For those of you parents and grandparents who are my age and older, you will remember when dentists did not use either gloves or masks on a routine bases to treat their patients.
Then came along the Acquired Immunodeficiency Syndrome (AIDS) epidemic in the early 1980’s. There was some resistance from some members of the profession citing that they would not be able to have the same tactile feel with latex gloves on and, as a result, not be able to perform procedures as well. Some dentists felt that using a mask would interfere with the Doctor – Patient relationship and the development of trust between the two. But… Things changed.
We now have Corona Virus Disease 2019 (COVID-19) and things are changing again.
Here is a basic face mask that would have been considered standard a few weeks ago. From the photo you can see they do not fit snuggly against the face and make a seal. This allows aerosols and even liquids and solids to move freely in and out from the mask to and from the patient.
In addition, viruses are to small for the mask material to prevent them from moving directly through the mask. Standard masks primarily provided some protection to the patient against aerosols coming from the person with the mask on getting onto the others. Standard mask provide little or no protection to the person using them, but do provide some protection to those around the person using this type of mask.
National Institute Occupational Safety and Health (NIOSH), part of the Centers for Disease Control and Prevention (CDC), developed guidance to help manufactures to decrease Corona Virus Disease 2019 (COVID-19). The N-95 masks prevent 95% of virus particles that are 100 nanometers (nm) and larger from penetrating through the mask. You an also see that the N-95 mask can form a fairly tight seal around the face unlike a regular mask. This protection is not complete however. It is important to note that that the COVID -19 virus can be as small as 60nm and even the common Influenza virus can be as small as 80nm.
Adding a regular mask to the outside of the N-95 mask does necessarily increase its effectiveness. It does however protect the N-95 mask and helps to keep it clean. The N-95 mask, when exposed to liquid over time, degenerates the material quicker then if the mask is kept dry.
A face-shield provides a lot of protection because it forms an in-penetrable barrier between the skin of the face, eyes and catches liquids before it can get to the provider or the providers masks. This, also, is not complete protection as the face shield not cover the sides and lower part of the face nor the neck area.
The goal of the personal protective equipment (PPE) is to prevent the transmission of disease from provider to the patient and other direction of patient to provider. Ideally one wants a system that prevents someone from transferring of bacteria and viruses even if they are contagious with a particular pathogen. No system is fail-safe, but this additional protection provides a high level and enhanced protection for the provider and the patient.
It is to early to tell if these new PPE protocols become permanent as the masks and gloves did for dentist in the 1980’s during the AIDS epidemic. The use of mask and gloves by dentists probably did not do much to prevent the spread of the Human Immunodeficiency Virus (HIV), the cause of AIDS, it did, however, provide a great deal of protection in preventing the transfer and propagation of the infectious diseases such as the common wart. Like the first photo, it now seems ridiculous that dentist ever practiced without the use of basic gloves and masks.
Our goal is to provide the best reasonable care and protection for our patients and ourselves so we all stay healthy and happy!