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




Students, Dental, Adaptation, Psychologica, Health Behavior, Physical Distancing, COVID-19


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 (rS = −0.14), poor positive correlations with the pressure to contribute financially in the household (rS = 0.19), and poor positive correlations with food choice frequency (rS = 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.


Sampath S, Khedr A, Qamar S, Tekin A, Singh R, Green R, et al. Pandemics throughout the History. Cureus. 2021;13(9):e18136.

Ye Z, Zhang Y, Wang Y, Huang Z, Song B. Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. Eur Radiol. 2020;30(8):4381-9.

Kalkan Uğurlu Y, Mataracı Değirmenci D, Durgun H, Gök Uğur H. The examination of the relationship between nursing students' depression, anxiety and stress levels and restrictive, emotional, and external eating behaviors in COVID-19 social isolation process. Perspect Psychiatr Care. 2021;57(2):507-16.

Umakanthan S, Sahu P, Ranade AV, Bukelo MM, Rao JS, Abrahao-Machadi LF,et al. Origin, transmission, diagnosis and management of coronavirus disease 2019 (COVID-19). Postgrad Med J. 2020;96(1142):753-8.

Li Q, Guan X, Wu P,Wang X, Zhou L, Tong y, et al. Early transmission dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. 2020;382:1199-1207.

Bezerra ACV, Silva CEM, Soares FRG, Silva JAM. Factors associated with people's behavior in social isolation during the COVID-19 pandemic. Cienc Saude Colet. 2020;25 Suppl 1:2411-21.

Shah SMA, Mohammad D, Qureshi MFH, Abbas MZ, Aleem S. Prevalence, psychological responses and associated correlates of depression, anxiety and stress in a global population, during the Coronavirus Disease (COVID-19) pandemic. Community Ment Health J. 2021;57(1):101-10.

Ray A, Gulati K, Rai N. Stress, anxiety, and immunomodulation: a pharmacological analysis. Vitam Horm. 2017;103:1-25.

Almeida-Leite CM, Stuginski-Barbosa J, Conti PCR. How psychosocial and economic impacts of COVID-19 pandemic can interfere on bruxism and temporomandibular disorders? J Appl Oral Sci. 2020;28:e20200263.

Kisely S, Sawyer E, Siskind D, Lallao R. The oral health of people with anxiety and depressive disorders - a systematic review and meta-analysis. J Affect Disord. 2016;200:119-32.

Christensen KA, Forbush KT, Richson BN, Thomeczek ML, Perko VL, Bjorlie K, et al. Food insecurity associated with elevated eating disorder symptoms, impairment, and eating disorder diagnoses in an American University student sample before and during the beginning of the COVID-19 pandemic. Int J Eat Disord. 2021;54(7):1213-23.

Mustafa RM, Alrabadi NN, Alshali RZ, Khader YS, Ahmad DM. Knowledge, attitude, behavior, and stress related to COVID-19 among undergraduate health care students in Jordan. Eur J Dent. 2020;14(S 01):S50-5.

Ministério da Educação (BR). Portaria Nº 343, de 17 de março de 2020. Dispõe sobre a substituição das aulas presenciais por aulas em meios digitais enquanto durar a situação de pandemia do Novo Coronavírus - COVID-19. Diário Oficial da União. 18 mar 2020 [cited 2021 Mar 6]; Seção 1:39. Available from:

Ministério da Educação (BR). Portaria Nº 837, de 21 de outubro de 2021. Estabelece as regras de retorno gradual e seguro às atividades presenciais no âmbito do Ministério da Educação - MEC, no contexto do enfrentamento do estado de emergência de saúde pública de importância internacional decorrente da Covid-19. Diário Oficial da União. 22 out 2021 [cited 2021 Dec 6]; Seção 1:50. Available from:

Maragha T, Donnelly L, Schuetz C, Bergmann H, Brondani M. Students' resilience and mental health in the dental curriculum. Eur J Dent Educ. 2022 Feb 17. Epub ahead of print

Noor R, Singh D, Agarwal A, Mansoori S, Ansari MI. Perception of dental students towards the online method of dental education during the COVID-19 pandemic. J Oral Biol Craniofac Res. 2022;12(2):223-7.

Hakami Z, Khanagar SB, Vishwanathaiah S, Hakami A, Bokhari AM, Jabali AH, et al. Psychological impact of the coronavirus disease 2019 (COVID-19) pandemic on dental students: a nationwide study. J Dent Educ. 2021;85(4):494-503.

Lestari W, Yazid NH, Azhar ZN, Ismail A, Sukotjo C. Impact of COVID-19 on Malaysian dental students' physical, mental, financial and academic concerns. BMC Oral Health. 2022;22(1):46.

Fernandez MS, Vieira IS, Silva NRJ, Cardoso TA, Bielavski CH, Rakovski C, et al. Anxiety symptoms and alcohol abuse during the COVID-19 pandemic: a cross-sectional study with Brazilian dental undergraduate students. J Dent Educ. 2021;85(11):1739-48.

Grimshaw J. SURGE (The SUrvey Reporting GuidelinE). In: Moher D, Altman DG, Schulz KF, Simera I, Wager E, editors. Guidelines for reporting health research: a user’s manual. Hoboken, NJ: John Wiley; 2014. Chapter 20; p. 206-13.

Ministério da Educação (BR). Cadastro Nacional de Cursos e Instituições de Educação Superior -Cadastro e-MEC. Brasília, DF; 2017 [cited 2021 Dec 6]. Available from:

Hossain MM, Tasnim S, Sultana A, Faizah F, Mazumder H, Zou L, et al. Epidemiology of mental health problems in COVID-19: a review. F1000Res. 2020;9:636.

Adam TC, Epel ES. Stress, eating and the reward system. Physiol Behav. 2007;91(4):449-58.

Jayawardena R, Sooriyaarachchi P, Chourdakis M, Jeewandara C, Ranasinghe P. Enhancing immunity in viral infections, with special emphasis on COVID-19: a review. Diabetes Metab Syndr. 2020;14(4):367-82.

Scarmozzino F, Visioli F. Covid-19 and the subsequent lockdown modified dietary habits of almost half the population in an Italian sample. Foods. 2020;9(5):675.

Conrads G, About I. Pathophysiology of dental caries. Monogr Oral Sci. 2018,27:1-10.

Pinzan-Vercelino CRM, Freitas KMS, Girão VMP, Silva DO, Peloso RM, Pinzan A. Does the use of face masks during the COVID-19 pandemic impact on oral hygiene habits, oral conditions, reasons to seek dental care and esthetic concerns? J Clin Exp Dent. 2021;13(4):e369-75.

Lobbezoo F, Ahlberg J, Aarab G, Manfredini D. Why using 'harmless behaviour', 'risk factor' and 'protective factor' as terms describing the various possible consequences of bruxism is still the best option. J Oral Rehabil. 2021;48(6):762-3.

Akoglu H. User's guide to correlation coefficients. Turk J Emerg Med. 2018;18(3):91-3.

Souza TGS, Lois RF, Câmara JVF, Simões MBA, Simões ACCD, Pereira GDS, et al. Covid-19 and its impact on dental practice: a literature review. Res Soc Dev. 2020;9(11):e2189119664.




How to Cite

Poly, A., Lopes, L. I. G., Câmara, J. V. F., Barreto, S. C., & Pereira, G. D. da S. (2023). Health changes during Covid-19: a nationwide study with dental students. Revista De Saúde Pública, 57(1), 22.



Original Articles