Loving your face mask

The other day an article about the worst pick-up lines caught my eye. It was funny and made me think about one of the worst pick-up lines I've ever heard.

By Anne Nugent Guignon

The other day an article about the worst pick-up lines caught my eye. It was funny and made me think about one of the worst pick-up lines I've ever heard. Let me share a story with you before moving on to information that is more serious.

On Friday, March 30, 1990, I went to work, fully expecting a very ordinary day. While I was reviewing the patient charts, I noticed some very distressing comments about my first patient. The notes indicated that he was difficult — not in the clinical sense, but rather, it was clear that the dental office was the last place on the planet he would choose to spend an hour of his time. What a way to start the day! But I decided to make the best of the situation.

My treatment room was small and cramped. The patient chair couldn't be repositioned and it barely accommodated his 6'5" frame. I tried to scale his lower anterior teeth while seated at the 12 o'clock position. It was hard to keep my chest from bumping his head. It was 7:30 a.m., and I was trapped in a treatment room trying to treat a case of gingivitis.

Women know when someone is flirting. It was obvious that my patient was flirting with me. I tried to brush his remarks off, certain that the office manager would hear the discourse and accuse me of flirting back.

I was anxious to get finished with this giant and get on with the day. As soon as I finished the appointment, he rose out of the chair said, "I'm just a sucker for a pretty smile and your's is beautiful." I nearly lost my composure. My response was incredulous: "How would you know? I've been behind a face mask for an hour!" What a pick-up line, but that line changed both of our lives. Derek and I got married in 1998.

Will your face mask ever play a part in such a dramatic transformation of your life? Probably not, but since not all face masks are created equal, it is important to understand the wide variety of options available for this very necessary part of our armamentarium.

Just how important is a face mask? Not many of us who practiced 20 or 30 years ago ever gave a second thought about filling our mouths, noses, sinus cavities, and lungs with all of those potential pathogens. After all, we weren't doing surgery; we were just cleaning teeth. Then, whammo, infection control became a hot issue and our faces have been shrouded in some type of barrier ever since. Even though face masks are an important part of our infection control protocol, the selection is often based on superficial attributes such as price or color. Have you ever stopped to consider that excellent fit, comfort, and filtration are part of the package as well? Fortunately, just like most other disposable products, there are a lot of options.

Masks are made in factories all over the world. A less expensive mask, often manufactured in a facility out side of this country, may not provide the same level of comfort or safety as those manufactured under more rigid conditions. For example, is your mask clean when you put it on or is it full of bio-burden? You may assume that a mask right out of the box is clean but tests by major mask manufacturers indicate otherwise. Since there are no regulated standards regarding factory cleanliness for products such as masks, gloves, and other disposables, using products that are less expensive to produce may actually result in unnecessary exposure to a wide variety of bacteria and other irritants. Talk about "in your face!"

In addition to the possibility of inhaling potential pathogens, your inexpensive mask may be giving you other risks that you didn't bargain for. Did you know that there are face masks that offer about as much protection as covering your mouth and nose with a few facial tissues while others, that were used during the anthrax scare, offer respirator-level protection? It takes quality materials to make quality products that deliver what we want and need. Let's look at all of the factors that you should consider when selecting a mask and the optimal ways to wear these devices.

Face masks come in two different designs: molded cups or flexible rectangular styles. Years ago, some cup masks contained fiberglass. Inhaling fiberglass micro-particles can lead to respiratory irritation, therefore it is not advisable to use this type of mask. For those sensitive to natural rubber, it is important to make sure that the mask you select does not contain latex.

Some clinicians with sensitive skin develop contact dermatitis from wearing masks. This is common in masks that contain dyes or printing on the side of the media that comes in contact with the skin. Masks with white inner layers can prevent skin irritation.

Face masks should be positioned so that a proper seal is maintained during clinical procedures. Masks have flexible nosepieces that can be adapted to create a precise fit over the bridge of the nose as well as the cheeks. Some masks have longer nosepieces, which help create a better seal and improve overall effectiveness.

Some masks are fabricated with extra padding or a foam strip in the nosepiece, which can improve comfort, especially when wearing magnification loupes. Some clinicians have trouble with their eyewear fogging up. There are masks that contain a specially designed strip to eliminate this problem.

While it may look backwards or sloppy, ear loop masks should be worn with the loop attachments on the outside of the mask, not next to your skin. This provides a better seal and prevents skin irritation.

The location of the ear loops is not the only thing to consider. High quality masks have the layers of filtration media ultrasonically welded together at the edges. The ear loops are attached the same way. Inexpensive masks are stitched together, which results in small holes all around the edges of the mask — little microscopic super highways for nasty bacteria to enter your mouth and nose.

Masks can be secured to your head in a variety of ways. The most popular choices are flexible ear loops and elastic head straps. Some clinicians prefer tie-on masks. For those of you who find it uncomfortable to wear ear-loop masks, special safety glasses are available that are designed with tiny hooks. The mask loops are attached to these hooks, which eliminate ear discomfort while still producing a good seal.

Most of us are using power scalers more than ever and, as a result, we are working around more aerosols than hygienists were exposed to years ago; therefore, a mask that is either splash or fluid resistant is a more appropriate choice than one that is designated to be only splash repellant. Fluid resistant masks should be used under the most severe conditions.

Just as it is important to change gloves, masks should be replaced after every hour of normal use. It is important to remember that, as a mask becomes wet, there is a corresponding reduction in effectiveness.

Two types of filtration are also important to consider. The first is bacterial filtration efficiency (BFE), which refers to how efficient a mask is in filtering bacteria that range in size from one to three microns. The higher the BFE number, the better the mask is at filtering out bacteria. However, it is important it is important to know the the particle size as well. For example, a mask that has a BFE of 99 percent at three microns offers a lower level of protection than one with at BFE of 99 percent at one micron.

Women often choose cup masks because other face mask designs tend to smear lipstick or makeup. While this may make sense on the surface, the best cup face masks only provide protection from bacteria that are larger than three to five microns. Rigid cup masks cannot provide the same type of customized seal as a mask made from a softer, more flexible fabric.

PFE or particle filtration efficiency is much more important than the bacterial filtration efficiency. This rating reflects how effectively the mask's microfiber media filters particles that range from 0.1 to one micron in size. Masks that have higher filtration rates, with smaller particle sizes, offer a higher level of protection.

This is important when using ultrasonic scalers, high-speed handpieces, air polishers and air abrasion units. To put this information into perspective, HIV pathogens are 0.1 micron in diameter, and many face masks today are only rated to filter at one micron. So it is important to know both the PFE filtration rate, as well as particle size.

Another comfort issue is the mask's breathability. While a mask that is approved as a N95 Respirator is the obvious choice when treating a high-risk patient, such as one with TB, this type of mask is not as breathable as a mask that has a lower filtration rate.

Infection control issues may not be the only thing to consider regarding filtration. While there are no long-term studies regarding frequent exposure to either air polishing or air abrasion powders it certainly cannot be healthy to get a lung full of these pathogen-laden particles. Surgical masks, rated by NIOSH as respirators, are the only type of masks that are designed to filter out particulate matter.

Here is another interesting tidbit about masks. Many masks are made overseas and as I alluded to earlier the quality of materials or cleanliness of the factories maybe less than ideal. When the SARS epidemic started last year, obtaining quality face masks became critical. American manufacturers were swamped with orders from all over the globe because their masks were manufactured with the most effective materials, under the most stringent conditions.

It is interesting how having the right equipment becomes important when facing a life-threatening pathogen that no one understands.

Since there are so many choices available, it just makes sense to know how to select the proper mask for each clinical application. So even if it sounds a bit far-fetched that you might fall in love with your face mask, finding one that gives you not only adequate protection but also superior comfort and fit is another way to keep practicing in the comfort zone.

By the way, if any of you have ever found love behind your face mask, I would certainly like to hear your story.

Anne Nugent Guignon, RDH, MPH, practices clinical dental hygiene in Houston, Texas. She writes, speaks, and presents continuing- education courses on ergonomics and advanced ultrasonic instrumentation through her company, ErgoSonics (www.ergosonics.com). She can be reached by phone at (713) 974-4540 or by e-mail at anne@ergosonics.com.

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