The health authorities of many countries are maximizing their efforts to prevent the spread of coronavirus disease (COVID-19) by implementing social distancing and mandating the use of facial masks. Facial masks act as a barrier and prevent the spread of COVID-19 which can occur either by direct, indirect, and droplet transmission.
The purpose of facial masks is to avert infected people from spreading the infection to
healthy individuals. However, the continuous wearing of a mask has been proven to cause respiratory physiology, rise in temperature, headache, fatigue and discomfort.
The change in the respiratory pattern due to the heavy barrier of the mask brings about a change in the normal breathing pattern of the individual and adapts them to become a potential mouth breather. To put forth in simple terms, a mouth breather is a person who breathes through the mouth rather than using the nose to breathe. Mouth breathing causes alteration of the oral flora leading to dry mouth, halitosis, increased chances of developing caries, gingival inflammation etc.
During the pre-pandemic era, people used to visit dentists mainly due to pain in the tooth or for missing teeth and also for esthetic purposes to achieve a pleasing smile. However, in the pandemic era with the implementation of facial
masks and social distancing norms, the dental care regimen has taken a turn for the worse.
Data published in an article shows that people are less concerned about their oral hygiene and are brushing fewer times a day due to the pandemic.
The decrease in the frequency of tooth brushing along with the mouth breathing habit has been associated with gingival and periodontal diseases, halitosis (infamously known as Mask Mouth), higher incidences of plaque deposit and development of newer carious lesions.
Also, 17.3 % of subjects felt the need to go for the orthodontic procedure only when
masks were no longer necessary.
This shows that the need to undergo esthetic treatment has also been reduced due to the wearing of masks. It has been documented that number of patients who have no concern to go for esthetic treatment until no longer mask is necessary has increased drastically from 21.5% pre-pandemic to 28.2% in the pandemic era.[
Another component of dental health that has seen a change during the pandemic is clenching or grinding of teeth during sleep or wakefulness. This can be attributed to stress and anxiety associated with the unknown fear of pandemic. It has been reported in an article that the prevalence of clenching or grinding of teeth (bruxism) has increased significantly during the pandemic era and 47.8 % of the participants have experienced myofascial pain due to bruxism. If left untreated, it can result in temporomandibular joint disorders.
As every cloud has a silver lining, similarly, wearing a face mask has instituted a sense of self-perceived awareness of dental health among some people. In a cross-sectional study conducted on 4647 participants, 33.8% of the study population changed their self-perceived breath odour (SPBO) after using face masks during the pandemic and nearly 645 individuals realized they have halitosis.
The SPBO was significantly higher for individuals who were under medication or having any systemic conditions. Due to this SPBO, many participants adapted to a newer Oral Health Hygiene routine.
In another study, 89.5% of participants answered that they would still seek dentists even with the use of masks due to dental
esthetics and oral health.
Many lifestyle modifications have taken place due to the onset of the pandemic, and one such is wearing of facial mask. This article brings us to light the various oral hygiene issues that people have faced and are facing during the pandemic. People are reluctant to visit the dentist with the fear of contracting COVID19. Also, social distancing norms along with the mandatory use of face masks have made them less perturbed about their dental hygiene.
Though there is literature available that supports SPBO by the people, there is also literature available that shows that people have reduced their frequency of brushing and maintaining oral hygiene. This is an issue of concern as poor oral hygiene causes gingival diseases, periodontal diseases, newer carious lesions, halitosis, accumulation of plaque and calculus. Also, due to the unknown fear, anxiety and stress-related to the pandemic people have developed myofascial pain associated with clenching or grinding of teeth (bruxism) which if not treated can give rise to temporomandibular joint disorders.
Ultimately, it is the good oral health thought that matters over the use or non – use of the facial mask. Therefore, it is important to perform simple yet effective oral health behaviours which can be continued at home and maintain oral hygiene. This includes brushing teeth twice a day to avoid Mask Mouth or halitosis. Flossing and using of mouth rinses to maintain good gingival health and prevent the development of newer carious lesions. Rinse the mouth frequently after each meal and after having hot or cold beverages.
Another important thing to remember is reusing the used masks also contributes to oral health problems along with Maskane (acne caused to using the used mask). Hence it is important to change the masks frequently and also to know how to wear a mask correctly. As dentists, we must educate the public about maintaining good oral hygiene and prevent further progression of oral diseases.