The Truth Behind “Mask Mouth”

With some areas experiencing an increasing surge in the number of COVID-19 cases, the United States Centers for Disease Control and Prevention continues to recommend the wearing of masks while in public to help curb the spread of the virus.¹ In contrast, many are still protesting the use of masks, citing various reasons for refusing to wear them. But what is the truth behind long-term mask use?

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 masks.²

In one study, nurses were tested and surveyed while wearing their masks over the course of two 12-hour shifts.³ Over the two days, 22% of the nurses removed their masks at some point due to discomfort and a perceived shortness of air with complaints of headaches and lightheadedness as well.

More recently, a study was conducted specifically related to headaches and their association with PPE such as N95 masks and protective eyewear.⁴ This study found that out of 128 participants with no preexisting headache condition, 81% reported PPE-associated headaches. Additionally, out of the 46 participants with a pre-existing headache diagnosis, 91.3% reported an exacerbation of their headache condition after the extended use of PPE.

Headaches can be a symptom of dehydration.⁵ Extended mask wearing may inhibit the consumption of enough fluids throughout the day. This could, in turn, lead to xerostomia, which opens the door for potential oral complications.

Xerostomia has been associated with an increased risk of caries, fungal infections, oral malodor, and periodontal diseases,⁶ which may be why we have started hearing the phrase “mask mouth.” Since masks are now required in many public settings, we need to discuss these potential complications with our patients, as they too are wearing masks for extended periods. Combatting xerostomia as a side effect of mask usage can be as simple as reminding our patients to drink enough water throughout the day. Additionally, chewing gum with xylitol can help stimulate salivary flow and prevent caries.⁷

Despite the chaotic environment of a dental office and the added PPE, we must also remember to drink enough water at the start of a long shift to stay hydrated. It can be difficult to combat xerostomia as it relates to extended mask usage, but please remember to take care of yourself so that you can continue to take care of others.

References

1. United States Centers for Disease Control and Prevention. Help Slow the Spread of COVID-19. Available at: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html
2. United States Centers for Disease Control and Prevention. N95 Respirators. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirators-strategy/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhcp%2Frespirators-strategy%2Fconventional-capacity-strategies.html
3. 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.
4. Goh Y, Ong JY, Bharatendu C, Tan BYQ, Sharma VS. Headaches associated with personal protective equipment- A cross-sectional study among frontline healthcare workers during COVID-19. Headache. 2020;60:864-877.
5. National Headache Foundation. Headaches and Dehydration. Available at: https://headaches.org/2016/07/07/headaches-and-dehydration/
6. American Dental Association. Xerostomia. Available at: https://www.ada.org/en/member-center/oral-health-topics/xerostomia
7. Xylitol.org. How to relieve dry mouth with xylitol. Available at: https://xylitol.org/relieve-dry-mouth-xylitol/