and focus more on ourselves.^5,6

Aim and Objectives

Many of us are busy in our jobs and do not have time to take care of our health. As per the government, there was an announcement of 2 months (approximately) lockdown. So, this questionnaire study is designed to evaluate the time given by the patients to oral hygiene maintenance and what merits and/or demerits (if any) it caused to theiroral health.

Inclusion Criteria

The selected patients were the cases who had gone through surgical periodontal therapy in the Department of Periodontology, Mahatma Gandhi Dental College, Jaipur, Rajasthan and were on the maintenance phase.

MATERIAL AND METHOD

The design of the questionnaire was based on the time given to brushing and interdental aids used by the patients for the maintenance after surgical periodontal therapy before and during the lockdown period. It includes a sample size of 40 patients. The questionnaire had 16 questions that were asked through a telephonic conversation afterthe lockdown. (Figure 1)

Sampling Method

The 40 samples were taken from our regular surgical periodontal therapy patients held between February-March 2020 inDepartment of Periodontology, Mahatma Gandhi Dental College and Hospital, Jaipur, Rajasthan and post-operative instructions were given to them at that time. The formation of the questionnaire was based on these instructions, to see that is time constrain an important factor to impede these oral hygiene practices. Through telephonic conversation the questionnaire was completed. It included questions about the type of oral hygiene aids,procedure and duration of practicing these aids.

Statistical analysis

Data obtained was compiled on a MS Office Excel Sheet (v 2019, Microsoft Redmond Campus, Redmond, Washington, United States). Data was subjected to statistical analysis using Statistical package for social sciences (SPSS v 26.0, IBM). Descriptive statistics like frequencies and percentage for categorical data, Mean & SD for numerical data has been depicted. Comparison of frequencies of responses for each question before vs during overall was done using chi square test. Comparison of frequencies of responses for each question before vs during (pairwise) was done using McNemar test.

RESULTS

The age group variable in the study was between 40-72 years. Among which 16 were females and 24 were male patients. The 27% of patients belongedto low socio-economic status and remaining were from middle socio-economic status(Figure 1-3). Distributing them on basis of their occupation to co-relate the time constraints, the majority of them were housewives, businessmen, and clerks. On comparing oral hygiene practices of all the 40 patientsbefore and during lockdown, highly significant changes in frequency of brushing were observed.

Before the lockdown 97.5% of patients brushed their teeth twice daily, but during the lockdown 72.5 % of patients brushed once a day. There were only 67.5 % of patients who were using mouthwash during the lockdown, 20% patients said they used it oftenly and 12.5% patient had stopped using it.The 10% of patients started diluting the mouthwash with water and 10 % patients complained about bad breath during the time of lockdown. Other questions responses showed no significant results in the oral hygiene measures before and during the lockdown period.

DISCUSSION

It is important to maintain oral hygiene practices after surgical periodontal therapy to obtain beneficial results. In a systematic review by Alex Solderer et al⁷ concluded that rinsing with chlorhexidine mouth wash significantly showed low biofilm formation and reduction in periodontal parameters when compared with patients who were not using mouthwash.⁸ Mouthwash and tongue cleaning results in reduction of volatile sulfur compounds which helps in treatment of halitosis or bad breath.⁹ Tonzetichin 1977 stated that to treat halitosis, a good oral health and deep tongue cleaning is necessary.¹⁰

During the lockdown, many people went under financial, social and also mental crisis. There is a systemic review and meta-analysis which concluded stress, anxiety and depression were seen in general population during the pandemic.¹¹ Though the patients were getting plenty of time because of closed business, schools and other working sectors the patient may have been facing crisis which affected their oral hygiene measures,they started diluting the mouth wash and due to increasing stress the brushing frequency was also reduced to once during the lockdown period. This could also be because of reduced visit to the dentist for the follow up during the maintenance period, and was no regular counselling by the dentist on the basis of the present periodontal status of the patients.¹² There was bad breath observed by some of the patients as some of them were not using or were not correctly following the oral hygiene measures.

According to other surveys it is seen that patients who were regularly following news related to the pandemic were more depressed than others.¹³ World health organization has stated that excessive anxiety or stress causes decrease in immune system activity which can attract COVID -19 and other diseases also.¹⁴ From our study,it seems that financial stress was the main cause of discontinuing or improper usage of oral hygiene practices.

So, in future, more longitudinal studies with large group size including periodontal parameters are required, to achieve more robust results.

CONCLUSION

The data obtained by this study focuses on the financial and mental strain caused by the patient during this pandemic, because of which they were not able to give time to their oral health.