In this study, the relationship between oral hygiene habits and the rate of family transmission of disease in patients with covid-19 referred to the Razi Medical Training Center in Rasht in 2021 was investigated.
The results of the present study showed that there is a significant relationship between oral hygiene habits and the age of the participants in the research so oral hygiene decreases with age. In this regard, the results of the Raskiliene study, which was conducted under the title of "elf-Reported oral health, oral hygiene and associated factors in Lithuanian adult population, 1994–2014", showed that with increasing age, health Patients' mouth reduced (21). The Olusile study, which was conducted in 2014 to determine oral health status, oral health service utilization, and oral hygiene practices among adult Nigerians, also achieved similar results in this regard (22). In justification of this finding, it can be said that the reduction of physical ability, various diseases, and limitations in doing things alone in elderly people lead to lower levels of oral hygiene.
A significant relationship was observed between oral hygiene habits and education level. Increasing the level of education by improving oral health knowledge and changing people's attitudes regarding adherence to oral hygiene improves oral health in this group. In line with the results of the present study, Raskiliene, Olusile, Al-Shammari, and Ahmadi reported a direct relationship between oral hygiene and education level in their studies (21–24). This is while in the study of Pourbaferani, no significant relationship between oral health and education level was shown (25).
According to the findings of the present study, there is a significant relationship between oral hygiene habits and place of residence in patients with covid-19. Perhaps, easier access to the Internet and educational facilities in urban areas can be seen as a reason for improving the health behaviors of patients in urban areas. In the studies of Rabiei and Raskiliene, a significant relationship was observed between oral hygiene habits and place of residence (21, 26)(21, 26), but in the Pourbafrani study, oral hygiene was not related to the place of residence (25).
In the present study, married people and people with a higher level of education had a higher score in infection control behaviors. From the researcher's point of view, it can be said that since the instructions for the prevention of Covid-19 have repeatedly emphasized the unique role of each person in complying with the protocols and its impact on reducing contagion and breaking the chain of transmission, married people are aware of this and feel Responsibility towards their partner had greater adherence to infection control behaviors.
In this study, there was a relationship between the duration of quarantine with oral hygiene habits and infection control behaviors, so with the increase in quarantine duration, the score of oral hygiene habits and infection control behaviors increased. In the review of the literature, no study was found that evaluated the relationship between the duration of quarantine and oral hygiene habits or infection control behaviors, but in many studies such as the mixed study by Samoui in 2019 was conducted on 1056 Iranians to identify self-care barriers to prevent covid-19 (27), Hosseinpour et al.'s study with the aim of evaluation of adherence to quarantine, health-related protocols and associated factors in Covid 19 pandemic (28), Bakry and Waly's study with the title of Perception and practice of social distancing among Egyptians in COVID-19 pandemic (29), Al zabadi's study on the factors affecting the adherence of people to quarantine in 2020 (30) and Pollak et al.'s study in 2020 to know the background factors effective in non-adherence to quarantine (31) people who gave more importance to health principles and had a higher level of education were more adherent to quarantine and health protocols.
The score of health habits was higher in people who were not hospitalized. In justification of this finding, it can be said that People with poor oral hygiene are more likely to be hospitalized and get a more severe form of Covid-19. Most of the risk factors for contracting the severe form of corona are related to poor oral and dental health and periodontitis. The oral cavity is a potential reservoir for respiratory pathogens, predisposing patients to secondary bacterial infection. Different studies state that there is an inverse correlation between oral health and the severity of Covid-19, the amount of CRP protein, and the recovery period of the disease (17). Anil et al.'s 2022 study investigated the relationship between periodontitis and the severity of Covid-19 based on the HRCT grade of the chest scan. The HRCT intensity score was correlated with the increase in the level of periodontal parameters. The results showed that the probability of contracting severe covid-19 in patients with periodontitis is 2.81 times higher (32). In 2020, Mitronin et al investigated the relationship between oral health and the severity of Covid-19 in a clinical trial. Their results were consistent with ours; The data showed the correlation between the severity of covid-19 and oral and dental diseases. Chronic infection in the oral cavity and poor oral hygiene can act as risk factors for viral infections, especially Covid-19 (33). In 2021, Lago Costa et al.'s study evaluated the dental and periodontal status of hospitalized patients with Covid-19 and its relationship with the occurrence of adverse outcomes of Covid-19. The result of the study showed that there is a positive relationship between oral and dental diseases, especially periodontitis, and the severe consequences of Covid-19, which was in line with our results (34). In 2021, Tamimi et al investigated 568 patients suffering from severe complications of Covid-19 in a case-control study using electronic health records in Qatar. The results showed that periodontitis is associated with more severe complications of Covid-19, including hospitalization in the intensive care unit, the need for assisted ventilation, increased levels of blood biomarkers, and death (35).
The analysis of the study data showed that the underlying systemic disease was higher in people with a lower score of oral hygiene habits and infection control behaviors. The oral cavity is the intersection of medicine and dentistry and a window to the general health of the patient. According to the Scannapieco study, poor oral and dental health is associated with the onset and progression of diabetes mellitus, and heart and neurological diseases. Aspiration of oropharyngeal bacteria leads to pneumonia, especially in hospitalized patients and the elderly, and may affect the course of chronic diseases. On the other hand, improving oral hygiene may help prevent aspiration pneumonia in high-risk patients (36). Jeffrey's study in 2010 also states the relationship between oral health and metabolic diseases such as diabetes and heart diseases (37). Song et al.'s study showed a direct relationship between oral and periodontal health and chronic kidney disease (CKD) (38). The results of the Vergnes study, which was conducted to investigate the relationship between periodontal status and diabetes control, showed that improving periodontal status in diabetic patients can be effective in better blood sugar control (39).
The results of our study show that there is a direct and significant relationship between oral hygiene habits and infection control behaviors, that is, as the score of oral hygiene habits increases, the score of infection control behaviors also increases. In justifying this finding, it can be said that the goal of all health and care behaviors is to maintain health and prevent various diseases. People who are aware of oral diseases and prevent various diseases such as periodontal diseases and caries through brushing, mouthwash, and other methods, to infection control behaviors such as how to protect toothbrushes from contamination and separating devices such as toothbrushes and toothpaste that may raise the transmission of various diseases, they will pay more attention.
In examining the questions related to infection control behaviors, the rate of family transmission of Covid-19 was related to the use of a shared toothbrush container and a shared toothpaste tube. Toothbrushes and other oral and dental cleaning devices are placed in places that are often at risk of contamination with microorganisms between uses. Toothbrushes can be infected with viruses, bacteria, and fungi and transmit them. In patients with infectious diseases such as tuberculosis, hepatitis, or AIDS, microbes can be easily transmitted in this way (40). Delgado-Ramos found a direct relationship between the use of a shared toothbrush holder container and the use of a shared toothpaste tube with the family transmission of Covid-19, which was in line with our study. In this study, there was a significant relationship between brushing the tongue, disinfecting the toothbrush, closing the toilet door before flushing, and changing the toothbrush after a positive PCR test and the transmission rate, which was not consistent with the results of our study (18).