Dr Ash Parmar gives his take on the conversations surrounding ‘mask mouth’ and how he tackles it among patients.
The COVID-19 pandemic has been with us for almost a year. It continues to bring a host of challenges not just to our profession, but also to our way of life. These look set to continue for some time despite the rollout of the vaccine program.
A new condition known as ‘mask mouth’, first termed by dentists in the US, highlighted the possible side effects of wearing a mask on people’s oral health. We asked Dr Ash Parmar to provide some insights into ‘mask mouth’ and how he addresses this with patients.
Does wearing a mask cause bad breath?
Whilst there are differing opinions as to whether this may be a serious issue, most appear to agree on one aspect – that wearing a mask can cause bad breath.
In a survey by Ultradex, more than half of dental professionals agreed they had recently seen patients suffering from bad breath. They believed this to be a side effect of patients wearing face coverings.
Of those surveyed, 49% said they had seen patients with dry mouth (xerostomia), while 41% reported seeing signs of poor oral hygiene. Although we cannot say definitively whether this is purely down to the wearing of a face covering.
While those of us working in healthcare are used to wearing masks for a period of time, I can understand that for some people it’s an ongoing and uncomfortable experience.
There are concerns about how well they can breathe while wearing a face covering, and this may result in them breathing through the mouth more than they usually might, contributing to a dry mouth.
In addition, people may find they drink less while wearing a mask, meaning that food debris in the mouth is not washed away as often as it should be.
Both these factors can lead to a person suffering with bad breath.
What are the main causes of bad breath and what implications does this have on a patient’s oral health?
The main root cause of bad breath is volatile sulphur compounds (VSCs), the by-products of decaying oral debris and bacteria.
In a typical human mouth, it has been estimated there are more than 100 million bacteria (more than 700 species) in every millilitre of saliva, some producing rotten smelling VSCs as a result of degradation of proteins from decaying cell tissue and oral debris.
However, the late eminent American periodontist, Professor Perry Ratcliff, claimed that high concentrations of VSCs are also highly toxic to the tissues in the mouth and alter the epithelial barrier, allowing bacterial toxins to penetrate into the deeper tissue, starting the inflammatory action that can lead on to more severe problems, such as gingivitis and periodontitis.
Mask mouth coupled with poor oral hygiene can exacerbate the problem. Therefore, as dental professionals it is our moral and ethical duty to identify and address bad breath with patients.
Identifying patients with mask mouth
According to research conducted in January 2021, the severity of mask mouth symptoms varies from person to person, but the condition most commonly presents itself as:
- Bad breath – your oral hygiene habits, what you eat and dry mouth can all cause halitosis, more commonly known as bad breath. Prolonged mask-wearing can intensify dry mouth as people become less likely to regularly drink fluids. Masks also trap the stench caused by poor oral hygiene or eating smelly foods like onions and garlic
- Dry mouth – xerostomia occurs when you have insufficient saliva to keep your mouth moist. Not only does dry mouth increase your chance of developing tooth decay and other oral infections, but it also makes it difficult to eat, swallow, and speak
- Bleeding gums – wearing a mask may impact the type and amount of bacteria in your mouth. This can cause plaque and biofilm build-up, leading to detrimental effects on periodontal tissues. If you notice your gums are swollen or bleeding, it could be a sign of gingivitis.
Now more than ever I look out for these signs with my patients. Once the issue has been identified I advise them on how to effectively manage their symptoms at home.
In most cases this comes through using the right products and following the correct regimen.
To what extent might having mask mouth affect your patient’s self-confidence?
Research carried out by Ultradex highlighted that, of an array of different social taboos, bad breath was the subject patients are least likely to talk about with friends or family.
In fact, in a One Poll survey, 70% of adults surveyed said they have anxiety about bad breath. Yet only 14% said they would tell a friend if they had bad breath.
This means that many may be unknowingly suffering from bad breath and have no way of improving the freshness of their breath or their lifestyle.
I find it professionally rewarding to be able to help people who suffer from bad breath, knowing that the majority of cases are related to a dental condition, and that we can help patients as dentists.
Responsibility to help
I feel that all dentists should be addressing this issue with their patients – there is a huge demand for bad breath treatment. More so now with the advent of mask mouth. It can be an embarrassing and difficult subject due to the emotive nature of the condition.
Bad breath is a condition that can impact on peoples’ social lives, relationships, even their work prospects. For example, 68% of people believe that if they have bad breath it could prevent their chances of employment (Sharma, 2016).
I have found middle-aged men particularly, can become very self-conscious about their breath. Often their partners send them in for treatment!
The simple fact is, bad breath is both a social and a dental problem.This is being exacerbated by mask mouth. The anxiety caused as a result of suffering from bad breath could have debilitating consequences.
With 90% of bad breath being caused by what happens in the mouth, dental professionals are well placed and have a responsibility to help patients.
Treating and preventing mask mouth
Research shows that products containing stabilised chlorine dioxide, such as Ultradex, can demonstrate efficacy at lowering concentrations of volatile sulphur compounds (VSCs), by changing the molecular structure of the VSCs on contact (Ratcliff and Johnson, 1999).
Stabilised chlorine dioxide acts as an oxidising agent. It effectively neutralises the acid in the mouth, eliminating VSCs, removing bacteria and gently lifting organic stains.
Ultradex is backed by nine clinical studies, which demonstrate its positive effect on eliminating VSCs and maintaining good oral health. It also shows its positive impact on bleeding gums and restoring natural tooth whiteness.
I have recommended Ultradex to my patients, family and friends for 20 years – it’s the mouthwash I use myself. It is the optimum mouthwash in my practice. Not only for bad breath, but also for gum health, smile makeover treatments, and implant patients.
Ultradex is free from alcohol and chlorhexidine. It is also safe to recommend for long-term daily use. It’s also vegan friendly.
The Ultradex range also includes a low-abrasion toothpaste, which is free from sodium lauryl sulphate (SLS) and ideal for patients with sensitive teeth or those prone to mouth ulcers.
For additional fresh breath confidence throughout the day, Ultradex offers an alcohol-free fresh breath spray. This pocket-sized spray is ideal for on-the-go use. It is also perfect for patients to freshen up while out and about, especially after they’ve been wearing a mask.
Mask or no mask it’s as important as ever that patients adopt the best possible hygiene regime between appointments.
Of course, this includes brushing for at least two minutes, twice a day, preferably with an electric toothbrush. It also means flossing or using interproximal brushes daily – and after meals, if possible.
Recommending a good quality toothpaste and mouthwash like Ultradex will help your patients remain ‘fresh breath confident’ for 12 hours. As well as removing harmful bacteria and providing long-lasting protection for the teeth and gums.
Kapoor U, Sharma G, Juneja M and Nagpal A (2016) Halitosis: Current concepts on etiology, diagnosis and management European Journal of Dentistry 10 (2): 292-300
Ratcliff P and Johnson P (1999): The relationships between oral malodor, gingivitis and periodontitis. J Periodontology 1-14
Ultradex is available to order direct from your dental wholesaler. For more details, visit www.ultradex.co.uk.
Ash has a private referral practice in Chigwell, Essex called Smile Design By Ash (www.smiledesignbyash.co.uk). He also offers inspirational courses for dentists (www.theacademybyash.co.uk).
Follow Ash on Instagram (@ashparmardentist) for top tips in dentistry and watch his webinar on growing your hygiene and fresh breath centre at www.dentistrystudyclub.com.