The Relationship between Wearing Protective Masks and Poor Oral Health

Since the beginning of the COVID-19 pandemic, the number of people wearing masks in everyday life has increased. At the same time, there has been a noticeable rise in the amount of patients with bad breath (foe-tor ex ore), gingivitis, caries, and xerostomia. The appearance of these symptoms and diseases caused by wearing a mask is designated by the term mask mouth. The aim of this article is to establish the link between wearing protective masks and deteriorating oral health. From the conducted research, it has been es-tablished that wearing a surgical mask over a long period of time leads to reduced air exchange in the mask and "recycling" of exhaled air. This leads to inhalation of air with increased CO2 content and increase in pCO2 in the blood, which is subsequently compensated by rapid and deep breathing in most cases through the mouth. The goal is to exhale the accumulated CO2. As the mask reduces air exchange, the level of CO2 in the mask remains relatively high. Prolonged breathing through the mouth often leads to xerostomia. Saliva is known to have protective functions against the development of bacteria in the oral cavity through its an-tibacterial properties. Xerostomia can be a prerequisite for the development of various diseases of bacterial origin, such as gingivitis. Furthermore, oral respiration leads to an increase in temperature and CO2 in the air in the mask and a decrease in pH in the oral cavity, which are optimal conditions for biofilm formation, plaque buildup, development of most bacteria, e.g., S. mutans, which is the main cause of caries.Copyright © 2022, Bulgarian-American Center. All rights reserved.

Self-Perceived Halitosis and Related Factors Among the Mask-Wearing Population During the COVID-19 Pandemic in Delhi, India: A Cross-Sectional Study.

Introduction Halitosis (oral malodor) is a common health condition throughout the world. In India, data on self-reported halitosis and related factors is limited. Mouth mask usage has been made compulsory after the coronavirus disease 2019 (COVID-19) pandemic. This could possibly alter oral microflora and environment and contribute to halitosis. The aim of the study was to determine the prevalence of self-perceived halitosis (SPH) among mask-wearing patients visiting a tertiary care dental hospital in Delhi, India. Methods A cross­sectional study was conducted among a convenience sample of 300 patients visiting a tertiary care dental hospital in the capital of India. SPH status was measured using a self-designed and structured questionnaire containing socio-demographic factors, mask-related habits, and self-perceived oral health status. Statistical analysis was done using Jamovi software (The jamovi project, Sydney, Australia) version 1.8. Descriptive analysis followed by a chi-square test and a multivariate logistic regression test was applied. Results Bad breath was perceived by 86 study subjects. Of the participants, 16.7% felt that they had bad breath before the pandemic, and 38% of the participants had an increased perception or feeling of bad breath since regular mask usage. Of the participants, 42.7% felt that they had an increased feeling of dryness in the mouth post-pandemic. SPH status was associated with mask usage frequency (p<0.001), change (p<0.001) and type of mask (p=0.004), increased feeling of dryness (p<0.001), frequency of toothbrushing (p<0.001), self-reported oral disease (p=0.007), and dental treatment in the past 12 months (p=0.005). Conclusion The SPH status of the study population was associated with mask-related habits and self-reported oral health status. The findings highlight the importance of possible amendments in preventive and curative care for patients with halitosis post-COVID-19 pandemic.

Effect of face masks on salivary parameters and halitosis: Randomized controlled crossover trial.

BACKGROUND: Face masking is associated with self-perceived dry mouth and halitosis. Aim of the study was to measure the effect of different face masks on salivary parameters and halitosis. METHODS: The randomized controlled crossover clinical trial with 4 periods included forty oral healthy participants using different face masks (cloth mask, surgical mask, FFP2 mask) or no mask (control) for 4 hours in random order. Unstimulated salivary flow rate (primary outcome) and stimulated salivary flow rate, salivary pH and buffer capacity of stimulated and unstimulated saliva (secondary outcomes, blinded), and volatile sulfur compounds (secondary outcome) were measured before and after the four-hour periods. Statistical analysis was performed by repeated measures ANOVA (p<0.05). RESULTS: Of 40 randomized participants, 39 completed the study. Unstimulated salivary flow rate prior to face masking amounted to 0.6±0.3 mL/min. Face masking had no significant effect on unstimulated salivary flow (p=0.550). Face masking had also no significant effect on the other salivary parameters (p≥0.518). The concentration of volatile sulphur compounds (VSC) prior to face masking amounted to 157.3±59.7 ppb. After face masking, the concentration of VSC increased slightly, but not significantly (p=0.055): 168.1±76.3 ppb (control), 199.3±132.7 ppb (cloth masks), 188.5±101.1 ppb (surgical masks), and 189.7±90.1 ppb (FFP2 masks). CONCLUSION: Four hours of face masking did not change the salivary flow rate, pH, and buffer capacity, and had no significant effect on VSC's levels. Wearing face masks does not seem to result in measurable side-effects on salivary parameters such as a reduced salivary flow rate or VSC's levels.

Examination of Dental Problems and Radiological and Cardiac Evaluations in Patients Affected by Covid-19

This study investigated dental problems and radiological and cardiac evaluations in patients affected by Covid-19. Heart disease is related to the health of the teeth, and people who have damaged and decayed teeth are more prone to cardiovascular disease. Researchers have concluded that poor dental hygiene is a sign of acute heart disease risks. In the report presented by Tarje Imna service, a group of researchers examined almost 65 thousand people infected with the corona virus in order to evaluate the effects of the covid 19 virus on the oral and dental health of the affected people. According to the results of this research, one of the effects of the corona virus on the body is the reduction of oral moisture. Almost 43% of patients accepted this effect. In general, dry mouth is one of the causes of oral and dental diseases, especially bad breath. Corona virus also increases the risk of tooth decay by reducing the moisture in the mouth. Another effect of the corona virus on the mouth and teeth is to cause ulcers in the gums and tongue. Of course, in this case, researchers do not comment with certainty, because they believe that other factors are also effective in causing these wounds. Some experts say that considering that more than 47 percent of adults who are 30 years old or older have periodontal diseases, such as gum infection, inflammation of the gums and bone around the teeth. We should expect that the existing dental and oral problems will become more acute in case of infection with Covid-19.

Necrotizing periodontal disease in a patient with COVID-19 history: A case report

Background: Necrotizing periodontal diseases (NPD) are fuso-spirochetal infections causing ulceration and destruction of periodontal tissues and associate with impaired host response. Elevated bacterial levels of Prevotella intermedia, Veillonella and Streptococci present in NPD lesions were detected in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Description of the procedure: A 40-year-old female, non-smoker patient was referred to the clinic with complaints of fever, halitosis, bad taste, severe gingival pain and bleeding. The patient reported a history of COVID-19 a month prior to any symptoms. Extra and intraoral examinations revealed submandibular lymphadenopathy, plaque accumulation, necrotic areas covered with pseudo-membranes, spontaneous gingival bleeding and suppuration. Alveolar bone loss was detected in the radiographic examination. Since periodontal pocket formation was present, the clinical diagnosis of the case was necrotizing gingivitis as a result of previously occurred periodontitis. During the first visit, necrotic areas were gently swabbed with 3% H2O2 moistened cotton pellets and oral hygiene instructions were given. Systemic antibiotic (metronidazole 500 mg 2 × 1) was prescribed for 5 days and rinsing with 0.12% chlorhexidine and 3% H2O2 was recommended. Three days later, since the acute complaints were reduced, clinical periodontal parameters were recorded and nonsurgical periodontal treatment (NSPT) was performed in 4 sessions in 2 weeks. One month after NSPT, all clinical periodontal parameters were recorded again. Outcomes: Following NSPT with the combination of systemic antibiotic regimen, all symptoms were resolved leading to the dissolution of necrotic areas. All clinical parameters were improved after NSPT. Conclusions: This case may be an evidence that COVID-19 could be a contributing factor for the appearance of NPD. Since COVID-19 leads to an altered immune response of the patient, a suitable environment becomes present orally for bacteria causing infections that result in NPD. The importance of routine intra-oral examination for COVID-19 patients is highlighted.

ORAL MANIFESTATIONS ASSOCIATED WITH COVID‑19 PATIENTS IN SAUDI ARABIA

COVID-19 was recognized by the World Health Organization (WHO) as a pandemic disease since most of the countries reported significant numbers of deaths and infected people starting with December 2019 (WHO, 2020). The diversity of COVID-19 manifestations can be attributed to the sites where the SARS-Cov-2 receptors Angiotensin-converting Enzymes 2 (ACE2) were found, which include, but were not limited to, lung, kidney, salivary glands and gastrointestinal tract [1,12-14]. Dealing with COVID-19 had shown that many oral manifestations could be in direct relation to the infection itself. [...]another study [15] reported that at least one oral manifestation concerning the oral cavity and salivary gland was found on 67.2% of the 58 observed patients, in whom a dry mouth had the highest prevalence and gingival bleeding - the lowest. A P-value < 0.05 was considered significant. 3.RESULTS The link was distributed to a total of 515 patients tested positive with COVID-19, 512 of them having responded to the questionnaire (a response rate of 99%).

Association and awareness on COVID associated halitosis among dental students- a survey

INTRODUCTION: Halitosis may be a reflective condition for systemic insults like respiratory, and gastrointestinal pathologies which will give salivary characteristics and tongue dorsum susceptibility for hosting anaerobic microorganisms. The high prevalence of halitosis globally requires a multidisciplinary approach for its diagnosis, assessment and treatment to reduce halitosis. During the COVID period, people affected by the COVID and in the older age people have several oral problems and halitosis. The aim of this is to create awareness among the people about bad breath during COVID and also aimed at investigating the effect of mouth breathing on dental, oral health status and halitosis. MATERIALS AND METHOD : This study was about bad breath during COVID pandemic period. A self-administered questionnaire concerning various aspects of bad breath was distributed among 113 dental students of Saveetha University, Chennai. A questionnaire based survey in google forms circulated within the dental students of Saveetha University, Chennai. Responses of about 113 participants were received and the data was recorded. Statistical analysis was done. The data was tabulated. The data was analysed using SPSS software (version 23) and the chi-square test was done. The level of significant difference was p<0.05. The study was approved by SRB of Saveetha Dental College. RESULT : In our study, the age group between 18-19 were more aware of halitosis during COVID. Male were more aware of halitosis and undergraduate students were more aware about halitosis. About 64.6% of people think that bad breath is common for all diseases and the p value is 0.35. About 63.7% of people are aware of the term halitosis and 36.3% of people are not aware of halitosis and the p value is 0.32. About 83.3% of people think that breathing through the mouth causes dental caries and 17.7% responded No and the p value is 0.057. CONCLUSION : The present study offers an opportunity of diagnosing the origin of halitosis and to create awareness among the people about oral complications. Majority of people think that bad breath is common for all diseases.In our study, we can see the complications of halitosis and create awareness among the people.

Mask mouth' - a new malady affecting oral health in the COVID era

Background: Presently the use face masks has become the need of the hour due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Although the use face mask protects the user from SARS-CoV-2 infection, it has certain adverse effects. One of the new and recently noticed side effect is on the oral health of the wearer known as "Mask Mouth". This consist of symptoms like caries, gingivitis, halitosis, candidiasis and angular cheilitis. In this article, a systematic review was done, where comprehensive, critical and objective analysis of the current knowledge regarding adverse effects of using face mask on the oral health was reviewed. It was observed that prolonged use of mouth mask can cause dryness of mouth as well as bring about a change in the oral microflora and have an impact on overall oral health. Mask mouth can be prevented by maintaining proper oral and mask hygiene, avoiding mouth breathing and staying hydrated.

The Impact of COVID-19 on Halitosis among the General Population in Saudi Arabia: A Potential Symptom

Background: This study assessed the impact of COVID-19 on levels of self-perceived halitosis among adults in Saudi Arabia. Methods: A total of 1,143 participants completed the study questionnaire, which was distributed online via different social media platforms. The Halitosis Associated Life-quality Test (HALT) and other questions were used to assess halitosis and various behaviors related to halitosis during the COVID-19 pandemic. Results: Participants' mean HALT score was 14.21 (out of 100), with a standard deviation of 17.52. Regarding self-perceived halitosis, 6.2% reported having halitosis, and 51% sometimes did. All participants used at least one natural remedy to protect themselves from or to treat COVID-19 during the lockdown;the most common item related to good breath was honey (38.40%), and for bad breath, it was garlic (15.5%). Participants who had COVID-19 and did not lose their sense of smell had significantly higher HALT scores than those not infected with COVID-19 (p=0.01). A total of 24% thought the COVID-19 pandemic improved their hygiene;32.20% noticed a bad smell after wearing masks, and 30.7% thought that wearing the mask prevented others from noticing their halitosis. Conclusion: This study indicated a low level of self-perceived halitosis among the population in Saudi Arabia during the COVID-19 pandemic. The lockdown changed Saudi Arabia residents' behaviours in ways that affected perception of and treatment for halitosis. It is suggested that halitosis might be a secondary symptom of COVID-19 infection;however, more studies are needed for validation.

COVID-19 Pandemic: Effect of Different Face Masks on Self-Perceived Dry Mouth and Halitosis.

Due to the COVID-19 pandemic, the use of face masks has increased, resulting in potential health-related side-effects. Therefore, the study aimed to analyse the effect of wearing face masks on self-perceived dry mouth and halitosis. A questionnaire addressing the daily wearing time of different face masks (community masks, surgical/medical masks and KN95-/N95-/FFP2-masks) and self-perceived dry mouth and halitosis was given to adults attending or working at a university hospital. Statistical analysis was performed using Wilcoxon signed-rank test and multiple linear regression analysis (p < 0.05). 3750 participants (age: 50.4 ± 15.5 years; 60.0% female) were included. During the pandemic, face masks were used for 4.7 ± 3.8 h per day: community masks: 0.9 ± 2.0 h, medical/surgical masks: 1.9 ± 2.8 h and KN95-/N95-/FFP2-masks: 1.9 ± 2.5 h per day. The use of face masks significantly increased self-perceived dry mouth and halitosis (both p < 0.001). Self-perceived dry mouth and halitosis increased with increasing wearing time (community masks: dry mouth: p < 0.001, halitosis: p = 0.014; medical/surgical masks: both: p < 0.001; KN95-/N95-/FFP2-masks: dry mouth: p < 0.001, halitosis: p = 0.011). The perception of dry mouth and halitosis was increased in females compared to males (both: p < 0.001). Participants used to wearing face masks prior to the pandemic perceived dry mouth to a higher extent (p = 0.043). Self-perceived halitosis was lower in older than in younger participants (p < 0.001). Due to the increased perception of dry mouth and halitosis, people might abstain from wearing face masks. Further studies need to analyse measurable changes in dry mouth or halitosis.

Self-perceived and self-reported breath odour and the wearing of face masks during the COVID-19 pandemic.

OBJECTIVES: To assess the self-perception of breath odour (SPBO) and oral hygiene habits (OHHs) while the wearing of face masks during the COVID-19 pandemic. SUBJECTS AND METHODS: This cross-sectional study included 4647 individuals who answered a structured questionnaire containing demographic, medical and dental variables and self-perceived breath odour. Variables associated with changes in self-perceived breath odour, self-perceived halitosis and changes in OHHs were assessed through multivariate logistic regression. RESULTS: Changes in self-perceived breath odour were reported by 1572 individuals and were associated with smoking, systemic conditions, dry mouth, tongue coating, the period of face mask use and its interaction with prior thinking of having bad breath. Likewise, 645 individuals started to consider having bad breath. This was associated with the interaction between prior family/friends saying they have bad breath and period of face mask use. Changes in OHHs were strongly associated with changes in SPBO and starting to consider having bad breath. CONCLUSION: Changes in one's SPBO was associated with the wearing of face masks and was significant for changes in OHHs. Findings may be important to guide comprehensive preventive and therapeutic strategies in relation to oral health care.

Oral manifestations in mild-to-moderate cases of COVID-19 viral infection in the adult population.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a serious worldwide threat presented by a broad range of symptoms, from mild flu to severe pneumonia. A rising number of atypical infections have been reported. Thus, scientists and clinicians are doing hard work to unravel scientific knowledge about this novel pandemic. OBJECTIVES: The aim of the present work was to highlight the oral manifestations which could be observed in mild-to-moderate cases of COVID-19. MATERIAL AND METHODS: A questionnaire survey was performed on 665 Egyptian patients who were confirmed COVID-19-positive based on the polymerase chain reaction (PCR) test. After applying the exclusion criteria, cases with mild-to-moderate symptoms were included in the study. The questionnaire consisted of 4 sections. The 1st section included demographic data, smoking, alcohol consumption, and general health status. The 2nd section contained questions regarding the oral hygiene status of the patients, and additionally a question about the hygienic measures they took while being infected with COVID-19. The 3rd section included questions about the most commonly reported COVID-19 symptoms the patients suffered from. The 4th section included questions that referred to the oral manifestations the patients complained of while being infected with COVID-19. RESULTS: A total of 573 patients were included in this survey. It was reported that 71.7% of COVID-19 patients presented with some oral manifestations at a level of significance, with variable incidence - oral or dental pain (23%), pain in jaw bones or joint (12.0%), halitosis (10.5%), ulcerations (20.4%), and xerostomia (47.6%). Some patients (28.3%) showed 2 or 3 manifestations simultaneously. CONCLUSIONS: It was proven that mild-to-moderate cases of COVID-19 infection are associated with oral symptoms, and thus the significance of dental examination of patients with communicable diseases should be emphasized.