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Factors associated with dentists’ search for oral health information during the COVID-19 pandemic

Abstract:

The aim of this cross-sectional study was to evaluate the factors associated with the search by Brazilian and Portuguese dentists for oral health information on social networks during the COVID-19 pandemic. A total of 597 Brazilian and Portuguese dentists answered an online questionnaire between January 17 and 31, 2021. Respondents were asked about sociodemographic data, weight and height, hours of sleep per night, screen time for work and leisure, and where they sought information about general and/or oral health for themselves and for their loved ones and information about COVID-19. Descriptive statistics and binary regression were used for the statistical analysis. Most participants were Brazilian (62.8%) and 451 (75.5%) were female. Mean age was 42.1 years (± 12.5 years). For every lost hour of sleep, the chances of participants frequently or always searching for information about self-perceived oral health problems on lay websites increased by 1.33 times. For every additional hour spent on social networks or on the Internet, the likelihood of participants frequently searching for self-perceived oral health problems on lay websites increased by 17% (OR = 1.17; 95% CI: 1.06–1.30). Individuals who searched the Internet for information about COVID-19 symptoms before consulting their doctors were 3.85 times more likely (95% CI: 2.22–6.67) to frequently or always search for information about self-perceived oral health problems on lay websites. Dentists used lay websites to search for general and oral health knowledge during the COVID-19 pandemic, and shorter sleep duration favored screen use.

Keywords
Covid-19; Epidemiology; Dentists; Internet; Oral Health

Introduction

Nowadays, accessing information can be as easy as raising one’s finger.11 Sparrow B, Liu J, Wegner DM. Google effects on memory: Cognitive consequences of having information at our fingertips. Science. 2011;333(6043):776-8. https://doi.org/10.1126/science.1207745
https://doi.org/10.1126/science.1207745...
The Internet enables access to facts, social networks, and both general and specific knowledge. This ability is increasingly available anytime and anywhere, offering access to a vast range of information.11 Sparrow B, Liu J, Wegner DM. Google effects on memory: Cognitive consequences of having information at our fingertips. Science. 2011;333(6043):776-8. https://doi.org/10.1126/science.1207745
https://doi.org/10.1126/science.1207745...
,22 Storm BC, Stone SM, Benjamin AS. Using the Internet to access information inflates future use of the Internet to access other information. Memory. 2017 Jul;25(6):717-23. https://doi.org/10.1080/09658211.2016.1210171
https://doi.org/10.1080/09658211.2016.12...
For health professionals, this is a challenging issue, as they must both remain constantly updated and not become overwhelmed by the volume of new information created each day.33 Sasidharan S, Harpreet Singh D, Vijay S, Manalikuzhiyil B. COVID-19: Pan(info)demic. Turk J Anaesthesiol Reanim. 2020 Dec;48(6):438-42. https://doi.org/10.5152/TJAR.2020.1008
https://doi.org/10.5152/TJAR.2020.1008...
Understanding, searching for, and using health data is critical for decision-making.44 Chen X, Hay JL, Waters EA, Kiviniemi MT, Biddle C, Schofield E, et al. Health literacy and use and trust in health information. J Health Commun. 2018;23(8):724-34. https://doi.org/10.1080/10810730.2018.1511658
https://doi.org/10.1080/10810730.2018.15...
However, authenticating sources has never been so important in health-related matters. Some international sources, such as the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), have provided evidence-based information in order to counter misinformation and information overload.33 Sasidharan S, Harpreet Singh D, Vijay S, Manalikuzhiyil B. COVID-19: Pan(info)demic. Turk J Anaesthesiol Reanim. 2020 Dec;48(6):438-42. https://doi.org/10.5152/TJAR.2020.1008
https://doi.org/10.5152/TJAR.2020.1008...

Since the recent COVID-19 outbreak, online information related to oral health has proven to play a major role in health-related policymaking. During the COVID-19 pandemic, different types of oral health-related information have been shared, some of which, such as social media, may have led to the policy of suspending dental practices in the early stages of the pandemic.55 Tao ZY, Chu G, McGrath C, Hua F, Leung YY, Yang WF, et al. Nature and diffusion of COVID-19-related oral health information on Chinese social media: analysis of tweets on weibo. J Med Internet Res. 2020 Jun;22(6):e19981. https://doi.org/10.2196/19981
https://doi.org/10.2196/19981...
SARS-CoV-2 is a contagious virus when present in respiratory droplets that come into contact with a healthy individual’s mucosa. These droplets can be expelled from an infected individual’s nose or mouth.66 Melo P, Barbosa JM, Jardim L, Carrilho E, Portugal J. COVID-19 Management in Clinical Dental Care. Part I: Epidemiology, Public Health Implications, and Risk Assessment [Internet]. Int Dent J. 2021 Jun;71(3):251-62. https://doi.org/10.1016/j.identj.2021.01.015
https://doi.org/10.1016/j.identj.2021.01...

7 Thamboo A, Lea J, Sommer DD, Sowerby L, Abdalkhani A, Diamond C, et al. Clinical evidence based review and recommendations of aerosol generating medical procedures in otolaryngology - head and neck surgery during the COVID-19 pandemic. J Otolaryngol Head Neck Surg. 2020 May;49(1):28. https://doi.org/10.1186/s40463-020-00425-6
https://doi.org/10.1186/s40463-020-00425...
-88 World Health Organization. COVID-19 weekly epidemiological update. Geneva: World Health Organization; 2021 [cited 2021 July 23]. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/weekly_epidemiological_update_22.pdf
https://www.who.int/docs/default-source/...
Although airborne transmission of COVID-19 was a possibility during the first months of the outbreak, the lack of evidence of SARS-CoV-2 transmission through dental aerosol-generating procedures led to extreme dental office protocols.66 Melo P, Barbosa JM, Jardim L, Carrilho E, Portugal J. COVID-19 Management in Clinical Dental Care. Part I: Epidemiology, Public Health Implications, and Risk Assessment [Internet]. Int Dent J. 2021 Jun;71(3):251-62. https://doi.org/10.1016/j.identj.2021.01.015
https://doi.org/10.1016/j.identj.2021.01...
,99 Centers for Disease Control and Prevention. About Adult BMI. 2020 [cited 2021 Feb 17]. Available from: https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html
https://www.cdc.gov/healthyweight/assess...

The use of screens during social distancing has increased because of distance learning and work from home.11 Sparrow B, Liu J, Wegner DM. Google effects on memory: Cognitive consequences of having information at our fingertips. Science. 2011;333(6043):776-8. https://doi.org/10.1126/science.1207745
https://doi.org/10.1126/science.1207745...
In addition to the use of screens for work, their use for leisure has also been intensified. Accessing the internet can be associated with several factors.22 Storm BC, Stone SM, Benjamin AS. Using the Internet to access information inflates future use of the Internet to access other information. Memory. 2017 Jul;25(6):717-23. https://doi.org/10.1080/09658211.2016.1210171
https://doi.org/10.1080/09658211.2016.12...
,33 Sasidharan S, Harpreet Singh D, Vijay S, Manalikuzhiyil B. COVID-19: Pan(info)demic. Turk J Anaesthesiol Reanim. 2020 Dec;48(6):438-42. https://doi.org/10.5152/TJAR.2020.1008
https://doi.org/10.5152/TJAR.2020.1008...
Habits, demographic factors, and anthropometric factors such as the body mass index (BMI) have been considered risk factors for increased consumption of online material.1010 Duke É, Montag C. Smartphone addiction, daily interruptions and self-reported productivity. Addict Behav Rep. 2017 Jul;6(April):90-5. https://doi.org/10.1016/j.abrep.2017.07.002
https://doi.org/10.1016/j.abrep.2017.07....
Misleading online information about prevention has been a common phenomenon during emerging situations such as the COVID-19 pandemic. Contact with a new disease often leads health professionals to experience sleep disorders and anxiety.33 Sasidharan S, Harpreet Singh D, Vijay S, Manalikuzhiyil B. COVID-19: Pan(info)demic. Turk J Anaesthesiol Reanim. 2020 Dec;48(6):438-42. https://doi.org/10.5152/TJAR.2020.1008
https://doi.org/10.5152/TJAR.2020.1008...
In order to reduce anxiety and/or panic, people who are already in a vulnerable position can benefit from authentic and accurate information.55 Tao ZY, Chu G, McGrath C, Hua F, Leung YY, Yang WF, et al. Nature and diffusion of COVID-19-related oral health information on Chinese social media: analysis of tweets on weibo. J Med Internet Res. 2020 Jun;22(6):e19981. https://doi.org/10.2196/19981
https://doi.org/10.2196/19981...

In view of the uncertainties of the second wave of the COVID-19 pandemic, the aim of this study was to evaluate factors associated with the search by Brazilian and Portuguese dentists for oral health information on social networks during the COVID-19 pandemic.

Methodology

Design, population, and study sample

This cross-sectional study involved Portuguese and Brazilian dentists who agreed to answer an online questionnaire available on the Google Forms platform between January 17 and 31, 2021. During this period, both countries were facing the second wave of the COVID-19 pandemic.66 Melo P, Barbosa JM, Jardim L, Carrilho E, Portugal J. COVID-19 Management in Clinical Dental Care. Part I: Epidemiology, Public Health Implications, and Risk Assessment [Internet]. Int Dent J. 2021 Jun;71(3):251-62. https://doi.org/10.1016/j.identj.2021.01.015
https://doi.org/10.1016/j.identj.2021.01...
,88 World Health Organization. COVID-19 weekly epidemiological update. Geneva: World Health Organization; 2021 [cited 2021 July 23]. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/weekly_epidemiological_update_22.pdf
https://www.who.int/docs/default-source/...
Participants were recruited through a link provided via WhatsApp, Facebook Messenger, and online forums for dentists.

The present study is part of a project in which other indicators were measured. The questionnaire was structured into three sections for collection of the dentists’ demographic information, general health features, and behaviors during the COVID-19 pandemic.

In order to participate in the study, each participant signed an informed consent form. Only dentists were included. Exclusion criteria were all individuals who were not dentists from Portugal or Brazil. Participants were compensated with individual educational information after answering all questions.

Data collection and variables

Participants answered a questionnaire with 13 closed-ended questions. The questionnaire collected the participants’ demographic information in seven questions. The dependent variable was self-reported habit of searching for information about oral health problems on lay websites during the COVID-19 pandemic, assessed through the following question: “Do you have a habit of searching about oral health problems perceived by yourself and/or for your family members on lay Internet sites (example: Google)?” This question was developed by the investigators and had the response options “never,” “rarely,” “sometimes,” “frequently,” and “always.”

The questionnaire also inquired about the number of hours participants slept each night, as well as their alcohol and tobacco consumption frequency. Height and weight were collected for later calculation of BMI.99 Centers for Disease Control and Prevention. About Adult BMI. 2020 [cited 2021 Feb 17]. Available from: https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html
https://www.cdc.gov/healthyweight/assess...

BMI was calculated by dividing an individual’s weight (in kilograms) by the square of their height (in meters). According to the CDC, adult nutritional status can be divided into four categories: underweight (below 18.5 kg/m2), normal weight (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2), and obesity (above 30 kg/m2). To simplify our analysis, in this study, the categories above 25 kg/m2 were combined.99 Centers for Disease Control and Prevention. About Adult BMI. 2020 [cited 2021 Feb 17]. Available from: https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html
https://www.cdc.gov/healthyweight/assess...
So, there were three categories for analysis: underweight, normal weight, and overweight.

Average time spent on smartphones and/or computers per day and dentists’ behavior during the COVID-19 pandemic were evaluated with four questions developed by the authors. Regarding time spent on smartphones and/or computers, the questions separated work time from leisure time. Participants were asked: “For how many hours in your day, on average, do you use your smartphone and/or computer for work/meetings/distance learning?” and “For how many hours in your day, on average, do you use your smartphone and/or computer for social media/the Internet?” These questions were developed based on questions from a previous study related to smartphone overuse and productivity.1010 Duke É, Montag C. Smartphone addiction, daily interruptions and self-reported productivity. Addict Behav Rep. 2017 Jul;6(April):90-5. https://doi.org/10.1016/j.abrep.2017.07.002
https://doi.org/10.1016/j.abrep.2017.07....

This questionnaire was answered during the COVID-19 pandemic. Dentists’ anxiety during this period was measured with the question “Comparing your behavior before and during the COVID-19 pandemic, how do you consider your anxiety about your health signs and symptoms and/or those of your loved ones?” Response options were “decreased,” “the same,” and “increased.”

Regarding how dentists perceived their Internet searches about COVID-19 symptoms, the question “Have you searched the Internet about COVID-19 symptoms before consulting your physician/health professional?” could be answered “never,” “rarely,” “sometimes,” “frequently,” or “always.” In order to simplify our statistical analysis, the categories “never,” “rarely,” and “sometimes” were clustered into one group and “frequently” and “always” into another.

Independent variables included age, years since graduation, country of residence, sex, marital status, BMI, highest educational attainment, children, alcohol and tobacco consumption, hours of sleep at night, average hours spent working on a smartphone or computer, average hours spent on a smartphone or computer using social media or the Internet, level of anxiety during the COVID-19 pandemic, and Internet searches related to COVID-19 symptoms.

Pilot study

Two Brazilian dentists residing in Portugal and two Portuguese dentists residing in Brazil for 20 years participated in the preparation of the questions, with the concern of using terms that could be understood in both countries. The instrument was tested in a pilot study, and it was found that the comprehension of the questions was positive for both Brazilians and Portuguese. A pilot study of 21 dentists (11 Brazilians and 10 Portuguese) was carried out to evaluate the proposed methodology. The results of the pilot study demonstrated that there was no need to modify the proposed methods of the main study. Pilot study participants were not included in the main study.

Ethical aspects

This study was conducted following the principles expressed in the Declaration of Helsinki (revised by the World Medical Association 2013). The study was approved by the Human Research Ethics Committee of the Federal University of Minas Gerais (Brazil) (protocol #91561018.5.0000.5149).

Results

A total of 598 dentists participated in our study. The statistical power was calculated later for the three covariables in the final model using OpenEpi (Open Source Epidemiologic Statistics for Public Health) version 3.01. Power was 62.7%, 95.5%, and 99.99%, respectively, for the covariates “Hours of sleep at night,” “For how many hours in your day, on average, do you use your smartphone and/or computer for social media/the Internet?” and “Have you searched the Internet about COVID-19 symptoms before consulting your physician/health professional?”

One dentist was excluded for providing an incomplete response. Complete data were obtained from 597 dentists. Mean age was 42.1 years (SD = 12.5 years, range = 22–77 years), and 451 respondents (75.5%) were female. Almost 73% (62.8%) of our sample was Brazilian, and 361 respondents were married or in a common-law marriage (60.5%). Most participants had obtained a master’s degree or higher (57.1%), with an average of 18.4 years since graduation (SD = 12.6 years; range: 0–51 years). More than half of the sample had children (55.6%). BMI scores showed that approximately 61% (60.8%) had normal weight and 210 (36.7%) were overweight. Participants reported a maximum of 10 and a minimum of three hours of sleep. Mean time spent on the smartphone and/or computer was 3.7 hours per day (SD = 2.9 hours) for work, meetings, and distance learning and 2.6 hours per day (SD = 2.1 hours) on social media and on the Internet (Table 1).

Table 1
Internet search for oral health signs and symptoms among Brazilian and Portuguese dentists during the COVID-19 pandemic.

For every additional hour of sleep, the likelihood of the participants and/or their family members frequently or always searching lay Internet sites (e.g., Google) for information about oral health problems decreased (OR = 0.75; 95%CI: 0.56–0.99). For every lost hour of sleep, the chances of the dentists and/or their family members frequently or always searching about oral health problems on Internet sites (e.g., Google) increased by 1.33 times. For every hour spent using a smartphone and/or computer on social networks and on the Internet, the chances of the dentists and/or their family members frequently or always searching about oral health problems on lay Internet sites (e.g., Google) increased by 17% (OR = 1.17; 95%CI: 1.06–1.30) (Table 2).

Table 2
Factors associated with the habit of searching the Internet for oral health signs and symptoms among Brazilian and Portuguese dentists during the COVID-19 pandemic.

Individuals who searched the Internet for information about COVID-19 symptoms before consulting their physician or another health professional were 3.85 times more likely (95%CI: 2.22–6.67) to frequently or always search for information about oral health problems perceived by themselves and/or by their family members on lay Internet sites (e.g., Google).

Despite the difference between Brazil and Portugal (p=0.009) regarding the frequency of searches for health content on social networks, this covariate was not incorporated into the final model. Therefore, there was no difference between these two groups (Table 2).

There was no violation of the linearity of the logit for the quantitative covariates in the final model (p > 0.05). The final model is appropriate according to the Hosmer–Lemeshow test (p = 0.213) (Table 2). There were no problems related to collinearity between the covariates of the final model when the variance inflation factor was evaluated.

Discussion

Several factors have impacted people’s lives during the COVID-19 pandemic.33 Sasidharan S, Harpreet Singh D, Vijay S, Manalikuzhiyil B. COVID-19: Pan(info)demic. Turk J Anaesthesiol Reanim. 2020 Dec;48(6):438-42. https://doi.org/10.5152/TJAR.2020.1008
https://doi.org/10.5152/TJAR.2020.1008...
Routines and lifestyles were modified because of the need for social distancing resulting from the COVID-19 pandemic.1616 Philpot LM, Ramar P, Roellinger DL, Barry BA, Sharma P, Ebbert JO. Changes in social relationships during an initial “stay-at-home” phase of the COVID-19 pandemic: a longitudinal survey study in the U.S. Soc Sci Med. 2021 Apr;274:113779. https://doi.org/10.1016/j.socscimed.2021.11377
https://doi.org/10.1016/j.socscimed.2021...

17 Majumdar P, Biswas A, Sahu S. COVID-19 pandemic and lockdown: cause of sleep disruption, depression, somatic pain, and increased screen exposure of office workers and students of India. Chronobiol Int. 2020 Aug;37(8):1191-200. https://doi.org/10.1080/07420528.2020.1786107
https://doi.org/10.1080/07420528.2020.17...

18 Thomée S, Härenstam A, Hagberg M. Mobile phone use and stress, sleep disturbances, and symptoms of depression among young adults: a prospective cohort study. BMC Public Health. 2011 Jan;11(1):66. https://doi.org/10.1186/1471-2458-11-66
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19 Dorrian J, Centofanti S, Smith A, McDermott KD. Self-regulation and social behavior during sleep deprivation. Progr Brain Res. 2019. 246:73-110. https://doi.org/10.1016/bs.pbr.2019.03.010
https://doi.org/10.1016/bs.pbr.2019.03.0...
-2020 Wang Y, McKee M, Torbica A, Stuckler D. Systematic literature review on the spread of health-related misinformation on social media. Soc Sci Med. 2019 Nov;240:112552. https://doi.org/10.1016/j.socscimed.2019.112552
https://doi.org/10.1016/j.socscimed.2019...

In the present study, participants sought health information on the Internet and on social networks, even during their leisure time. The Internet, by allowing instant communication, brought about an important change in human behavior and increased the chance of misinformation through the dissemination of concepts without scientific basis.2020 Wang Y, McKee M, Torbica A, Stuckler D. Systematic literature review on the spread of health-related misinformation on social media. Soc Sci Med. 2019 Nov;240:112552. https://doi.org/10.1016/j.socscimed.2019.112552
https://doi.org/10.1016/j.socscimed.2019...
An important observation is that participants’ searches were performed on lay websites and not in scientific databases.2121 Campbell JM, Umapathysivam K, Xue Y, Lockwood C. Evidence-based practice point-of-care resources: a quantitative evaluation of quality, rigor, and content. Worldviews Evid Based Nurs. 2015 Dec;12(6):313-27. https://doi.org/10.1111/wvn.12114
https://doi.org/10.1111/wvn.12114...
The questionnaire did not involve any questions that would allow the investigators to understand whether the dentists sought information on scientific evidence-based sites during the COVID-19 isolation period. This is a limitation that should be considered when analyzing the results of this study. Healthcare information provided on websites can prove difficult for the general population to understand.2222 Ihler F, Canis M. The role of the internet for healthcare information on ENT specific issues. Laryngorhinootologie. 2019;98:S1-23. This is one of the main reasons to search for information on social networks, where information is easy to understand and rapidly spread, but generally lacks a scientific basis.2323 Balatsoukas P, Kennedy CM, Buchan I, Powell J, Ainsworth J. The role of social network technologies in online health promotion: A narrative review of theoretical and empirical factors influencing intervention effectiveness. J Med Internet Res. 2015 Jun;17(6):e141. https://doi.org/10.2196/jmir.3662
https://doi.org/10.2196/jmir.3662...
A recent study has found that, during the SARS-CoV-2 pandemic, most dental professionals sought information about COVID-19 on social networks.2424 Al-Amad SH, Hussein A. Anxiety among dental professionals and its association with their dependency on social media for health information: insights from the COVID-19 pandemic. BMC Psychol. 2021 Jan;9(1):9. https://doi.org/10.1186/s40359-020-00509-y
https://doi.org/10.1186/s40359-020-00509...
This observation converges with our results. This behavior was significantly associated with younger age, less clinical experience, and fewer academic qualifications.2424 Al-Amad SH, Hussein A. Anxiety among dental professionals and its association with their dependency on social media for health information: insights from the COVID-19 pandemic. BMC Psychol. 2021 Jan;9(1):9. https://doi.org/10.1186/s40359-020-00509-y
https://doi.org/10.1186/s40359-020-00509...
There is a general consensus that misinformation is highly prevalent on lay websites, such as social media.2020 Wang Y, McKee M, Torbica A, Stuckler D. Systematic literature review on the spread of health-related misinformation on social media. Soc Sci Med. 2019 Nov;240:112552. https://doi.org/10.1016/j.socscimed.2019.112552
https://doi.org/10.1016/j.socscimed.2019...
However, dentists are included in a group of professionals with medical training, good levels of health literacy, and ability to critically assess the credibility of information.2525 Vázquez-Otero C, Vamos CA, Thompson EL, Merrell LK, Griner SB, Kline NS, et al. Assessing dentists’ human papillomavirus-related health literacy for oropharyngeal cancer prevention. J Am Dent Assoc. 2018 Jan;149(1):9-17. https://doi.org/10.1016/j.adaj.2017.08.021
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Social media were the first to react to the effects of the emerging SARS-CoV-2 pandemic on the dental profession.55 Tao ZY, Chu G, McGrath C, Hua F, Leung YY, Yang WF, et al. Nature and diffusion of COVID-19-related oral health information on Chinese social media: analysis of tweets on weibo. J Med Internet Res. 2020 Jun;22(6):e19981. https://doi.org/10.2196/19981
https://doi.org/10.2196/19981...
,2626 Mundluru SN, Werbaneth K, Therkelsen KE, Larson AR, Santini VE. “But doctor, I googled it!”: The “three Rs” of managing patients in the age of information overload. Clin Dermatol. 2019 Jan - Feb;37(1):74-7. https://doi.org/10.1016/j.clindermatol.2018.08.002
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The relevance of the healthcare information found on social media has increased, but scientific knowledge is limited.2222 Ihler F, Canis M. The role of the internet for healthcare information on ENT specific issues. Laryngorhinootologie. 2019;98:S1-23. Therefore, dentists should be encouraged to seek information with scientific evidence.

COVID-19 is a new disease. In the area of oral health, further investigations are still needed. This may be the reason why the dentists in this study searched for information on lay websites. There is growing concern with the high virulence and routes of transmission of this disease through saliva aerosols. This concern makes the practice of dentistry a risk for dentists.1111 Pereira LJ, Pereira CV, Murata RM, Pardi V, Pereira-Dourado SM. Biological and social aspects of Coronavirus disease 2019 (COVID-19) related to oral health. Braz Oral Res. 2020 May;34(41):e041. https://doi.org/10.1590/1807-3107bor-2020.vol34.0041
https://doi.org/10.1590/1807-3107bor-202...

In the United Kingdom, a longitudinal study found that individuals who perceived themselves as having sufficient information about the COVID-19 pandemic reported lower levels of anxiety and sleep disorders.2727 Kemper KJ, Mo X, Khayat R. Are mindfulness and self-compassion associated with sleep and resilience in health professionals? J Altern Complement Med. 2015 Aug;21(8):496-503. https://doi.org/10.1089/acm.2014.0281
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There is a complex effect of social conditions, country politics, and environmental factors on individual experience, which needs further exploration to help prevent unwanted consequences from COVID-19 control measures.2828 Batista AU, Silva PL, Melo LA, Carreiro AD. Prosthodontic practice during the COVID-19 pandemic: prevention and implications. Braz Oral Res. 2021 Mar;35:e049. https://doi.org/10.1590/1807-3107bor-2021.vol35.0049
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,2929 Sarialioglu Gungor A, Donmez N, Uslu YS. Knowledge, stress levels, and clinical practice modifications of Turkish dentists due to COVID-19: a survey study. Braz Oral Res. 2021 Mar;35:e048. https://doi.org/10.1590/1807-3107bor-2021.vol35.0048
https://doi.org/10.1590/1807-3107bor-202...

One of the factors associated with seeking health information on social networks in this study was short sleep duration. Our study found that shorter sleep duration was associated with longer average screen time. These results are consistent with a study conducted among young American adults.1111 Pereira LJ, Pereira CV, Murata RM, Pardi V, Pereira-Dourado SM. Biological and social aspects of Coronavirus disease 2019 (COVID-19) related to oral health. Braz Oral Res. 2020 May;34(41):e041. https://doi.org/10.1590/1807-3107bor-2020.vol34.0041
https://doi.org/10.1590/1807-3107bor-202...
,1212 Christensen MA, Bettencourt L, Kaye L, Moturu ST, Nguyen KT, Olgin JE, et al. Direct measurements of smartphone screen-time: relationships with demographics and sleep. PLoS One. 2016 Nov;11(11):e0165331. https://doi.org/10.1371/journal.pone.0165331
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People who sleep later and/or wake up in the middle of the night tend to use screens until they can sleep again.1313 Mireku MO, Barker MM, Mutz J, Dumontheil I, Thomas MS, Röösli M, et al. Night-time screen-based media device use and adolescents’ sleep and health-related quality of life. Environ Int. 2019 Mar;124:66-78. https://doi.org/10.1016/j.envint.2018.11.069
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This behavior can negatively influence the production of melatonin because of the stimulus of blue light emitted by the screens.1414 Lawrenson JG, Hull CC, Downie LE. The effect of blue-light blocking spectacle lenses on visual performance, macular health and the sleep-wake cycle: a systematic review of the literature. Ophthalmic Physiol Opt. 2017 Nov;37(6):644-54. https://doi.org/10.1111/opo.12406
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Social isolation is an important measure for mitigating the risk of COVID-19 infection.1515 Losada-Baltar A, Jiménez-Gonzalo L, Gallego-Alberto L, Pedroso-Chaparro MD, Fernandes-Pires J, Márquez-González M. “We Are Staying at Home.” Association of self-perceptions of aging, personal and family resources, and loneliness with psychological distress during the lock-down period of COVID-19. J Gerontol B. 2021 Jan;76(2):e10-6. https://doi.org/10.1093/geronb/gbaa048
https://doi.org/10.1093/geronb/gbaa048...
However, mental and physical health effects affect sleep schedules.1616 Philpot LM, Ramar P, Roellinger DL, Barry BA, Sharma P, Ebbert JO. Changes in social relationships during an initial “stay-at-home” phase of the COVID-19 pandemic: a longitudinal survey study in the U.S. Soc Sci Med. 2021 Apr;274:113779. https://doi.org/10.1016/j.socscimed.2021.11377
https://doi.org/10.1016/j.socscimed.2021...
Screen use has increased.1717 Majumdar P, Biswas A, Sahu S. COVID-19 pandemic and lockdown: cause of sleep disruption, depression, somatic pain, and increased screen exposure of office workers and students of India. Chronobiol Int. 2020 Aug;37(8):1191-200. https://doi.org/10.1080/07420528.2020.1786107
https://doi.org/10.1080/07420528.2020.17...
In the present study, decreased sleep increased the dentists’ chances of frequently or always searching for information about oral health problems on lay Internet sites by 1.33 times. Sleep is critical to physical and mental health and helps reduce stress and anxiety indicators.1717 Majumdar P, Biswas A, Sahu S. COVID-19 pandemic and lockdown: cause of sleep disruption, depression, somatic pain, and increased screen exposure of office workers and students of India. Chronobiol Int. 2020 Aug;37(8):1191-200. https://doi.org/10.1080/07420528.2020.1786107
https://doi.org/10.1080/07420528.2020.17...
High screen exposure, particularly cell phone use, is a risk factor for sleep disorders.1818 Thomée S, Härenstam A, Hagberg M. Mobile phone use and stress, sleep disturbances, and symptoms of depression among young adults: a prospective cohort study. BMC Public Health. 2011 Jan;11(1):66. https://doi.org/10.1186/1471-2458-11-66
https://doi.org/10.1186/1471-2458-11-66...
Reductions in sleep duration may influence cognitive appraisal of situations because the frontal region of the brain, which is involved in executive functioning, is affected by sleep deprivation.1919 Dorrian J, Centofanti S, Smith A, McDermott KD. Self-regulation and social behavior during sleep deprivation. Progr Brain Res. 2019. 246:73-110. https://doi.org/10.1016/bs.pbr.2019.03.010
https://doi.org/10.1016/bs.pbr.2019.03.0...
Sleep behavior and screen use were important confounding variables in the present study.

Some limitations of this study should be noted. The sample of this investigation comprised dentists from Portugal and Brazil. It is important to conduct major multicenter studies that include other countries and other types of health professionals. The results of the present study emphasize the need to create guidelines and platforms that are reliable and easily accessible to health professionals and simplify their searches for health information. Longitudinal studies evaluating general and oral health information sought by dentists during this pandemic period are important, as are post-pandemic studies. Research is needed to develop interventions that can limit screen time and help reduce the negative impacts of sleep deprivation.

Conclusions

We conclude that Brazilian and Portuguese dentists searched for general and/or oral health information on lay websites during COVID-19-related social distancing, even during their leisure time. The use of screens increased among those who slept for fewer hours each night. Searching for health content related to the COVID-19 pandemic on lay websites before a medical consultation was routine among the sampled dentists.

Acknowledgments

The authors wish to thank all the Brazilian and Portuguese dentists who participated in this study for their assistance and support. This study was funded by the Brazilian Higher Education Coordination (Coordenação Brasileira do Ensino Superior de Educação (CAPES)) and the National Research Council (Conselho Nacional de Pesquisa (CNPq)).

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Publication Dates

  • Publication in this collection
    15 Apr 2022
  • Date of issue
    2022

History

  • Received
    19 Apr 2021
  • Reviewed
    11 Oct 2021
  • Accepted
    18 Jan 2022
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