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Year : 2020  |  Volume : 8  |  Issue : 3  |  Page : 52-56

Psychological impact of quarantine on mental and oral health: Lessons learned from previous quarantine and can be applied for current COVID-19 pandemic

Department of Oral Maxillofacial Surgery, Al-Farabi Private Colleges, Jeddah, Saudi Arabia

Date of Submission08-Jul-2020
Date of Acceptance11-Aug-2020
Date of Web Publication28-Sep-2020

Correspondence Address:
Prof. Mohamed Yaser Kharma
Department of Oral Maxillofacial Surgery, Al-Farabi Private colleges/ Jeddah.
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/INJO.INJO_28_20

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Stress, depression, and anxiety are commonly associated with the long-term of Corona virus disease 2019 (COVID-19) quarantine. These effects have implications on mental and oral health. We did a review of the psychological impact of quarantine in general using electronic data base. We tried to focus on psychological effects of quarantine on immune response, parafunctional habits and periodontal diseases. We included in this research, most studies which reported psychological effects of quarantine including: post-traumatic stress symptoms, confusion, anger, stress, depression, and anxiety. During several weeks of COVID-19 quarantine or social distancing, individuals will have to establish their own ways of preserving their mental health at home. Studies surveying those who had been quarantined reports of emotional disturbance, depression, stress, low mood, irritability, insomnia, post-traumatic stress symptoms, anger and emotional exhaustion. Stress, depression, and anxiety have impacts on immune responses, oral health and periodontal disease. It becomes more important in the quarantine period of the epidemic outbreak to understand the psychological impact of the quarantine on mental and oral health. This article presents valuable knowledge about psychological hygiene during the quarantine, whose behavior is extremely important from the point of view of systemic health, including oral health.

Keywords: Anxiety, COVID-19, depression, mental health, periodontal diseases, stress

How to cite this article:
Kharma MY, Koussa B, Sadki M, Abdulkarim N, Aljefri M, Alharthi M, Mohsen M. Psychological impact of quarantine on mental and oral health: Lessons learned from previous quarantine and can be applied for current COVID-19 pandemic. Int J Oral Care Res 2020;8:52-6

How to cite this URL:
Kharma MY, Koussa B, Sadki M, Abdulkarim N, Aljefri M, Alharthi M, Mohsen M. Psychological impact of quarantine on mental and oral health: Lessons learned from previous quarantine and can be applied for current COVID-19 pandemic. Int J Oral Care Res [serial online] 2020 [cited 2022 Jan 24];8:52-6. Available from: https://www.ijocr.org/text.asp?2020/8/3/52/296226

  Introduction Top

World Health Organization (WHO) declared a public health emergency of international concern over global pneumonia outbreak on January 30, 2020. The rapidly increasing number of cases and evidence of human-to-human viral transmission is originated in Wuhan City. In the late December 2019, the pneumonia infection has rapidly spread from Wuhan to most other provinces and countries around the world.[1]

Chinese researchers have quickly isolated the new virus from the patient and sequenced its genome. The infectious agent of this viral pneumonia happening in Wuhan was finally identified as a novel coronavirus (2019-nCOV), the seventh member of the family of coronaviruses that infect humans.[2] This disease was referred as 2019 novel coronavirus (2019-nCo), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and coronavirus disease-2019 (COVID-19). This virus is a new virus linked to the same family of viruses as severe acute respiratory syndrome (SARS) but it was more contagious than SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV).[3] Most of the countries are locked down and applied quarantine to prevent further spread of this virus.

  COVID-19 Quarantine Top

Quarantine is one of several public health measures to prevent the spread of COVID-19. Strategies such as self-quarantine and social distancing are deemed by medical experts as necessary in reducing the spread of the virus. People understand by being reinforced of quarantine is helping to keep others safe including those particularly vulnerable (such as those who are very young, old, or with preexisting serious medical conditions).

The WHO recognized the problem and released in March 18, 2020 guidance on how people can protect their mental health during the outbreak,[4] but what about the impact on oral health?

In any crisis, we deal with the physical issues first, then the mental health issues much later. I challenge this article because we feel the needed to educate the public to any changes in mental behavior’s during the quarantine and their impact to the general health and also to the oral health.

During several weeks of quarantine or social distancing, individuals will have to establish their own ways of preserving their mental health at home.

Studies surveying those who had been quarantined report emotional disturbance,[5] depression,[6] stress,[7] low mood,[8] irritability,[8] insomnia,[8] post-traumatic stress symptoms,[9] anger,[10] and emotional exhaustion.[11] Low mood and irritability stand out as having high prevalence.[8] A qualitative study[12] reported longer-term effects of quarantine, including alcohol abuse, dependency symptoms, and avoidance behaviors, and for some, the return to normality was delayed by many months. Qualitative studies also identified a range of other psychological responses to quarantine, such as confusion,[13] fear,[14] anger,[14] grief,[15] 29 numbness,[16] and anxiety-induced insomnia.[17] Only one study[18] compared psychological outcomes during quarantine with later outcomes and found that during quarantine, 7% (126 of 1656) showed anxiety symptoms and 17% (275) showed feelings of anger, whereas 4–6 months after quarantine these symptoms had reduced to 3% (anxiety) and 6% (anger). However, another study[6] suggested that demographic factors such as marital status, age, education, living with other adults, and having children were not associated with psychological outcomes.

Confinement, loss of usual routine, and reduced social and physical contact with others were frequently shown to cause boredom, frustration, and a sense of isolation from the rest of the world, which was distressing to participants.[19] Successful use of quarantine as a public health measure requires us to reduce, as far as possible, the negative effects associated with it.

  Impact of Psychological Stress on Immune Responses Top

The relationship between stress and body systems has been considered for decades.[20],[21] Various factors, for example, hormones, neuroendocrine mediators, peptides, and neurotransmitters, are involved in the body’s response to stress. Many disorders originate from stress, especially if the stress is severe and prolonged.[22]

Several studies showed that psychological stress can downregulate the cellular immune response by at least three mechanisms.[23],[24],[25],[26]

First, stress-induced response is transmitted to the hypothalamo–pituitary–adrenal (HPA) axis and promotes the release of corticotropin-releasing hormone from the pituitary gland and glucocorticoid hormones from the adrenal cortex. Glucocorticoids released decreases the production of proinflammatory cytokines (interleukins, prostaglandins, and tumor necrosis factor).

Second, exposure to stressor agents can induce the sympathetic nervous system to release adrenaline and noradrenaline from the adrenal medulla and, therefore, can exert an immunosuppressive effect,[27] which can indirectly provoke periodontal tissue breakdown.[28]

Third, stress can induce the release of neuropeptides from sensory nerve fibers (neurogenic inflammation), and the presence of neuropeptides has been implicated as a neurogenic promoter in various inflammatory processes modulating the activity of the immune system and the release of cytokines.[29]

  Impact of Stress on Oral Health Top

Poor oral health has long been theorized to cause the dysfunction of other critical physiologic systems.[30] This relationship has been shown for some diseases more so than others, including respiratory infections, osteoporosis, childhood obesity, cardiovascular disease, and type II diabetes.[31],[32],[33] A shared impetus for the development of both oral and systemic disease may be the presence of stress.[34]

Chronic stress is likely to contribute to the progressive long-term development of oral disease through two pathways:

First, stress can motivate individuals to cope in unhealthy ways that foster oral disease (illicit drugs, alcohol and tobacco, poor diet, and sedentary behavior).

Second, chronic stress contributes to high allostatic load that can lead to the dysfunction of physiological systems critical to homeostasis, and thus affect the underlying mechanisms of disease progression, more generally.[35]

  Impact of Stress on Parafunctional Habit Top

From the point of view of dentistry, the stress experienced as an intense and traumatic event can increase the odds of orofacial pain, affect the biomechanics of masticatory system.

Bruxism is a complex occlusal parafunction which can hardly be placed in several different categories of parafunction.[36] Psychosocial factors such as stress or personal characteristics and pathophysiological factors (e.g., illness, trauma, genetics, smoking, intake of caffeine, medications, and illicit drugs), sleep disorders (sleep apnea and snoring), and involving dopaminergic system are often present in the etiology of bruxism.

The mobility of teeth, pain, hypertrophic facial muscles, and reduced capacity to open the patient’s mouth in the morning are changes that are observed. Frequent headaches, especially in the temporomandibular region in everyday life are often noticed.[37]

  Impact of Stress, Depression, and Anxiety on Periodontal Disease Top

Depression, anxiety, and stress (DAS) also have shown a strong association with periodontitis. Depression has considered an indicator of the level of stress. Periodontal disease has been hypothesized to occur through the influence of stress on behavioral changes that affect at-risk health behaviors, such as smoking, poor oral hygiene, and poor compliance with dental care.

It was shown that psychological responses to emotional stresses modulate the immune system, resulting in significant adverse effects on the proper functioning of the immune system. Literature suggests that psychological stress has a detrimental effect on oral health. However, stress, such as other risk indicators of periodontal disease (i.e., osteoporosis, HIV, immunocompromised conditions) are commonly accepted (putative) as variables that influence the onset, progression, and severity of periodontal disease.

Psychological stress can down-regulate the cellular immune response. Communication between the central nervous system and the immune system occurs via a complex network of bidirectional signals linking the nervous, endocrine, and immune systems. Stress disrupts the homeostasis of this network, which in turn, alters immune function. There are many factors influencing the incidence and severity of periodontal disease. Periodontitis is a chronic inflammatory disease, characterized by gingival bleeding, periodontal pocket formation, connective tissue destruction, and alveolar bone loss. Oral bacterial pathogens are responsible for the initiation and progression of periodontitis. Abnormal host responses like elevating the pro-inflammatory cytokines by pathogenic bacteria also play a crucial role in the progression of periodontitis. Periodontal diseases are common chronic inflammatory diseases caused by pathogenic microorganisms which induce elevations of pro-inflammatory cytokines resulting in tissue destruction. Evolution of periodontal diseases is influenced by many local or systemic risk factors. Stress has been suggested as one of them and may negatively influence the outcome of periodontal treatment.

Furthermore, the cellular immune response plays a vital role in wound healing. It not only protects the wound site from infection, but also prepares the wound for healing and regulates its repair. As stress deregulates inflammatory and immune response, stress releases highly active hormones such as catecholamine, which results in altered blood flow, peripheral vasoconstriction may affect oxygen-dependent healing mechanism which impairs wound healing. The impact of stress on periodontal wound healing may be influenced by others health-impairing behaviors include neglecting oral hygiene practices increased consumption of cigarettes and alcohol, and disturbed sleeping patterns.

It was concluded that this variation may influence the in vivo composition of the subgingival biofilm in response to stress-induced changes in local catecholamine levels and play a significant role in the etiology and pathogenesis of periodontal diseases.

  What Can Be Done to Mitigate the Consequences of Psychological Impact of Quarantine? Top

  1. Recognizing the problem

The Centers for Disease Control and Prevention (CDC) notes that people should identify mental health disturbance by looking out for signs of distressed mental health in themselves and others. Symptoms may include the following:

  • Fear and worry about your own health

  • Changes in sleep or eating patterns

  • Difficulty in sleeping or concentrating

  • Worsening of chronic health problems

  • Increased use of alcohol, tobacco, or other drugs

    • 2. What individuals can do

    The breakdown of the stressors is needed to come up with solution, the advice of psychology experts, as well as several health bodies, to find out their top tips:

  • Acknowledge the role of healthcare workers who play in saving lives

  • Create a routine: make a list of what-to-do of all the things you want to achieve each day to create a sense of normality and productivity.

  • Break up your day: find tasks to break up your day and, where possible, change your environment for different activities.

  • Take care of your body: eat healthily, get plenty of sleep, and exercise daily.

  • Help others: find ways to support those in need by offering to help them.

  • Stay connected: make the most of technology and stay in touch with colleagues, friends, and family via phone calls, texts, social media, and video conferencing.

  • Limit media intake: stay informed about the situation via reliable sources with limit.

  • Prepare medical supplies for quarantine periods.

  • Fight boredom: make the most of catching up TV series, reading, and exploring projects.

  • Focus on the positives: amplify good news stories to resolve the situation.

  • Take 1 day at a time: try not to project too far into the future. Remember that these are temporary measures and you are not alone.

  • stop worrying about those stressors you can’t control and fix your focus on the stressors you can control.

  • Learn simple daily physical exercises to perform at home, in quarantine or isolation so you can maintain mobility and reduce boredom.

  •   How We Take Care of Oral Health While Having Self-Quarantine Top

    Due to COVID-19, people are warned to isolate themselves or to self-quarantine. During this time, people should take care of their physical health, boost their immune system, remain mindful of their mental health, and practice good habits to promote dental health.

    Good dental hygiene might be important during the COVID-19 pandemic when Dentist offices are closed for routine procedures during the COVID-19 outbreak.

    The most important points that must be noticed are as follows:

  • Highest levels of oral hygiene, which is crucial when dentists or hygienists for cleanings and checkups aren’t available.

  • The oral microbiome is a key component of the immune system. Mouthwashes high in alcohol or toothpastes with bactericidal components in them, or other antibacterial ingredients, can greatly disrupt the health of the oral microbiome. Brush the teeth at least twice a day and flossing once per day is recommended (take care that toothbrush is very sensitive for transmitting viruses).

  • Rinsing with a nonalcohol-based mouthwash twice a day also can help reduce plaque buildup leading to inflammation of the gums (gingivitis).

  • Avoiding excessive snacking––a habit that’s all too easy to adopt when dealing with the stress and boredom. Starchy foods or drinks lead to acid in the mouth which leads to disseminating caries.

  • Resist turning to unhealthy habits to manage the stress: Smoking inhibits the blood supply to your gums and increases your risk for gum infections.

  • Drink plenty of water to wash away acids from your mouth.

  • In conclusion during a pandemic, the goal is to optimize the immune system., the impact of stress on the immune system has been documented widely and a possible influence on chronic inflammatory periodontal disease is likely to occur. The psychological impact of quarantine is wide-ranging, it is important to inform the people with clear information about how to minimize and reduce these effects. it is recommended to educate the people on how to maintains their oral hygiene during quarantine and reduce the impact of stress/psychological factors as risk factors for mental and oral disease.

    Financial support and sponsorship


    Conflicts of interest

    There are no conflicts of interest.

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