Next Article in Journal
Influence of Electrostatic Field on Mixed Aqueous Solution of Calcium and Ferrous Ions: Insights from Molecular Dynamics Simulations
Next Article in Special Issue
Immediate Hypersensitivity Reactions to Paraformaldehyde Used as a Dental Material
Previous Article in Journal
Thin Films Characterization and Study of N749-Black Dye for Photovoltaic Applications
Previous Article in Special Issue
Comparative Analysis of Implant Prosthesis Treatment Planning and Execution Following Bone Repair Procedures Using Dynamic Surgical Navigation in Augmented Areas
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Coatings
Volume 12
Issue 8
10.3390/coatings12081164
coatings-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Changes in the Oral Cavity Mucosal Surface under the Influence of Wearing Protective Face Masks—Nitric Oxide Concentration Analysis—Preliminary Report

by
Magdalena Wyszyńska
1,*,
Aleksandra Czelakowska
2,
Przemysław Rosak
3,
Ewa Białożyt-Bujak
1,
Olaf Gruca
2,
Joanna Rosak-Szyrocka
4,
Jacek Kasperski
2 and
Małgorzata Skucha-Nowak
5
1
Department of Dental Materials, Division of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 15 Poniatowskiego Street, 40-055 Katowice, Poland
2
Department of Dental Prosthetics, Division of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 15 Poniatowskiego Street, 40-055 Katowice, Poland
3
Specialist Dental Practice Przemysław Rosak, 13 Piłsudskiego Street, 41-300 Dąbrowa Górnicza, Poland
4
Faculty of Management, Czestochowa University of Technology, 19b Armii Krajowej Street, 42-209 Czestochowa, Poland
5
Department of Dental Propedeutics, Division of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 15 Poniatowskiego Street, 40-055 Katowice, Poland
*
Author to whom correspondence should be addressed.
Coatings 2022, 12(8), 1164; https://doi.org/10.3390/coatings12081164
Submission received: 15 July 2022 / Revised: 5 August 2022 / Accepted: 9 August 2022 / Published: 12 August 2022
(This article belongs to the Special Issue Advances and Innovations in Dental Materials and Coatings)
Browse Figures
Review Reports Versions Notes

Abstract

:
Orders to cover the mouth and nose were introduced as a prophylaxis for COVID-19. The use of face masks, apart from their benefits, has some side effects. It can affect, among other things, the oral cavity mucosa, manifested by its dryness, and can increase the amount of inflammatory markers, for example, nitric oxide (NO). The aim of this research was to determine changes in the oral cavity mucosal surface under the influence of the use of protective face masks based on an innovative measurement of NO levels in the exhaled air of healthcare workers. The people taking part in this study were dental assistants and recorders who used masks during work. The first measurement of NO was carried out before starting work and putting on a mask, and the second measurement was carried out after work. Based on the research, a statistically significant difference was shown in the NO values before putting on a mask and immediately after removing it. Despite the advantages of wearing protective masks, studies have shown that their long-term use has an impact on the oral cavity mucosa, which is reflected in the higher level of NO in exhaled air.

1. Introduction

The outbreak of the epidemic caused by SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), causing an acute syndrome of pneumonia, prompted researchers from many countries to undertake intensive research into the diagnosis, pathogenesis, and transmission routes of this virus. SARS-CoV-2 is a highly infectious single-stranded RNA coronavirus and has the largest genome of any RNA virus [1,2,3,4]. Coronaviruses cause common respiratory, digestive, and nervous system diseases. The severity of the disease itself or its complications often threatens human health as a result of mild infections in the upper or lower respiratory tract. People have no immunity to such viruses. Subsequently, these mutations can quickly cause another disease outbreak and, consequently, a pandemic [5,6,7,8].
The disease caused by SARS-CoV-2, called COVID-19, is transmitted by airborne droplets, through the respiratory tract, through direct contact, and possibly via the fecal–oral route. Most often, however, the virus is transmitted by airborne droplets when an person who has been infected coughs or sneezes, as does the spread of the flu and other respiratory pathogens. These droplets can end up on the mucosa of the mouth, nose, and eyes of people nearby, or they can be inhaled. It is also possible to become infected with COVID-19 by touching a surface or object containing the virus and then transferring it to the mucosa of your mouth, nose, or eyes [9,10,11,12,13]. There is a big spectrum of clinical symptoms in the course of a COVID-19 infection. According to epidemiologists, frequent hand washing, social distancing, and wearing masks are three basic behaviors that effectively contribute to reducing transmissions of the coronavirus in society. The best way to prevent the disease is to limit exposure to infectious agents. Orders to cover the mouth and nose in public spaces were introduced as one of the preventive measures for limiting the spread of the SARS-CoV-2 virus. Face masks that protect the face are considered personal protective equipment (PPE); turned out to be the most popular tool for protection against infections; and can also be used for source control, which refers to blocking droplets ejected by the wearer [14]. However, the effectiveness of wearing face masks for preventing respiratory infections during epidemics has often been questioned. At the time when the COVID-19 pandemic started to pose a global threat, the World Health Organization (WHO) did not recommend wearing face masks for healthy people in the community as a method of preventing infections [15]. However, as the pandemic progressed, more and more agencies and governments recommended the use of masks in public spaces [16].
To be effective, face masks must cover both the nose and mouth and should fit as close to the face as possible [17]. Avoiding touching the outer surface of the mask, and washing or disinfecting your hands after each accidental touch were also recommended. Under no circumstances should wet masks be used; they should then be replaced with new ones. After removal, disposable masks should be treated as contaminated material and disposed of immediately, and then hands should be washed or disinfected [18,19]. Protective masks are classified according to the degree of filtering and shape. For protection of the respiratory tract, in accordance with the PN-EN 149 standard, half-masks can be distinguished by three classes: FFP1 (the lowest level of protection), FFP2 (medium efficiency), and FFP3 (high efficiency). They differ by the limit of maximum internal leakage (i.e., leaks resulting from incomplete adhesion of the mask to the skin and the passage of air through the exhalation valve). Except for surgical masks and several types of half-masks, material masks fulfill their protective and antiviral functions. The most popular are cotton masks that you can buy or make yourself [1].
However, the use of conventional face masks, apart from their obvious benefits, has some side effects. These side effects result from possible pressure on the face; limited communication possibilities; microclimate parameters under the mask; and above all, the need to overcome additional resistance during the inhalation because the exhaled air first fills the inside of the mask and then escapes to the environment through the coatings of the mask or the exhalation valve. Moreover, it can damage the natural skin barrier and induce new reactions or exacerbate preexisting skin problems such as acne, rosacea, seborrheic or atopic dermatitis, and skin surface dryness [20,21]. As a consequence of all these factors, face masks may have a negative impact on the oral cavity mucosal surface. The presence of mask coatings makes patients breathe not through the nose but through the mouth. This way of breathing changes the surface of the mucosa in the oral cavity, which becomes excessively dry. The dryness could contribute to most of the problems that arise with the hard tissues of the teeth and oral mucosa. A proper level of moisture in the mouth and on the surface of the gingiva is extremely important. Saliva is a natural way to remove food remnants from their surface. In addition, it neutralizes the effects of acids, supports the remineralization of enamel, and restores the correct pH [22]. The inflammation process may develop both on the skin surface and within the oral mucosal surface. Inflammatory clinical and histopathological symptoms are connected to an increase in inflammatory markers, and one of them is NO. In a diagnosis of general diseases, tests with NO levels are commonly used, but determining the concentration of NO is still rare. The interest in the concentration of NO in exhaled air is growing, and there are more and more reports on its role in the diagnosis and monitoring of inflammation [23].
NO is produced by nitric oxide synthase (NOS) as a result of the oxidation of L-arginine to L-citrulline and NO [24]. NO is a molecule that participates in pathological and physiological reactions. The function of NO depends on its concentration, site of production, and relationships with other molecules [25]. NO can react with oxygen to produce the NO2 radical, which consequently produces nitrites. In the subsequent reactions, the hydroxyl radical and nitrogen dioxide are formed [26]. NO is synthesized in the body by three forms of nitric oxide synthase (NOS): two constitutive—neuronal (nNOS—NOS I) and endothelial (eNOS—NOS III), stimulated by calmodulin—and one induced (iNOS—NOS II), stimulated by cytokines and lipopolysaccharides. NO deficiency occurs in many diseases. Septic shock is a completely different state of affairs. The iNOS is then overexpressed, which is not beneficial for the body. In such states, NO has a toxic effect at the cellular level, leading to organ damage [27,28,29,30].
There are several methods of measuring NO in exhaled air, e.g., colorimetry, chemiluminescence, fluorescence, electrochemical detection, chromatography, electron spin resonance spectroscopy (ESR), and magnetic resonance imaging (MRI). Portable measuring devices use chemiluminescence, electrochemical, and laser methods (Figure 1). Exhaled NO is a precise index of inflammation, responsive to healing, or deterioration of the illness. According to the literature, an increased NO concentration is very well related to other inflammation markers; therefore, it is reasonable to measure NO levels to monitor the effects of wearing masks in the COVID-19 era [31,32].
The oral cavity mucosal surface undergoes modifications, especially dryness of its surface under the influence of various external and internal factors. One of the extracorporeal factors is the use of face masks by medical professionals. Healthcare workers wear face masks during their working hours, during the COVID-19 pandemic, and also after work. The COVID-19 pandemic increased the need for research into this topic. There is a great need to expand the literature on this disease and on its symptoms, treatment, prevention, and side effects. Our own observations and the sparse literature on this topic encouraged the authors to conduct this study.

2. Aim of the Study

The aim of the research was to conduct a pilot study on state changes in the oral cavity mucosal surface under the influence of wearing protective face masks and to check if the NO concentration changes using an innovative measurement of NO level in the exhaled air of healthcare workers.

3. Materials and Methods

3.1. Clinical Materials and Methods

This study included one group of 49 healthcare workers, in the age range 31–57, who were working in medical practices. Participants qualified for the study by filling out a questionnaire asking about general health and by undergoing a standard dental examination conducted by a dental practitioner. Healthy people who did not take any drugs permanently, were vaccinated against COVID-19 but had a negative history of developing COVID-19, did not smoke, did not have signs of oral inflammation, and did not use any prosthetic restorations were enrolled in the study. Oral hygiene was evaluated also with a standard dental examination. In the case of poor hygiene, participants were eliminated from the research. The people who participated in the study were dental assistants, nurses, and workers of registration at the dentist’s office who, due to the guidelines in the COVID-19 era, used the same brand of FFP2 masks during an 8-hour work day. The use of a mask was interrupted for two short breaks, including one for lunch for all the participants. All participants signed informed consent and agreed to participate in the study. The NO concentration in exhaled air was determined twice. The first NO determination was carried out in the morning on an empty stomach before applying the mask and served as a control measurement. The second measurement was carried out after 8 hours of work, after removing the mask (at least 1.5 hours after the last meal). The NO concentration was tested with the Vivatmo pro (Bosch, Waiblingen, Germany). The procedure to obtain the measurements is easy to employ, and the test results were received immediately. The device had a special strainer that removes the NO in the atmosphere. Each measurement was checked according to the isoline level to ensure correct and repeatable measurements. The patient was handed a single-use mouthpiece for the procedure [33]. The device does not use any difficult calibration processes or expensive overviews. The data could be managed directly through a touch screen. The results were provided in parts per billion (ppb; the number of NO particles in one billion gas particles, i.e., 1 ppb is equal to 1 nL/L) [31].
The study’s limitations were the inclusion of patients in this research. Only healthy participants with no pathologies in their oral cavities qualified for this study. In this research, a comparison had to be made only between healthy people because any general diseases or any pathology in the oral cavity could affect the levels of NO in exhaled air. Changes in NO concentration had to be checked only under the influence of wearing protective face masks [31].

3.2. Statistical Analysis

In the statistical analysis performed, the results of NO measurements obtained for forty-nine people before and immediately after the FFP2 mask was put on were considered. Therefore, two dependent samples with the N = 49 each were available. The non-parametric Wilcoxon test was used to test the equality of distributions (null hypothesis). The alternative hypothesis, on the other hand, contradicts the null hypothesis. The level of significance in the studies was 0.05. The basic measures of descriptive statistics were also calculated (Table 1.).

4. Results

In the clinical study conducted, the level of NO in exhaled air was determined in healthcare workers. The measurement carried out twice showed an increase in NO levels in exhaled air after eight hours of using a mask. The mean level of NO in exhaled air before using the mask was 14.5 ppb. The level of NO in exhaled air after eight hours of wearing a mask was 16.5 ppb (Table 1). Table 2 shows the results of the Wilcoxon test for two paired trials. The number N changed. It decreased (N = 42) compared to the initial N = 49 because, for 7 people, the level of NO was the same before putting on the mask and immediately after removing it. The p-value obtained, 0.000422 (Table 2), is less than the significance level of 0.05, which allows for a rejection of the null hypothesis at the level of significance adopted and for the conclusion that there is a statistically significant difference in the condition of the oral cavity according to the distribution of NO values before putting on the mask and immediately after removing it (Figure 2). Both the arithmetic mean value and the median value are higher for the second exhaled NO measurement. Additionally, the minimum and maximum values are larger in the case of the second measurement. Meanwhile, standard deviations (SD) have similar values. Based on the statistical analysis, it can be concluded that eight-hour use of a mask statistically significantly changes the oral cavity environment, which is confirmed in the increase in the NO level. Besides conducting the NO concentration statistical analysis, the patients’ subjective opinions were taken after 8 hours of wearing face masks. Of the 49 patients, 38 (77.6% of all participants) reported a subjective feeling of dry mouth after long-term use of protective face masks.

5. Discussion

The use of a face mask, in addition to social distancing and disinfecting regularly, is the most important element in the prophylaxis of the SARS-CoV-2 virus. By using masks in a public space, the people who use the mask and those in their immediate vicinity are protected. However, while protecting one’s health is undoubtedly very necessary, wearing a mask for several hours a day can decrease a person’s quality of life and can lead to adverse effects on the skin of the face and oral mucosa [34].
Elisheva Rosner et al. conducted research on the side effects of long-term mask use among healthcare workers during COVID-19. Prolonged use of N95 and surgical masks by healthcare workers during COVID-19 caused headaches, rashes, acne, and skin problems [35]. Chris C. I. Foo et al. conducted research about pathological skin reactions to PPE against acute respiratory syndrome. The use of PPE relates to high rates of pathological skin reactions [36]. Kaihui Hu et al. investigated abnormal skin manifestations in healthcare workers using PPE for COVID-19. The most common adverse effects of using masks included symptoms such as itching and rash [37]. Teresa Makowiec-Dąbrowska et al. composed a review of the literature about the physiological cost of wearing protective masks. She described different physiological reactions depending on the type of mask and the impact of air composition, temperature, and humidity under the mask. An analysis of the studies presented showed that masks—regardless of their type—can cause more frequent negative bodily reactions, causing both physical and mental discomfort. Wearing masks can also cause more frequent headaches, symptoms of fatigue, or feelings of discomfort [38]. Jonathan J.Y. Ong et al. determined the risk factors associated with PPE headaches and COVID-19, and their influence on personal health and work. Their study was conducted among healthcare workers in hospitals during COVID-19. All participants filled out a questionnaire. Most healthcare workers developed headaches or experienced aggravation in their pre-existing headache disorders after the use of a new PPE [39]. Y. Li et al. investigated the side effects of using N95 and surgical facemasks on heart rate, thermal stress, and subjective sensations. The respondents had lower average heart rates while using nano-treated and untreated facemasks in comparison to using nano-treated and untreated N95 facemasks. The microclimate and skin temperatures inside the facemasks were significantly lower than those in N95 facemasks. Surgical facemasks were worse for a sense of humidity, heat, breath resistance, and general discomfort [40]. Philipp Kanzow et al. analyzed the disadvantages of using face masks for dry mouth and halitosis. The authors prepared a questionnaire for adult patients and hospital staff about the duration of daily use for different face masks (community masks, surgical/medical masks, and KN95/N95/FFP2 masks) and the sense of dry mouth and halitosis. The results revealed that wearing face masks increased the symptoms of dry mouth and halitosis [41]. Kai Kisielinski et al. conducted research on the negative side effects of wearing face masks. The aim of their study was researching adverse effects related to using masks. Their review of the literature reveals that both people who are healthy and sick can suffer from changes and symptoms, such as an increase in breathing dead space volume, an increase in breathing resistance, a decrease in blood oxygen saturation, an increase in blood pressure, a decrease in cardiopulmonary capacity, an increase in respiratory rate, and many skin complications [42,43,44,45].
The lack of literature reports on research on the NO level in exhaled air in patients wearing protective masks makes it difficult for the authors to discuss this matter. The literature reports an increase in the number of patients with the problem of so-called mask mouth due to the pandemic, that is, various types of ailments within the oral cavity environment resulting from long-term use of protective masks [46]. First, there is an increased risk of caries, gingivitis, oral mucosa, and bad breath. According to many authors, this type of problem may now occur in every second patient who goes for a routine visit to a dental office [47]. Due to the presence of the mask, people who wear it have a natural tendency to breathe through the mouth. Then, dry mouth increases, which in turn promotes changes in the bacterial flora and the multiplication of pathogens responsible for, e.g., diseases of the teeth or gums. If the mouth is dry for too long, it also promotes gingivitis, which is one of the factors that predispose patients to periodontopathy. Long-term and improper use of a mask can also result in bad breath due to excessive amounts of bacteria in the mouth. Bad breath is mainly caused by anaerobic bacteria, which produce volatile sulfur compounds (VSC), for example, methyl mercaptan, hydrogen sulfide, or methyl sulfide. The specific smell appears after many hours of wearing the mask when the mouth begins to dry out. Changing eating habits related to the epidemic also does not help. When spending time at home, patients are more likely to have so-called guilty pleasures or snacks rich in simple sugars. This serves as a haven for bacteria responsible for bad breath and caries [48,49,50,51]. Physicians recently found that a new type of irritant, rhinitis, is connected to N95 mask use. Endoscopic examination and nasal irrigations on mask wearers were performed and revealed pathologies. Clinical problems have been reported in questionnaires. They found proof of mask-induced rhinitis, itching, and swelling of the mucous membranes. Endoscopic examination presented an increased secretion and evidence of inhaled mask polypropylene fibers [52].
The use of NO levels in exhaled air as a diagnostic marker has not been the subject of research in the field of dentistry so far. The literature reports increased NO concentrations in saliva, gingival pocket fluid, inflamed mucosa, and lesion tissue. Vanessa G.S. Reher et al. reported the increased presence of NO in saliva in patients with exacerbated chronic periodontitis. The NO concentration and the relationship between patients suffering from exacerbated chronic periodontitis and non-inflammatory persons were determined. The measurement of NO level in saliva was investigated with the Griess reaction. The Griess solution reacts with saliva; when NO is present in saliva, the mixture turns purple. The authors revealed in this study that the level of NO in saliva increases with an exacerbation of periodontitis. NO levels were lower in non-inflammatory subjects [53].
The increase in NO synthesis in cases of inflammation of the periodontal tissues was also demonstrated by AC. Batista et al. The researchers took samples of the mucosa with chronic periodontitis. The concentration of NO was statistically significantly higher in participants suffering inflammation [54]. Masaru Ohashi et al. conducted a study that recorded the level of NO in patients suffering from oral lichen planus (OLP) and recurrent aphthous ulceration (RAU). They revealed that OLP and RAU increased the NO level in the exhaled air. [55]. Similar to OLP or RAU, Behcet’s syndrome was studied by Mukadder Kocak et al. The authors presented a significantly higher level of NO in patients suffering from Behcet’s syndrome [56]. The research conducted showed that, among healthy patients, a large influx in the presence of the carious process, periodontitis, and the lack of oral hygiene increased the level of NO in exhaled air [57]. Such a relationship has also been demonstrated among generally healthy edentulous patients. The hygiene status of the prostheses and the mucosa of the prosthetic substrate significantly influenced the determination of the inflammation marker in air. Teeth with decay most significantly increased the level of NO in exhaled air. In the case of generally healthy patients with proper hygiene, the level of NO concentration was relatively low [57]. Wyszyńska et al. described a case of significantly elevated NO levels in a patient with advanced periimplantitis. After the elimination of inflammatory foci in the oral cavity and treatment, the level of NO in exhaled air became lower and a healthy oral cavity environment was gained [58]. The latest evidence-based reviews help to picture NO physiology and its participation in many important processes in the human body. In many physiological processes, NO plays an important part in human anatomical systems, and the level of NO increases in cases where inflammation is present [59].

6. Conclusions

Despite the overwhelming advantages of wearing protective face masks, studies have shown that their long-term use has an impact on the oral cavity mucosa, causing so-called mask mouth. Wearing a mask makes patients breathe through their mouth and consequently changes the surface of the mucosa in the oral cavity, which becomes excessively dry. The dryness is responsible for most of the problems that arise with the hard tissues of the teeth and oral mucosa, which was confirmed by high levels of the inflammatory marker NO in exhaled air.

Author Contributions

Conceptualization, M.W., A.C., E.B.-B. and M.S.-N.; Data curation, M.W., P.R. and J.R.-S.; Formal analysis, M.W., P.R., A.C., E.B.-B., O.G. and J.R.-S.; Methodology, M.W., P.R., A.C. and M.S.-N.; Resources, M.W., A.C., O.G., J.R.-S. and M.S.-N.; Visualization, M.W., A.C. and M.S.-N.; Writing—original draft, M.W. and A.C.; Writing—review & editing, M.W., A.C., J.K. and M.S.-N. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by Śląski Uniwersytet Medyczny w Katowicach, ul. Poniatowskiego 15, 40-055 Katowice, research number: PCN-1-204/N/9/0, PCN-1-016/N/1/K.

Institutional Review Board Statement

In The study was conducted with the prior approval from the Bioethics Committee of the Medical University of Silesia in Katowice, Poland, Resolution No PCN/0022/KB1/22/II/19/21, 18 May 2021.

Informed Consent Statement

Informed consent was obtained from all patients involved in the study.

Data Availability Statement

Data supporting our results are available for request from the cor-responding author.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Velavan, T.P.; Meyer, C.G. The COVID-19 epidemic. Trop. Med. Int. Health 2020, 25, 278–280. [Google Scholar] [CrossRef]
  2. Gorbalenya, A.E.; Baker, S.C.; Baric, R.S.; de Groot, R.J.; Drosten, C.; Gulyaeva, A.A.; Haagmans, B.L.; Lauber, C.; Leontovich, A.M.; Neuman, B.W.; et al. The species Severe acute respiratory syndrome-related coronavirus: Classifying 2019-nCoV and naming it SARS-CoV-2. Nat. Microbiol. 2020, 5, 536–544. [Google Scholar] [CrossRef]
  3. Lu, H.; Stratton, C.W.; Tang, Y.-W. Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracle. J. Med. Virol. 2020, 92, 401–402. [Google Scholar] [CrossRef]
  4. Zhou, F.; Yu, T.; Du, R.; Fan, G.; Liu, Y.; Liu, Z.; Xiang, J.; Wang, Y.; Song, B.; Gu, X.; et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet 2020, 395, 1054–1062. [Google Scholar] [CrossRef]
  5. Liu, W.; Tao, Z.-W.; Wang, L.; Yuan, M.-L.; Liu, K.; Zhou, L.; Wei, S.; Deng, Y.; Liu, J.; Liu, H.-G.; et al. Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease. Chin. Med. J. 2020, 133, 1032–1038. [Google Scholar] [CrossRef] [PubMed]
  6. Guan, W.; Ni, Z.; Hu, Y.; Liang, W.; Ou, C.; He, J.; Liu, L.; Shan, H.; Lei, C.-l.; Hui, D.S.C.; et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N. Engl. J. Med. 2020, 382, 1708–1720. [Google Scholar] [CrossRef]
  7. Calmes, D.; Graff, S.; Maes, N.; Frix, A.-N.; Thys, M.; Bonhomme, O.; Berg, J.; Debruche, M.; Gester, F.; Henket, M.; et al. Asthma and COPD Are Not Risk Factors for ICU Stay and Death in Case of SARS-CoV2 Infection. J. Allergy Clin. Immunol. Pract. 2021, 9, 160–169. [Google Scholar] [CrossRef]
  8. Docherty, A.B.; Harrison, E.M.; Green, C.A.; Hardwick, H.E.; Pius, R.; Norman, L.; Holden, K.A.; Read, J.M.; Dondelinger, F.; Carson, G.; et al. Features of 20 133 UK patients in hospital with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol: Prospective observational cohort study. BMJ 2020, 369, m1985. [Google Scholar] [CrossRef]
  9. Chen, X.; Zhang, G.; Tang, Y.; Peng, Z.; Pan, H. The coronavirus diseases 2019 (COVID-19) pneumonia with spontaneous pneumothorax: A case report. BMC Infect. Dis. 2020, 20, 662. [Google Scholar] [CrossRef]
  10. Huang, Y.; Tan, C.; Wu, J.; Chen, M.; Wang, Z.; Luo, L.; Zhou, X.; Liu, X.; Huang, X.; Yuan, S.; et al. Impact of coronavirus disease 2019 on pulmonary function in early convalescence phase. Respir. Res. 2020, 21, 163. [Google Scholar] [CrossRef] [PubMed]
  11. Mo, X.; Jian, W.; Su, Z.; Chen, M.; Peng, H.; Peng, P.; Lei, C.; Chen, R.; Zhong, N.; Li, S. Abnormal pulmonary function in COVID-19 patients at time of hospital discharge. Eur. Respir. J. 2020, 55, 2001217. [Google Scholar] [CrossRef] [PubMed]
  12. Lerum, T.V.; Aaløkken, T.M.; Brønstad, E.; Aarli, B.; Ikdahl, E.; Lund, K.M.A.; Durheim, M.T.; Rodriguez, J.R.; Meltzer, C.; Tonby, K.; et al. Dyspnoea, lung function and CT findings 3 months after hospital admission for COVID-19. Eur. Respir. J. 2021, 57, 2003448. [Google Scholar] [CrossRef] [PubMed]
  13. Daher, A.; Balfanz, P.; Cornelissen, C.; Müller, A.; Bergs, I.; Marx, N.; Müller-Wieland, D.; Hartmann, B.; Dreher, M.; Müller, T. Follow up of patients with severe coronavirus disease 2019 (COVID-19): Pulmonary and extrapulmonary disease sequelae. Respir. Med. 2020, 174, 106197. [Google Scholar] [CrossRef] [PubMed]
  14. Howard, J.; Huang, A.; Li, Z.; Tufekci, Z.; Zdimal, V.; van der Westhuizen, H.-M.; von Delft, A.; Price, A.; Fridman, L.; Tang, L.-H.; et al. An evidence review of face masks against COVID-19. Proc. Natl. Acad. Sci. USA 2021, 118, e2014564118. [Google Scholar] [CrossRef] [PubMed]
  15. Smit, M.; Marinosci, A.; Agoritsas, T.; Calmy, A. Prophylaxis for COVID-19: A systematic review. Clin. Microbiol. Infect. 2021, 27, 532–537. [Google Scholar] [CrossRef]
  16. Hafeez, A.; Ahmad, S.; Siddqui, S.; Ahmad, M.; Mishra, S. A Review of COVID-19 (Coronavirus Disease-2019) Diagnosis, Treatments and Prevention. EJMO 2020, 4, 116–125. [Google Scholar]
  17. Otrisal, P.; Bungau, C.; Obsel, V.; Melicharik, Z.; Tont, G. Selected Respiratory Protective Devices: Respirators and Significance of Some Markings. Sustainability 2021, 13, 4988. [Google Scholar] [CrossRef]
  18. Singhal, T. A Review of Coronavirus Disease-2019 (COVID-19). Indian J. Pedi. 2020, 87, 281–286. [Google Scholar] [CrossRef]
  19. Center for Disease Control and Prevention, Coronavirus Disease 2019 (COVID-19). Available online: https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html (accessed on 21 July 2022).
  20. Bourouiba, L. Turbulent Gas Clouds and Respiratory Pathogen Emissions: Potential Implications for Reducing Transmission of COVID-19. JAMA 2020, 323, 1837–1838. [Google Scholar] [CrossRef]
  21. Leung, N.H.L.; Chu, D.K.W.; Shiu, E.Y.C.; Chan, K.-H.; McDevitt, J.J.; Hau, B.J.P.; Yen, H.-L.; Li, Y.; Ip, D.K.M.; Peiris, J.S.M.; et al. Respiratory virus shedding in exhaled breath and efficacy of face masks. Nat. Med. 2020, 26, 676–680. [Google Scholar] [CrossRef] [PubMed]
  22. Chia, S.E.; Koh, D.; Fones, C.; Qian, F.; Ng, V.; Tan, B.H.; Wong, K.S.; Chew, W.M.; Tang, H.K.; Ng, W.; et al. Appropriate use of personal protective equipment among healthcare workers in public sector hospitals and primary healthcare polyclinics during the SARS outbreak in Singapore. Occup. Environ. Med. 2005, 62, 473. [Google Scholar] [CrossRef]
  23. Sokołowska, M.; Włodek, L. Dobre i złe strony tlenku azotu. Folia Cardiol. 2001, 8, 467–474. [Google Scholar]
  24. Available online: https://ksiegarnia.pwn.pl/Druga-twarz-tlenu,68720454,p.html (accessed on 21 July 2022).
  25. Beckman, J. Biochemistry of Nitric Oxide and Peroxynitrite. Kubes P wyd. Nitric Oxide: A modulator of Cell–Cell Interactions in the Microcirculation; Landes Company: Austin, TX, USA, 1995; pp. 1–18. [Google Scholar]
  26. Moncada, S.; Higgs, A. The L-arginine-nitric oxide pathway. N. Engl. J. Med. 1993, 329, 2002–2012. [Google Scholar] [CrossRef] [PubMed]
  27. Kelm, M. Nitric oxide metabolism and breakdown. Biochem. Biophys. Acta 1999, 1411, 273–289. [Google Scholar] [CrossRef]
  28. Marsh, N.; Marsh, A. A short history of nitroglycerine and nitric oxide in pharmacology and physiology. Clin. Experimen. Pharmacol. Physiol. 2000, 27, 313–319. [Google Scholar] [CrossRef]
  29. Kasperski, J.; Wyszyńska, M.; Kustra, S.; Czecior, E.; Misiołek, M.; Kasperska-Zając, A. Letter to the Editor: Does Helicobacter Pylori infection increase the levels of exhaled nitric oxide? Eur. J. Inflamm. 2013, 11, 279–282. [Google Scholar] [CrossRef]
  30. Kumor, M.; Przybyłowski, T.; Maskey-Warzęchowska, M.; Hildebrand, K.; Fangrat, A.; Bielecki, P.; Górska, K.; Kościuch, J.; Kucińska, J.; Chazan, R. Powtarzalność pomiaru stężenia tlenku azotu w powietrzu wydechowym (FENO) przeprowadzonego z wykorzystaniem zestawu NIOX u zdrowych osób. Pneumonol. Alergol. 2004, 72, 283–289. [Google Scholar] [CrossRef]
  31. Korn, S.; Wilk, M.; Voigt, S.; Weber, S.; Keller, T.; Buhl, R. Measurement of Fractional Exhaled Nitric Oxide: Comparison of Three Different Analysers. Respiration 2020, 99, 1–8. [Google Scholar] [CrossRef]
  32. Schiller, B.; Hammer, J.; Barben, J.; Trachsel, D. Comparability of a hand-held nitric oxide analyser with online and offline chemiluminescence-based nitric oxide measurement. Pediatr. Allergy Immunol. 2009, 20, 679–685. [Google Scholar] [CrossRef]
  33. Amaral, R.; Jácome, C.; Almeida, R.; SáSousa, A.; Pinho, B.; Guedes, R.; Jacinto, T.; Fonseca, J. Reproducibility of the Vivatmo pro measurements for exhaled nitric oxide values. Eur. Respir. J. 2019, 54, PA3909. [Google Scholar] [CrossRef]
  34. Matuschek, C.; Moll, F.; Fangerau, H.; Fischer, J.C.; Zänker, K.; van Griensven, M.; Schneider, M.; Kindgen-Milles, D.; Knoefel, W.T.; Lichtenberg, A.; et al. Face masks: Benefits and risks during the COVID-19 crisis. Eur. J. Med. Res. 2020, 25, 32. [Google Scholar] [CrossRef]
  35. Rosner, E. Adverse Effects of Prolonged Mask Use among Healthcare Professionals during COVID-19. Rosner. J. Infect. Dis. Epidemiol. 2020, 6, 130. [Google Scholar] [CrossRef]
  36. Foo, C.C.I.; Goon, A.T.J.; Leow, Y.-H.; Goh, C.-L. Adverse skin reactions to personal protective equipment against severe acute respiratory syndrome—A descriptive study in Singapore. Contact Derm. 2006, 55, 291–294. [Google Scholar] [CrossRef] [PubMed]
  37. Hu, K.; Fan, J.; Li, X.; Gou, X.; Li, X.; Zhou, X. The adverse skin reactions of health care workers using personal protective equipment for COVID-19. Medicine 2020, 99, 24. [Google Scholar] [CrossRef] [PubMed]
  38. Makowiec-Dąbrowska, T.; Gadzicka, E.; Bortkiewicz, A. Physiological Cost Of Wearing Protective Masks—A Narrative Review Of The Literature. Med. Pracy 2021, 72, 569–589. [Google Scholar] [CrossRef]
  39. Ong, J.; Bharatendu, C.; Goh, Y.; Tang, J.; Sooi, K.; Tan, Y.L.; Tan, B.; Teoh, H.L.; Ong, S.T.; Allen, D.M.; et al. Headaches Associated With Personal Protective Equipment—A Cross-Sectional Study Among Frontline Healthcare Workers During COVID-19. Headache 2020, 60, 864–877. [Google Scholar] [CrossRef] [PubMed]
  40. Li, Y.; Tokura, H.; Guo, Y.P.; Wong, A.S.W.; Wong, T.; Chung, J.; Newton, E. Effects of wearing N95 and surgical facemasks on heart rate, thermal stress and subjective sensations. Int. Arch. Occup. Environ. Health 2005, 78, 501–509. [Google Scholar] [CrossRef]
  41. Kanzow, P.; Dylla, V.; Malina Mahler, A.; Hrasky, V.; Rödig, T.; Barre, F.; Scheithauer, S.; Wiegand, A. COVID-19 Pandemic: Effect of Different Face Masks on Self-Perceived Dry Mouth and Halitosis. Int. J. Environ. Res. Public Health 2021, 18, 9180. [Google Scholar] [CrossRef]
  42. Kisielinski, K.; Giboni, P.; Prescher, A.; Klosterhalfen, B.; Graessel, D.; Funken, S.; Kempski, O.; Hirsch, O. Is a mask that covers the mouth and nose free from undesirable side effects in everyday use and free of potential hazards? Int. J. Environ. Res. Public Health 2021, 18, 4344. [Google Scholar] [CrossRef]
  43. Johnson, A.T.; Scott, W.H.; Lausted, C.G.; Coyne, K.M.; Sahota, M.S.; Johnson, M.M. Effect of External Dead Volume on Performance While Wearing a Respirator. AIHAJ-Am. Ind. Hyg. Assoc. 2000, 61, 678–684. [Google Scholar] [CrossRef]
  44. Fikenzer, S.; Uhe, T.; Lavall, D.; Rudolph, U.; Falz, R.; Busse, M.; Hepp, P.; Laufs, U. Effects of Surgical and FFP2/N95 Face Masks on Cardiopulmonary Exercise Capacity. Clin. Res. Cardiol. 2020, 109, 1522–1530. [Google Scholar] [CrossRef] [PubMed]
  45. Lee, H.P.; Wang, D.Y. Objective Assessment of Increase in Breathing Resistance of N95 Respirators on Human Subjects. Ann. Occup. Hyg. 2011, 55, 917–921. [Google Scholar] [PubMed]
  46. Roberge, R.; Bayer, E.; Powell, J.; Coca, A.; Roberge, M.; Benson, S. Effect of Exhaled Moisture on Breathing Resistance of N95 Filtering Facepiece Respirators. Ann. Occup. Hyg. 2010, 54, 671–677. [Google Scholar]
  47. Achanta, S.; Sasidharan, S.; Majji, D.; Uppala, D. “Mask Mouth” During COVID-19 Pandemic—A Myth or A Truth. Int. J. Med. Dent. Res. 2021, 1, 56–63. [Google Scholar]
  48. Muley, P. ‘Mask Mouth’—A Novel Threat to Oral Health in the COVID Era–Dr Pooja Muley. Dent. Trib. South Asia 2020. Available online: https://in.dental-tribune.com/news/mask-mouth-a-novel-threat-to-oral-health-in-the-covid-era/ (accessed on 12 November 2020).
  49. Liu, C.; Li, G.; He, Y.; Zhang, Z.; Ding, Y. Effects of Wearing Masks on Human Health and Comfort during the COVID-19 Pandemic. IOP Conf. Ser. Earth Environ. Sci. 2020, 531, 012034. [Google Scholar]
  50. Jamjoom, A.; Nikkar-Esfahani, A.; Fitzgerald, J. Operating Theatre Related Syncope in Medical Students: A Cross Sectional Study. BMC Med. Educ. 2009, 9, 14. [Google Scholar] [CrossRef]
  51. Liu, Z.; Chang, Y.; Chu, W.; Yan, M.; Mao, Y.; Zhu, Z.; Wu, H.; Zhao, J.; Dai, K.; Li, H.; et al. Surgical Masks as Source of Bacterial Contamination during Operative Procedures. J. Orthop. Transl. 2018, 14, 57–62. [Google Scholar]
  52. Klimek, L.; Huppertz, T.; Alali, A.; Spielhaupter, M.; Hörmann, K.; Matthias, C.; Hagemann, J. A New Form of Irritant Rhinitis to Filtering Facepiece Particle (FFP) Masks (FFP2/N95/KN95 Respirators) during COVID-19 Pandemic. World Allergy Organ. J. 2020, 13, 100474. [Google Scholar] [CrossRef]
  53. Reher, V.G.S.; Zenobio, E.G.; Costa, F.O.; Reher, P.; Soares, R.V. Nitric oxide levels in saliva increase with severity of chronic periodontitis. J. Oral Sci. 2007, 49, 271–276. [Google Scholar] [CrossRef] [PubMed]
  54. Batista, A.C.; Silva, T.A.; Chun, J.H.; Lara, V.S. Nitric oxide synthesis and severity of human periodontal disease. Oral Dis. 2002, 8, 254–260. [Google Scholar] [CrossRef] [PubMed]
  55. Ohashi, M.; Iwase, M.; Nagumo, M. Elevated production of salivary nitric oxide in oral mucosal diseases. J. Oral Pathol. Med. 1999, 28, 355–359. [Google Scholar] [CrossRef] [PubMed]
  56. Kocak, M.; Erbas, D.; Karabulut, A.A.; Ozturk, G.; Eksioglu, M. Behcet’s disease and nitric oxide production. Int. J. Dermatol. 2003, 42, 244–248. [Google Scholar] [CrossRef]
  57. Wyszyńska, M.; Czelakowska, A.; Rafał, R.; Zajac, M.; Mielnik, M.; Kasperski, J.; Skucha-Nowak, M. Measurement of the Level of Nitric Oxide in Exhaled Air in Patients Using Acrylic Complete Dentures and with Oral Pathologies. Coatings 2021, 11, 169. [Google Scholar] [CrossRef]
  58. Wyszyńska, M.; Rosak, P.; Czelakowska, A.; Białożyt-Bujak, E.; Kasperski, J.; Łopaciński, M.; Al Khatib, N.; Małgorzata Skucha-Nowak, M. Pilot Study of Use of Nitric Oxide in Monitoring Multiple Dental Foci in Oral Cavity—A Case Report. Healthcare 2022, 10, 195. [Google Scholar] [CrossRef]
  59. Wyszyńska, M.; Nitsze-Wierzba, M.; Czelakowska, A.; Kasperski, J.; Żywiec, J.; Skucha-Nowak, M. An Evidence-Based Review of Application Devices for Nitric Oxide Concentration Determination from Exhaled Air in the Diagnosis of Inflammation and Treatment Monitoring. Molecules 2022, 27, 4279. [Google Scholar] [CrossRef]
Coatings 12 01164 g001 550
Figure 1. Methods of NO indication in exhaled air: (A) electrochemistry, (B) chemiluminescence, and (C) laser technology.
Figure 1. Methods of NO indication in exhaled air: (A) electrochemistry, (B) chemiluminescence, and (C) laser technology.
Coatings 12 01164 g001
Coatings 12 01164 g002 550
Figure 2. Statistically significant difference in the distributions of NO values before putting on the mask and immediately after removing it.
Figure 2. Statistically significant difference in the distributions of NO values before putting on the mask and immediately after removing it.
Coatings 12 01164 g002
Table
Table 1. Basic measures of descriptive statistics.
Table 1. Basic measures of descriptive statistics.
NArithmetic AverageMedianMinimumMaximumStandard Deviation
First measurement of exhaled NO *4914.514.07.038.05.8
Second measurement of exhaled NO **4916.516.08.041.05.3
* Level of NO in exhaled air before using the mask for 8 h. ** Level of NO in exhaled air after using the mask for 8 h.
Table
Table 2. Wilcoxon test results for two paired samples.
Table 2. Wilcoxon test results for two paired samples.
Np-Value
Difference between first and second measurements of exhaled NO420.000422
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Share and Cite

MDPI and ACS Style

Wyszyńska, M.; Czelakowska, A.; Rosak, P.; Białożyt-Bujak, E.; Gruca, O.; Rosak-Szyrocka, J.; Kasperski, J.; Skucha-Nowak, M. Changes in the Oral Cavity Mucosal Surface under the Influence of Wearing Protective Face Masks—Nitric Oxide Concentration Analysis—Preliminary Report. Coatings 2022, 12, 1164. https://doi.org/10.3390/coatings12081164

AMA Style

Wyszyńska M, Czelakowska A, Rosak P, Białożyt-Bujak E, Gruca O, Rosak-Szyrocka J, Kasperski J, Skucha-Nowak M. Changes in the Oral Cavity Mucosal Surface under the Influence of Wearing Protective Face Masks—Nitric Oxide Concentration Analysis—Preliminary Report. Coatings. 2022; 12(8):1164. https://doi.org/10.3390/coatings12081164

Chicago/Turabian Style

Wyszyńska, Magdalena, Aleksandra Czelakowska, Przemysław Rosak, Ewa Białożyt-Bujak, Olaf Gruca, Joanna Rosak-Szyrocka, Jacek Kasperski, and Małgorzata Skucha-Nowak. 2022. "Changes in the Oral Cavity Mucosal Surface under the Influence of Wearing Protective Face Masks—Nitric Oxide Concentration Analysis—Preliminary Report" Coatings 12, no. 8: 1164. https://doi.org/10.3390/coatings12081164

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop