Mask mouth: A Novel Threat to Oral cavity

 

Meenakshi P¹, Soumya Mohanan T V², Anjali S³

¹Final Year Student, Dept of Public Health Dentistry, Govt Dental College, Kozhikode 673008.

²Assistant Professor, Dept of Public Health Dentistry, Govt Dental College, Kozhikode, 673008.

³Senior Resident, Dept of Public Health Dentistry, Govt Dental College, Kozhikode, 673008.

 

ABSTRACT:

There is a new public health crisis threatening the world with the emergence and spread of 2019 novel coronavirus (2019-nCoV). Covid 19 is transmitted by inhalation or contact with infected droplets. The symptoms are usually fever, cough, sore throat, breathlessness, fatigue, malaise among others. The disease is mild in most people; in some (usually the elderly and those with comorbidities), it may progress to pneumonia, acute respiratory distress syndrome (ARDS) and multi organ dysfunction. Many people are asymptomatic. Masks act as a simple barrier and help stop respiratory droplets from traveling into the air and onto other people. However, wearing a mask for an extended period can create unwanted side effects, such as mask mouth.

 

 

 

 

INTRODUCTION:

Wearing a mask is not new for dental and medical professionals; however, the extended wear time is. And with supplies of personal protective equipment (PPE) low in some regions, many healthcare providers are keeping the same mask on instead of donning a new one after each patient, further extending the wear time of masks¹. Masks act as a simple barrier and help prevent respiratory droplets from travelling into the air and onto different people. But, sporting a mask for an prolonged period can create unwanted aspect effects, which include mask mouth².

 

Systems science reveals an interconnection between masks and oral health. If there is a shift from a commensal to a pathogenic oral microbiome, it causes an imbalance of oral homeostasis, phenomena called dysbiosis, which not only affects the mouth but other body sites^. There is a proven relationship between oral and overall health. It is reported that there is a link between periodontal (Gum) disease and inflammatory conditions such as cancer, heart disease, diabetes, stress, atherosclerosis³.

 

Wearing facemasks can lower the pH and create an acidic content in the mouth and a microenvironment around the mouth and nose is created which impacts the heat exchange significantly⁴. Wearing facemasks creates a microenvironment around the mouth and nose which impacts the heat exchange significantly, respiratory heat loss is impaired and heat burden is increased inside the face mask, increasing the facial temperature from 1.5 to 2.0°C. Oral temperature was significantly higher when a mask was worn⁵.

 

Mask Mouth: Causes:

Tooth decay and periodontal disease are two of the most potentially serious oral health issues that can affect a person, and if left untreated, mask mouth can lead to such conditions.

 

Dry Mouth – Dry mouth or Xerostomia is a basic trigger for mask mouth. Xerostomia is a subjective sensation of dry mouth due to decreased amount of saliva in oral cavity. Saliva helps defend enamel from harmful bacteria, the shortage of saliva will create a breeding ground for bacteria causing the gums to become infected and the enamel to decay.

 

Shallow and speedy breaths:

When a person breathes naturally, they are generally taking slow controlled breaths using their diaphragm. Many people tend to take accelerated shallow breaths, thereby reducing the saliva in their mouth.

 

Poor Air Quality:

When you have a mask constricting your breathing zone, the concentrated carbon dioxide forces you to reuse and recycle the air that you breathe. While the recycled carbon dioxide is not particularly harmful, it will heighten the level of acidic build-up within your body, ultimately putting you at a much greater risk of developing tooth decay and other health issues⁶.

 

Mask Mouth: Signs and Symptoms

 

Foul Breath:

Perhaps one of the most common complaints with regards to wearing a mask, is the fact that many people find themselves bothered by smell of their own breath. Indeed halitosis (or bad breath) is a frustrating problem; however, this also might be a sign that your mask is affecting your oral health.⁶

 

Chronic Dry Mouth:

Dry mouth is a signal that your facemask might be having a damaging impact on your oral fitness. If you find your mouth is feeling dry constantly, you might be in jeopardy and ought to cope with this issue properly.

 

Gum Inflammation:

As a progressive infection within the gumline, gum disease typically begins with inflammation. If your gums are dark pink, tender, or have a tendency to bleed, then you have likely developed gingivitis. Stemming the excess bacteria, plaque will slowly begin to build up in your mouth until it reaches the gum tissue. Once the gum tissue has become infected you will experience swollen and bleeding gums, which are hallmark signs of gingivitis. If the condition is left untreated however, the infection will eventually progress into full blown gum disease.⁷ 

Mask Mouth: Solutions

 

Washing or Replacing Masks:

A dirty mask makes a dirty mouth. By repeatedly using the same mask over and over, you are giving bacteria a place to survive and thrive. We recommend washing and rotating several cloth masks at a time, or simply throwing away disposable masks after each use.

 

Keeping Hydrated:

Drink plenty of water while using a mask for a prolonged period. Obviously, water does the body good in more ways than one.⁶

 

Proper Oral Hygiene:

With facemasks continuing to be required for daily use, proper oral hygiene is now more important than ever. While taking a few extra minutes twice a day to thoroughly brush and floss your teeth might not seem like it makes much of a difference. Taking a refreshing shower after work, a mid-day brushing really helps rejuvenate your smile and freshen your breath.

 

Diet:

If dry mouth and bad breath are really proving to be a problem for you then perhaps you should consider altering your diet. While it doesn’t have to be permanent, temporary dietary changes could be a key factor in reducing these issues. Commonly used substances such as caffeine or alcohol for instance, both expedite the rate of dehydration, thus worsening the affects of mask mouth. By limiting your consumption of sugary, alcoholic, acetic, caffeinated, or tobacco-based products, you can diminish such concerns in a major way.

 

Routine Dental Exams:

It’s imperative for the health and future of your smile that you continue to receive dental exams every 6 months.⁹

 

Prevention:

Even if you experience some of these symptoms, keep wearing your mask. Wearing your mask slows the spread of the virus and helps protect the vulnerable in your community. Instead, implement some of these preventative measures¹⁰

·      Focus on your oral care routine. Brush your teeth for two minutes twice a day and clean between your teeth with floss or other interdental devices once a day. Make sure you use the proper brushing technique to clean all your mouth's nooks and crannies.

·      Keep a mouthwash on hand to freshen your breath and fight bacteria between cleanings. Ask your dental professional to recommend a mouthwash that does not exacerbate dry mouth. Chewing sugar-free gum can also help remove food debris and fix bad breath.

·      Keep an eye on tooth and gum health. Because mask mouth increases your chances of infection, watch out for sensitive teeth and gums. If you notice any discoloration, pain, bleeding, or tenderness, see your dentist as soon as you safely can for treatment.

·      Stay hydrated. Drink water throughout the day to help prevent dry mouth. It might also help to limit alcohol and coffee consumption, which can cause dehydration.

·      Use a clean mask. Regularly replace the mask. The CDC recommends washing your mask daily or throwing your mask out after each wear.

 

REFERENCES:

1.     American Dental Association. Xerostomia. Available at: https://www.ada.org/en/member-center/oral-health-topics/xerostomia

2.     Colgate https://www.google.com/amp/s/amp.colgate.com/en-us/oral-health/threats-to-dental-health/what-is-mask-mouth

3.     Ratcliff PA, Johnson PW. The relationship between oral malodor, gingivitis, and periodontitis. A review. J Periodontol. 1999 May; 70(5):485-9. doi: 10.1902/jop.1999.70.5.485. PMID: 10368052.

4.     Yip W, Leung L, Lau P, Tong H. The Effect of Wearing a Face Mask on Body Temperature. Hong Kong Journal of Emergency Medicine. 2005;12(1):23-27. doi:10.1177/102490790501200102

5.     Rebmann T, Carrico R, Wand J. Physiologic and other effects and compliance with long-term respirator use among medical intensive care unit nurses. Am J Infect Control. 2013;41: 1218–1223.

6.     Dr Charles R Kimes How to Stop Bad Breath: It's a stinky situation https://overlandparkcosmeticdentist.com/blog/stopbadbreath2 // How to Stop Bad Breath: It’s a Stinky Situation

7.     Gum disease and heart disease: https://overlandparkcosmeticdentist.com/blog/stopbadbreath2 //Dental Health Awareness: Gum Disease and Heart Disease

8.     Itodo ES (2021) The Interconnection between Masks and Oral Health. Health Sci J. 15 No. 1: 794.

9.     Ash Parmar, Mask mouth identifying and treating the symptoms, available on: https://dentistry.co.uk/2021/02/11/mask-mouth-identifying-symptoms/

10.   Roberge RJ, Kim JH, Coca A (2012) Protective Facemask Impact on Human Thermoregulation: An Overview. Ann Occup Hyg 56: 102–112.

11.   Fatima Malik Abood1, Ghassan A. Abbas HD. Conserv, Luma Jasim Witwit, Nada Khazal Kadhim Hindi, Halah Khaleel Ahmed Abu Khmra, Mohmmed R. Abid Ali. The occurrence of alveolar bone resorption with oral bacterial infection. Research J. Pharm. and Tech. 2017; 10(6): 1997-2000. doi: 10.5958/0974-360X.2017.00349.3   Available on: https://rjptonline.org/AbstractView.aspx?PID=2017 10-6-73

12.   Shrada. B. Kumar. Occurrence of Bacteremia in Patients with Chronic Periodontitis. Research J. Pharm. and Tech. 8(11): Nov., 2015; Page 1605-1606. doi: 10.5958/0974-360X.2015.00285.1   Available on: https://rjptonline.org/AbstractView.aspx?PID=2015-8-11-26  

13.   Jyothi. S. Halitosis – A Growing Psychosocial Problem. Research J. Pharm. and Tech 2017; 10(11): 4024-4029. doi: 10.5958/0974-360X.2017.00729.6   Available on: https://rjptonline.org/AbstractView.aspx?PID=2017-10-11-68K. Siva Priyah, Sherlyn Sheeba, Dhanraj

14.   Ganapathy. Fetor Oris - A Review on Classification and Management. Research J. Pharm. and Tech 2018; 11(5):2127-2130. doi: 10.5958/0974-360X.2018.00394.3   Available on: https://rjptonline.org/AbstractView.aspx?PID=2018-11-5-79

15.   Nausheen Mobeen. Oral Malodor: Prevention and it's Treatment. Research J. Pharm. and Tech. 7(10): Oct. 2014 Page 1175-1177.   Available on: https://rjptonline.org/AbstractView.aspx?PID=2014-7-1

16.   Jyothi. S. Halitosis – A Growing Psychosocial Problem. Research J. Pharm. and Tech 2017; 10(11): 4024-4029. doi: 10.5958/0974-360X.2017.00729.6  

 

 

 

Received on 19.11.2021       Modified on 07.02.2022

Accepted on 21.03.2022     ©A&V Publications All right reserved