Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : September | Volume : 16 | Issue : 9 | Page : ZC36 - ZC40 Full Version

Impact of the COVID-19 Pandemic Lockdown on Oral Health and Behaviour Change among Children in the Eastern Province of Saudi Arabia


Published: September 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/57487.16964
Tarek Ezzeldin, Yasmin Alzayer, Jawhara Aljandan, Bayan Alsahwan, Intisar Ahmad Siddiqui

1. Consultant (Paediatric Dentistry) and Medical Director (Complete Saudi Board Program), Department of Paediatric Dentistry, Dammam Specialised Dental Center, Dammam Medical Complex, Dammam, Eastern Province, Saudi Arabia. 2. Consultant Prosthodontics, Department of Prosthodontics, Dammam Specialised Dental Center, Dammam Medical Complex, Dammam, Eastern Province, Saudi Arabia. 3. Saudi Board Resident, Department of Paediatric Dentistry, Dammam Specialised Dental Center, Dammam Medical Complex, Dammam, Eastern Province, Saudi Arabia. 4. Resident, Department of Paediatric Dentistry, Dammam Specialised Dental Center, Dammam Medical Complex, Dammam, Eastern Province, Saudi Arabia. 5. Lecturer, Department of Dental Education, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.

Correspondence Address :
Dr. Intisar Ahmad Siddiqui,
Building No. 7404, Petromin King Faisa Road, Dammam, Saudi Arabia, Eastern Province, Saudi Arabia.
E-mail: iasiddiq@iau.edu.sa

Abstract

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic has been concomitant to a number of alterations in children’s dental health. The indoor activities and intermittent eating during the COVID-19 pandemic lockdown had an impact on oral hygiene practices and behavioural change in children.

Aim: To assess the impact of the COVID-19 pandemic lockdown on oral health and behaviour change among children in the eastern province of Saudi Arabia.

Materials and Methods: This cross-sectional study was conducted in Department of Paediatric Dentistry, Dammam Specialised Dental Center, Dammam, Eastern Province, Saudi Arabia, from 6th October 2021 to 8th March 2022, among 510 children. A well-structured questionnaire consisting of 24 closed-end items related to socio-demographic data, children’s behavioural change during lockdown and oral health practices in the eastern province of Saudi Arabia was tailored. All parents or legal guardians of children aged between 6 and 12 years old were asked to sign a written informed permission to complete a questionnaire voluntarily. Statistical analysis was executed by using Statistical Package for Social Sciences version 22.0 (IBM Product, USA).

Results: Of 510 children to be evaluated for the impact of the COVID-19 pandemic lockdown, 284 (55.7%) mothers, 209 (41%) fathers, and 17 (3.3%) caregivers were the respondents. Although one-half of the children 273 (53.5%) had no change in oral health attention, 72 (14.1%) had increased, while 165 (32.5%) had decreased oral health attention during the COVID-19 pandemic lockdown. There were three significant predictors of children’s oral health behaviour during the COVID-19 pandemic lockdown including frequency of tooth brushing increased (OR=18.7), decreased brushing (OR=28.3), consumption of sugary meals (OR=4.6), and noticing of caries, toothache, bad breath, bleeding/ swelling of the gingiva (OR=3.1).

Conclusion: Study findings demonstrated that the COVID-19 pandemic caused considerable behavioural and psychological alterations in children. The frequency of brushing, dental visits, and sugar consumption all decreased significantly.

Keywords

Bad breath, Brushing, Coronavirus Disease 2019, Dental visits, Gingival health, Sugary meals

The World Health Organisation (WHO) classified Coronavirus Disease 2019 (COVID-19) as pandemic on 11th March 2020. The disease was initially reported to the WHO China Office in December 2019 as pneumonia of unknown origin. A new coronavirus, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), was discovered in January 2020, and its genome was sequenced (1). Saudi Arabia, like other countries, has witnessed and begun to take preventative measures to prevent a sudden and abrupt increase in the number of cases (2), which has resulted in a significant lifestyle change with ramifications for many aspects of health, stress, and anxiety (3).

The COVID-19 pandemic has forced children to restrain themselves at home in all countries around the world for several months. During quarantine, social distance plays an essential role in the reduced spread of disease among the population, so the country tends to lockdown, school is closed, and the child starts online class (4). Despite the benefits of lockdown, a recent study addressed several consequences that impact child psychology like stress, anxiety, sleep, and appetite change during the lockdown (5). Also, in some situations, it is important to recognize oral health and behaviour in addition to caregiver mental attitudes during the lockdown (6).

As this unexpected public incident had an impact on daily living as well as many aspects of health care, particularly dentistry. The dental clinics were considered high-risk place to spread the virus because of the dental aerosols produced during treatment and the close proximity between dentists and patients. As a result, the majority of dental clinics have halted their regular oral health clinics (7). Consequently, the COVID-19 pandemic had an impact on children’s gingival health and oral hygiene habits, resulting in a considerable increase in the number of junior high school students who require dental care (8),(9),(10).

Despite the fact, previous research studies have mainly focused on exploring the consequences of the COVID-19 pandemic on behavioural change in routine oral hygiene practice instead of exclusive oral health features, oral hygiene maintenance and dental problems during the pandemic (8),(9),(11). Hence, there has been a lack of comprehensive research studies that may cover the effect of lockdown on both aspects, i.e., children’s oral health and behavioural change in the Eastern Province of Saudi Arabia, where a strict lockdown was imposed, social distancing was enforced, and educational, sports, and entertainment activities were suspended for the entire population. Thus, the present study aimed to investigate the impact of the COVID-19 pandemic lockdown on oral health and behaviour change among children in the Eastern Province of Saudi Arabia.

Material and Methods

This cross-sectional study was conducted in Department of Paediatric Dentistry, Dammam Specialised Dental Center, Dammam, Eastern Province, Saudi Arabia, from 6th October 2021 to 8th March 2022, among 510 children. The ethical approval was obtained from the Institutional Review Board (Research No. DEN-03).

Inclusion and Exclusion criteria: All parents or legal guardians of children aged between 6 and 12 years old of either genders, physically healthy to perform their routine activities, oral healthcare, and to be noticed for their behaviour were asked to sign a written informed permission to complete a questionnaire voluntarily. The participants who were not willing to participate were excluded from the study. Sample size calculation: Anticipating proportion (p-value=0.272) of covid-19 fear on child’s behaviour (12), on 5% margin of error and 95% confidence of interval, the minimum required sample size calculated was 305 individuals. A total of 510 parents or caregivers participated in online as well as paper format questionnaire with complete responses. Non probability consecutive sampling technique was used for selection of the participants.

Questionnaire

A well-structured questionnaire consisting of 24 closed-end items was devised by following questionnaire of similar study carried out after pilot testing in Wuhan city of China (11). The questionnaire was tailored for the present study and distributed in Arabic and English versions.

• The first eight items (1-8 items) of the questionnaire were related to socio-demographic characteristics of the participants including place of residence, nationality, relationship, child’s age, gender, type of school and number of siblings.
• Further, eight items (9-16 items) were concerned to the effect of lockdown. The subjective measurements of change in behaviour were standardised on verbal scales of one-item question with Likert scale about presence of particular characteristics same as before or varied.
• The last eight items i.e. 17-24 were related to oral hygiene behaviour in terms of attention towards oral health, tooth brushing habits, change in sweet food and drinks consumption, and oral health status described by parents if noticed any dental problems.

Item’s validity and reliability was tested by using Cohen’s kappa coefficient based on random selected of 5% data of children’s oral health attention and behavioural change provided with k=0.749, p-value <0.001, that revealed high validity of survey tool.

Statistical Analysis

Data were analysed by using Statistical Package for Social Sciences (SPSS IBM product of Chicago, USA) version 22.0. All categorical variables in our study including demographic characteristics, child’s behaviour, and oral health status during COVID-19 pandemic lockdown were presented as frequencies and percentages. A logistic regression model was prepared by taking oral health attention during COVID-19 pandemic lockdown as binary variable i.e. change (increase or decrease) and no change. The covariates related to oral health status and practices were considered as panel variables to see how the COVID-19 pandemic lockdown affects oral health. A statistically significant outcome was defined as a p-value ≤0.05.

Results

As per the first and third items of the questionnaire, a total of 510 participants who gave consent to participate and resided in the Eastern province of Saudi Arabia were included in the study. Of 510 children to be evaluated for the impact of the COVID-19 pandemic lockdown, 284 (55.7%) mothers, 209 (41%) fathers, and 17 (3.3%) caregivers were the respondents. Gender distribution among the children was almost similar i.e. 49.4% males and 50.6% females, but a preponderance of Saudi nationals (94.9%) was found. The mean age of children was 7.91±1.81 years. Most of the children (36.7%) were aged 6-7 years. The majority of the children (74.7%) had two or more siblings; nevertheless, 64.1% were studying in public-administrated schools (Table/Fig 1).

The majority of the children 398 (78.02%) had full-time social distancing during the lockdown, whereas 471 (92.4%) were taking online classes, whereas 39 (7.6%) children were not engaged with any academic activity during the lockdown. Most of the children had adopted their routines for their studies and playtime accordingly. Although one-half of the children had no change in behaviour during the COVID-19 pandemic lockdown, 12.5% had aggression, 23.5% anxiety, and 13.1% feared being infected by COVID-19. Thus, 255 (50.0%) of children were performing physical activity in some way at home. A majority of children 358 (70.2%) were engaged with cellular phones, computers, or television as a source of entertainment. Sleeping schedule and appetite changes during social distancing were reported at 407 (79.8%) and 273 (53.5%), respectively (Table/Fig 2).

Although almost one-half of the children 273 (53.5%) had no change in oral health attention, 72 (14.1%) had increased, while 165 (32.5%) had decreased oral health attention during the COVID-19 pandemic lockdown. Increased consumption of sugary meals, including soft drinks, sweets, sugars, and flavored infant formula during the pandemic was noticed in 330 (64.7%) children. The frequency of a child’s brushing habit during COVID-19 lockdown was once a day, more than 2 days, and not every day, as reported at 282 (55.3%), 137 (26.9%), and 91 (17.8%), respectively. Despite the fact that 359 (70.4%) of parents supervised their children’s tooth brushing, 483 (94.7%) use toothpaste, and 377 (73.9%) confirm that their toothpaste contains fluoride. Almost one-half 251 (49.2%) of respondents noticed caries, toothaches, bad breath, and bleeding/swelling of the gingiva (Table/Fig 3).

Logistic regression analysis based on children’s attention towards oral health as a binary variable used to evaluate the impact of the COVID-19 pandemic lockdown on oral health behaviour as a covariate. There were three significant predictors of change in children’s oral health behaviour during the COVD-19 pandemic lockdown, including frequency of tooth brushing increased (OR=18.7), decreased brushing (OR=28.3), consumption of sugary meals (OR=4.6), and increased oral health issues like caries, toothache, bad breath, bleeding/swelling of the gingiva (OR=3.1). These findings revealed that in COVID-19 lockdown, tooth brushing increased 19 times and decreased 28 times compared to the normal brushing habit, that sugary meals were consumed five times more frequently, and that oral health issues increased by three times (Table/Fig 4).

Discussion

When compared to the normal brushing habit, tooth brushing increased 19 times and decreased 28 times during the COVID-19 lockdown, sugary meals were consumed five times more frequently and oral health issues increased by three times in the present study. Despite the fact that earlier research have looked at changes in general population behaviours (12),(13), this is the first study to look at changes in behavioural and psychosocial difficulties related to oral health in children during a pandemic (5),(11),(12) as presented in (Table/Fig 5).

It is becoming more difficult to ensure appropriate oral hygiene and maintain proper oral health habits throughout the COVID-19 epidemic (14). Previous studies suggest that, during the off-campus period, students start to lose the routine good habits obtained during the school period, resulting in a decline in health-related activities such as oral hygiene and physical activity (8),(15). This can be explained by the fact that individuals adopt fewer rigid behaviours on days when the daily routine is not followed (16),(17).

Food-related habits may have been impacted by a number of psychological changes associated to COVID-19. According to the results, this study revealed that consumption of sugary meals increased during the pandemic. These results are comparable with the study that has shown that during the lockdown in Italy, individuals tend to increase their consumption of processed “comfort foods,” such as chocolate, chips, and snacks (18). One possible reason for these findings is that parents struggled to provide complete and healthy meals for their children since they had to balance smart work and family life. Because they could not cook for themselves, eating habits deteriorated, especially among younger and less autonomous youngsters.

From the analysis of the observed caries, toothaches, bad breath, and bleeding/swelling of the gingiva in the present study, it revealed that the lockdown was an obstacle in well-timed dental treatment and lead towards deteriorate condition. Sugar consumption plays a crucial part in the etiology of caries, according to the pathogenesis model based on the “ecological plaque theory.” Increased fermentable sugar intake resulted in low pH conditions in biofilms, resulting in the selection of an acid-tolerant bacterial community and cariogenic species (19).

The findings in this study showed that 50.8% of children’s parents did not notice any change in their behaviour during the COVID-19 lockdown, but the anxiety was approximately only 23.5%. However, a previous study conducted in Brazil showed that anxiety was present in about 52% of the children. While studies developed in Italy and Spain report that approximately 85.7% of parents report negative effects on the emotional state and behaviour of their children during lockdown (4),(20) that may be related to the impact of the news of the highest number of cases and deaths in the world in these two countries.

In this study, 70.2% of children spent their time exposed to cellphones, computers, or television. Also, in previous studies developed in Italy and Spain, the majority of children spent their time using an iPad, television, or computer. Consequently, this may lead to a lack of physical activity and increase the risk of psychological problems among children and adolescents, which, in the long term, may have a significant impact on the health of the population (18),(20).

Furthermore, this new era of COVID-19 fear may have a negative impact on the prevention-based approach to dentistry, as it may drive patients to the dental clinic exclusively for urgent or curative treatments, ignoring the preventive assistance that is so vital for oral health. Patients should be evaluated every 6 months or atleast once a year, according to specialists. Early intervention can reduce the need for invasive procedures like tooth extraction. Patients who see their dentist on a regular basis avoid pain and oral pathology, as well as the negative consequences of infection spread (21).

Limitation(s)

Considering a limited-time pandemic lockdown, a short-term predesigned questionnaire based study was planned instead of newly designed questionnaire based study after pilot testing. There were employed most of the subjective measurements instead of following standard criteria or analogue scales for measurement of psychological factors and self-perceived oral health evaluations.

Conclusion

Findings of present study demonstrated that the COVID-19 pandemic caused considerable behavioural alterations in children. The frequency of brushing decreased and sugar consumption increased significantly. Furthermore, educating parents about oral health and disease is essential to become more knowledgeable about prevention rather than intervention. Also, there is an adverse association between lockdown, emotional and behavioural well-being among children during the lockdown period, which emphasize the potential role of parents in children’s behavioural and emotional modifications in addition to following preventive measures and self-care with regards to life style and oral healthcare. In this way, the children’s behaviour can be studied in future research in relation to post COVID-19 era and their capability to perform better as compared to their past experience of COVID-19 pandemic.

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DOI and Others

DOI: 10.7860/JCDR/2022/57487.16964

Date of Submission: May 01, 2022
Date of Peer Review: May 26, 2022
Date of Acceptance: Jul 27, 2022
Date of Publishing: Sep 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: May 05, 2022
• Manual Googling: Jul 26, 2022
• iThenticate Software: Aug 10, 2022 (5%)

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