JIDAM
ORIGINAL ARTICLE
eISSN 2582 - 0559
“An Official Journal of IDA - Madras Branch”©2019.
Available online
KNOWLEDGE AND PRACTICES ABOUT
MOUTH MASKS AMONG DENTAL STUDENTS
IN CHENNAI CITY - A CROSS SECTIONAL
DESCRIPTIVE STUDY
Dr.Vinita Mary. A, Dr. Kesavan.R , Teenu Lakshmi. V, Thamilazhagi. S, Vaishnavi. K
Department of Public Health Dentistry,
Thai Moogambigai Dental College and Hospital, Chennai, Tamilnadu, India.
ABSTRACT
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BACKGROUND: A surgical facemask plays an important role
Website: jidam.idamadras.com
in every procedure among dental health care professionals. It acts as
a barrier to prevent transmission of pathogens, infected water aerosols
and many microorganisms produced in the dental setup. In order to
minimize the risk of infection, dental practitioner and clinical auxiliary
staff must wear suitable fluid resistance mask. This study was conducted
to check the knowledge, attitude and awareness of mouth mask among
dental professionals.
MATERIALS AND METHODS: A cross sectional study was
conducted between July-Sep 2019 among the postgraduates, interns,
undergraduates (3rd and 4th year) of two randomly selected private
dental colleges in Chennai. A pilot study was conducted to evaluate their
understanding of the questions. Set of 25 closed questioners were given
to the participants as a survey form. Data was collected and statistical
analysis was done using SPSS.
Address for correspondence:
RESULTS: It was observed that 57.5% (195) had answered correctly
that mouth mask should be used with white side facing in; 52.2%
Dr. A. Vinita Mary, MDS,
(177) had answered correctly that masks have three layers; 26.8% had
Professor,
answered correctly that masks can be used for maximum of 8 hours;
66.7% agreed that wearing mouth masks decreased post-operative
Department of Public Health
wound infections and these findings were statistically significant. When
Dentistry,
it was asked which layer acts as a filter media barrier, 64.3% (218)
Thai Moogambigai Dental College
had answered correctly i.e. middle. When it was asked what type of
and Hospital
mask they preferred in dental setting, only 30.1% (102) had answered
Chennai, Tamilnadu, India
correctly as 95% BFE and PFE.
E-mail: viniebe@gmail.com
CONCLUSION: The risk of health care associated
infections and its transmission not only involved the people
who are in direct contact with the patients but also those who
work in such environment. Thus, it is necessary to improve
awareness among dental professionals regarding its proper usage.
Received
: 28.10.2019
KEYWORDS: Mouth mask, infection control, survey, dental
Accepted
: 18.11.2019
professionals, pathogens.
Published
: 27.12.2019
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JIDAM/Volume:6/Issue:4/Pages 117 - 124/October - December 2019
Vinita et al: Knowledge and practices about mouth masks among dental students
INTRODUCTION:
evidence will provide educational interventions to
improve the attitude and practices among DHCPs.
In dentistry, there is constant exposure to
various blood borne and upper respiratory pathogens
MATERIALS AND METHODS:
through blood, saliva and various other body fluids.
Microorganisms can easily spread in closed spaces
A descriptive cross-sectional study was
such as dental operatories, where every procedure
conducted between July-Sep
2019 among the
performed in the oral cavity of a patient contaminates
undergraduates
(3rd and
4th year), interns and
not only the instruments used in the treatment but
postgraduate students of two randomly selected private
also the hands of the dentist, objects and surfaces of
dental colleges in Chennai. All the study subjects
the dental unit. The main route for infection is by
present on the day of data collection were included
aerosols and splatter production, which are produced
in the study. Those who were absent on that day were
by use of airotors, micromotor hand pieces, air
excluded from the study. Initially the questionnaire
water syringes, and ultrasonic scalers. It can also be
was distributed to a group of ten dental students as
transmitted indirectly either through contaminated
a pilot study to evaluate their understanding of the
needle stick injury or improper handling and contact
questions. After student’s feedback, amendments
with unsterilized instruments. Exposure to blood
were made to the questionnaire. The students were
borne pathogens can be from patients suffering from
approached after obtaining the necessary permission
HIV (Human immune deficiency virus), hepatitis B,
from the head of the institution. The nature and
hepatitis C, HSV (Herpes simplex virus), tuberculosis,
purpose of the study was explained to them and
SARS (Severe acute respiratory syndrome), type
informed written consent was obtained prior to
I and II streptococcus, staphylococcus and other
the inception of the study. All the participants in
infectious agents1,2.
the study completed a paper-based questionnaire
consisting of 25 closed ended questions. First part of
The guidelines related to infection control
the questionnaire consisted of demographic details of
measures in dental set up have been regularly
the subject, their academic year and specialization (if
updated and latest was made available by the Centers
any). The second part of the questionnaire assessed
of Disease Control (CDC) in March 2016. According
their knowledge and awareness about mouth mask.
to these guiding principles of CDC, it is mandatory
The information obtained during the data collection
to wear face masks, eyewear, gloves, properly
was strictly kept confidential.
disinfected clothes as well as use adequate high-
speed suction while using high and low speed rotary
Data was collected and statistical analysis
instruments2.
was done using SPSS. Descriptive statistics with
frequency, percentage, means and standard deviation
In order to minimize the risk, dental operating
was computed.
personnel are required to follow accepted infection
control practices. One of the infection control
RESULTS:
measure is the routine use of face masks. Therefore,
dental practitioners and clinical auxiliary staff must
The age of participants ranged from 20 to
wear suitable fluid resistant mask that block particles
30 years with the mean value of 22.79±1.84. One
of 3 microns or less in size. Most masks feature pleats/
twenty-seven participants (37.5%) were male and two
folds, commonly three pleats are used allowing the
hundred and twelve participants (62.5) were female.
user to expand the mask, so that it covers from nose
46 participants (13.6%) were 3rd year students, 100
to chin. However, there is evidence which shows that
participants
(29.5%) were 4th year students,
132
the DHCPs (Dental Health Care Professionals) have
participants (38.9%) were interns and 61 participants
an inadequate knowledge, negative attitude and poor
(18.1%) were the postgraduate students.
practice regarding the infection control measures3.
The purpose of this study was to investigate
knowledge and awareness about mouth mask
among faculty members, postgraduates, interns and
undergraduates (III and IV year) students. The new
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JIDAM/Volume:6/Issue:4/Pages 117 - 124/October - December 2019
Vinita et al: Knowledge and practices about mouth masks among dental students
Table 1: Knowledge and Practices regarding mouth mask use among study participants
Question
Options
Frequency
%
p value
Which is the correct way of
White side facing out
144
42.5
White side facing in
195
57.5
0.006*
using mouth mask by a dentist
How many layers are there in
Two
87
25.7
Three
177
52.2
a mask
Four
45
13.3
0.000*
Don’t know
30
8.8
Which layer acts as filter media
First layer
75
22.1
Middle layer
218
64.3
0.000*
barrier
Last layer
46
13.6
What type of mask is preferred
95%Bacterial Filtration Efficiency
102
30.1
in dental setting
(BFE)and Particulate Filtration
Efficiency(PFE)
97%BFE and PFE
124
36.6
0.000*
91%BFE and PFE
63
18.6
99%BFE and PFE
50
14.7
How long can you wear a
Maximum 8hr
91
26.8
Maximum 4hr
163
48.1
surgical mask
Maximum 2hr
60
17.7
0.000*
Maximum 1hr
25
7.4
Do you think surgical
Yes
181
53.4
No
158
46.6
0.212
facemasks used in dentistry are
certified respirators
Which level of mask you
Level 1 mask
131
38.6
Level 2 mask
164
48.4
0.000*
should wear during hand
Level 3 mask
44
13
instrumentation
Which level of mask you
Level 1 mask
79
23.3
Level 2 mask
164
48.4
0.000*
should wear while exposing
Level 3 mask
96
28.3
radiographs
Which level of mask you
Level 1 mask
53
23.3
Level 2 mask
137
48.4
0.000*
should wear during ultrasonic
Level 3 mask
149
28.3
scaling
Level 3 mask should be used
Sealants
38
11.2
Surgical procedures
236
69.6
0.000*
for
Brief examination
65
19.2
Do you think wearing surgical
Yes
226
66.7
0.000*
No
113
33.3
mask decreases post-operative
wound infections
How much are you concerned
Not concerned
60
17.7
Somewhat concerned
152
44.8
0.000*
about contact infections during
Very concerned
127
37.5
treatment
Are you aware of contact
Yes
199
58.7
No
140
41.3
0.001*
dermatitis caused by surgical
mask
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Vinita et al: Knowledge and practices about mouth masks among dental students
During which procedure you
During examination
95
58.7
On exposing radiographs
147
41.3
0.000*
do not like to wear mouth
Impression making
75
22.1
mask
Any other (please
22
6.5
mention)_________________
Which type of mask do you
Disposable with rubber bands
171
50.4
Disposable with long ties
154
45.4
0.000*
prefer
Washable or reusable
14
4.1
Do you prefer wearing mouth
Yes
182
53.7
No
157
46.3
0.175
mask in public places
Do you feel comfortable
Yes
136
40.1
No
203
59.9
0.000*
wearing mouth mask for long
hours
Do you prefer changing your
Yes
209
61.7
No
130
38.3
0.000*
mouth mask for every patient
Do you prefer wearing colorful
Yes
227
67
0.000*
No
112
33
masks for attracting pediatric
patients
During dental procedure, if
Yes, I will remove and change my
90
26.5
there is a need to talk to the
mask
Yes, I will remove but I will not
178
52.5
0.000*
patient, will you remove your
change my mask
mask
No, I will not remove my mask
71
20.9
Do you feel difficulty in
Yes
196
57.8
0.004*
No
143
42.2
breathing while wearing a
mouth mask
Do you immediately dispose
Yes
119
35.1
No, after an hour
120
35.4
0.325
your mask after completing the
No, at the end of the day
100
29.5
treatment
In which color bag will you
Red plastic bag
62
18.3
Yellow plastic bag
174
51.3
0.000*
dispose your mask
Blue plastic bag
66
19.5
Black plastic bag
37
10.9
For how long do you wear a
Maximum 1 hour
107
31.6
Maximum 2 hours
167
49.3
0.000*
mask
More than 2 hours
65
19.2
To which extent of your nose
1/3 of your nose
73
21.5
2/3 of your nose
164
48.4
0.000*
do you wear the mouth mask
Covering the full nose
91
26.8
I don’t cover my nose at all
11
3.2
* Highly Significant
Pearson’s Chi-Square Test
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Vinita et al: Knowledge and practices about mouth masks among dental students
When the study population was asked about
preferred washable or reusable.
the right way of using mouth mask, 57.5% (195) had
answered correctly i.e. white side facing in and it was
When it was asked, do they prefer wearing
significant statistically (p=0.006). When it was asked
mouth masks in public places, 53.7% (182) had said
about the number layers in the mask 52.2% (177) has
yes and it was not significant statistically (p=0.175).
answered correctly i.e. three layers in a mask and it
When the study population was asked do they feel
was significant statistically (p=0.000). When it was
comfortable wearing mouth mask for a long time,
asked which layer acts as a filter media barrier, 64.3%
rest
59.1% (203) answered no. When the study
(218) had answered correctly i.e. middle. When it
population was asked, do they prefer changing mouth
was asked what type of mask they preferred in dental
mask for every patient 61.7(209) said yes. When the
setting, only 30.1% (102) had answered correctly as
study population was asked do, they prefer wearing
95% BFE and PFE. When the question was asked
colorful mask for attracting pediatric patients 67%
about how long can you wear a surgical mask, only
(227) said yes and it was significant statistically
26.8% (91) had answered correctly i.e. maximum 8
(p=0.000). When the study population was asked
hours, while the rest had answered incorrectly and
during dental procedures, if there is a need to talk to
it was significant statistically
(p=0.000). When it
the patient, will they remove their mask 26.5%(90)
was asked whether the surgical facemask used in
said yes, they will remove and change the mask,
dentistry were certified respirators, 46.6% (158) had
52.5%(178) said yes, they will remove but they will
answered correctly i.e. no and it was not significant
not change the mask, 20.9%(71) said no. When it
statistically
(p=0.212). When asked about which
was asked, do they feel difficulty in breathing while
level of mask you should wear while exposing
wearing the mouth mask, 57.8% (196) said yes
radiographs 23.3% (79) had answered correctly, level
and it was significant statistically (p=0.004). When
1 mask. When the study population was asked about
asked do they immediately dispose the mask after
which level of mask you should wear during hand
completing the treatment,
35.1% (119) said yes,
instrumentation, 48.4% (164) had answered correctly
35.4% (120) said no, after an hour, 29.5%(100) said
i.e. level 2 masks. When it was asked about which
no, and it was not significant statistically(p=0.325).
level of mask you should wear during ultrasonic
When asked about the disposal of mouth mask 51.3%
scaling 44% (149) had answered correctly, level 3
(174) had answered correctly, yellow plastic bag, and
mask and when asked for what procedure level 3
it was significant statistically (p=0.000). When the
mask should be used for, 69.6%(236) had answered
study population was asked for how long do, they
correctly, surgical procedures. The study population
wear a mask, 31.6% (107) said maximum 1 hour,
was asked whether they think wearing surgical mask
49.3
%(167) said maximum 2 hours, 19.2%(65)
decreases post-operative wound infections
66.7%
said more than
2 hours and it was significant
(226) had answered correctly, and it was significant
statistically(p=0.000). When the study population
statistically(p=0.000).
was asked to which extent of the nose they wear their
mouth mask, 21.5%(73) said till 1/3rd of their nose,
When the study population was asked how
48.4%(164) said till 2/3rd of their nose, 26.8%(91)
much are they concerned about contact infections
said covering their full nose, 3.2%(11) said that they
during treatment 37.5% (127) were very concerned,
don’t cover their nose at all and it was significant
17.7%(60) were not concerned. When it was asked that
statistically(p=0.000).
are you aware of contact dermatitis caused by surgical
mask, 58.7% (199) were aware of contact dermatitis.
DISCUSSION:
When the study population was asked during which
procedure you do not like to wear mouth mask 28%
A descriptive cross-sectional study was
(95) had said during examination, 43.4%(147)had
conducted to assess the knowledge and awareness
said while exposing radiographs, 22.15(75) while
about mouth masks among dental students in
making impressions, 6.5%(22) other procedures, and
Chennai. In the present study 57.5% were aware
it was significant statistically(p=0.000). When it was
of the correct way of using mouth mask which was
asked which type of mask they prefer,50.4% (171)
almost similar compared to the study done by St. Paul
preferred disposable with rubber bands, 45.4%(154)
3M occupational health and environmental safety
preferred disposable with long ties,
4.1%(14)
division, in which it was 56.1%7. Also, the knowledge
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JIDAM/Volume:6/Issue:4/Pages 117 - 124/October - December 2019
Vinita et al: Knowledge and practices about mouth masks among dental students
about layer acting as filter media barrier was similar
transmission of viruses.
among both the populations being 64.3% in the present
study and 63.7% by St. Paul 3M occupational health
The present study showed 66.7% were aware
and environmental safety division7. In this study we
that wearing surgical mask decreased post-operative
also asked about the different levels of mouth mask
wound infections, which was much more when
and its applications during dental procedures, 23.3%
compared to the study done by Allyson Lipp in the
had answered correctly that level 1 mask should
year 2005 about disposable surgical face mask which
be worn while exposing radiographs, 48.4% had
was 30%4. This shows that knowledge and awareness
answered correctly that level 2 mask should be worn
about wearing surgical mask has increased in these
during hand instrumentation,
44% had answered
many years by the dentists. When the participants
correctly that level 3 mask should be worn during
were asked about in which color bag, they dispose
ultra-sonic scaling and 69.6% had answered that level
their mouth mask 51.3% had answered correctly
3 mask should be used for surgical procedures which
that they dispose their mouth mask in yellow-non
was almost similar when compared to the study done
chlorinated plastic bags. 11
by Kandis V Garland1 in 2018 about what level of
mask should dental hygienists use? In the study by
In this study, questions were asked about
Faisal M Al Badri about current allergy and clinical
their attitude towards the mouth mask, 48.4% had
immunology in the year 2017, 59.6% were aware of
said that they covered their mask only till 2/3 of
contact dermatitis caused by surgical mask which is
their nose, whereas the
3.2% didn’t cover their
similar to the present study; 58.7%. On comparing
nose. Only 26.8% covered their full nose with the
both the studies the difference was only 1%; even
mouth mask and thus it should be brought into the
after two years of contact dermatitis survey, 40% were
practice of every dentist to wear their mask covering
still not aware of it. This shows that epidemiology of
the full nose, along with the infection control of the
occupational skin diseases due to masks is not well
patients, the dentists should also be in a good state
documented and studies addressing these topics are
to prevent themselves from infections. 4 Majority
rare6,14.
of the participants (49.3%) had said that they wore
their mouth mask for maximum 2hours and then
However, there was marked difference in
disposed it, but still there were 19.2% who used
knowledge regarding the number of layers viz.
their mask for more than two hours; wearing a mask
52.2% in the present study population and 70.1%
for more than two hours may cause infection to the
in the study by St. Paul 3M occupational health
dentists as well as to the patient; so more studies
and environmental safety division7 and the type of
and awareness should be imparted to the dentists
mask preferred in dental setting i.e. one with 95%
to prevent transmission of diseases. In this study
Bacterial Filtration Efficiency (BFE) and Particulate
29.5% had answered no to the question that they do
Filtration Efficiency (PFE) viz. 30.1% in the present
not immediately dispose the mask after completing
study population and 71.2% in the study by St.
a patient. They said only at the end of the day they
Paul
3M occupational health and environmental
disposed their mask, whereas 35.1% had the habit
safety division7. The difference may be due to lack
of disposing the mask immediately after completing
of exposure to theoretical knowledge about the
a patient. Immediate disposal of mouth mask will
specifications of masks in the present population.
reduce the spread of infection to the patient as well
Thus according to Adrian Wong5, dental practitioners
as to the dentist; these practices should be practiced
are required to enhance their knowledge about the
by every dentist in clinical practice that they should
bacterial efficiency of the mask. Furthermore, the
dispose the mask immediately after completing a
present study populations’ knowledge regarding
patient2.
the maximum time duration for wearing a mask
(i.e.
8 hours) was markedly low when compared
When the question was asked whether they
to a study by Bageshri Gogate3 viz.
26.8% and
felt difficulty in breathing while wearing mouth
52.1%, respectively. Also, only 46.6% had answered
mask, 57.8% had problem in breathing while wearing
correctly that face masks used in dentistry were not
the mouth mask, which might be due to thick barriers
certified respirators and were inefficient to prevent
provided by the manufacturing companies; the
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JIDAM/Volume:6/Issue:4/Pages 117 - 124/October - December 2019
Vinita et al: Knowledge and practices about mouth masks among dental students
manufacturing companies may further research to
prevent themselves from the smoke and the pollution.
reduce the thickness of the layers of the mask, may
This habit can be practiced by every individual to
be after doing so the dentist might feel comfortable in
protect themselves from the pollution which may
wearing a mouth mask. During dental procedures, if
lead to infections and respiratory problems and also
the dentist has a need to talk to the patient, 52.5% had
government should take initiative in such activities10,8.
answered that they removed their mask and talked
Half of the participants of this study had answered
and again wore the same mask, whereas only 26.5%
that they preferred disposable mouth masks with
had said that they removed and talked and disposed
rubber bands, whereas
45.4% had answered
it immediately, but 20.9% had no habit of removing
disposable mouth masks with long ties. The
their mask while talking to the patient; this attitude
preference for disposable mouth masks with rubber
should be changed that the mask should be removed
band might be because they were easy to wear and
by the dentist while talking to the patient, this would
easy to dispose and also, these were dependent on
reduce the risk of infection from the patient to the
individual concerns and comfort13. In this study when
dentist and also from the dentist to the patient3. In
the question was asked during which procedure they
the case of pediatric patients, 67% of dentists used
didn’t prefer wearing a mouth mask, 43.4% had
colorful masks to attract the pediatric patients and
answered that while exposing radiographs they didn’t
to make them cooperative, whereas the rest 33%
feel it is necessary to wear a mouth mask and 28%
has answered that they didn’t use any colorful mask
answered while examination they didn’t prefer using
to attract the pediatric patients. Usually kids are
a mouth mask, 22.1% had answered while making
attracted by colorful things and toys and thus mouth
an impression they didn’t like to wear a mouth mask,
mask could play an important role as during the
whereas the remaining 6.5% has answered that there
treatment the pediatric patients usually sees what the
were other treatments during which they didn’t
dentists is wearing and wearing a colorful mask will
feel it’s necessary to wear a mask like during hand
not only attract them but also sometimes it may make
scaling and restorations. It is recommended that the
them cooperative towards the dental treatment12.
mouth mask should be worn by the dentist for every
treatment procedure and during every treatment15.
In this study, 61.7% of the population had
answered that they usually changed their mouth
CONCLUSION:
mask after every patient, but still there were nearly
40% who didn’t change their mouth mask after
The current results have important implications
completing a patient. A step towards to protect
for public health as wearing face masks has become
themselves from infection should always be a part
common protective measure. In the present day,
of their practice and it should be changed because
the risk of health care associated infections and its
there are chances for the next patient to get infected
transmission not only involved the people who are
by the previously used mouth mask for a patient and
in direct contact with the patients but also those who
not only the patients but also the dentist could get
work in such environment.8Use of personal protective
infected. So, these kinds of practice should soon be
wear and its disposal must be followed by all those
implemented by all the practitioners to dispose the
who work in dental environment. The fundamental
mask after completing every patient3. Most of the
reason for directing the wearing of face masks is to
dentist and dental students had answered that they
protect dental professionals from airborne pathogens
didn’t feel comfortable wearing the mouth mask
and microorganisms. 3 It is essential to study the
for a long period of time (59.9%). This issue can
degree of protection facemask provided to dental
be sorted out only when the manufacture provides a
health care professionals which has been used as a
thinner layer for the mask, or after every two hours
preventive measure that defense against airborne
of the treatment the dentist takes time to relax for
pathogen transmissions.
about five to ten minutes and can change the mouth
Possible factors related to the protective efficiencies
mask according to their comfort9. When the question
observed with face mask include the efficiency
was asked do the participants, whether they preferred
of penetration and fabrication materials having a
wearing the mouth mask in the public places, like in
characteristic particle loading. Face masks design
polluted areas or in traffic, 53.7% has answered that
and the performance can be enhanced by analytical
they preferred wearing a mouth mask in such area to
models.
123
JIDAM/Volume:6/Issue:4/Pages 117 - 124/October - December 2019
Vinita et al: Knowledge and practices about mouth masks among dental students
FINANCIAL SUPPORT AND
hygiene practice in Japan, BMC Public Health
SPONSORSHIP:
2012, article number: 1065(2012); vol 12.
9. Ghada Alharbi, Noura Shono, Lamya Alballaa
Nil
and Alaa Aloufi. Knowledge, attitude and
compliance of infection control guidelines among
CONFLICTS OF INTEREST:
dental faculty members and students. BMC Oral
Health (2019); vol 19:7.
There are no conflicts of interest.
10. Farheen Taha, Joe Joseph, Chandrashekar Janaki
Ram, Raghunath Puttaiah. Dental Infection
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