#229 Behind the Mask: What Every Dental Pro Should Know

Masks are a cornerstone of infection control in dental practice, protecting both patients and providers. Check out this episode as the Divas help you choose the right mask for the right task or procedure. Understanding standards, mask types, and proper usage ensures compliance, safety, and professional credibility.

• OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030): https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030
• CDC Infection Prevention and Control in Dental Settings: https://www.cdc.gov/dental-infection-control/hcp/index.html
• CDC Best Practices for Personal Protective Equipment (PPE): https://www.cdc.gov/dental-infection-control/hcp/dental-ipc-faqs/personal-protective-equipment.html

                                                 https://www.thecompliancedivas.com

Transcript

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SPEAKER_00 0:04

Welcome. I'm Leslie Cannon. I'm Mary Gavoni. I'm Linda Harvey.

SPEAKER_01 0:10

I'm Olivia Juan. And together we are the Compliance Divas.

SPEAKER_02 0:19

Welcome to the Compliance Divas Podcast. This is Linda Harvey, and I will be your moderator for this episode titled Behind the Mask: What Pros Should Know. I think we'd all agree masks are a cornerstone of infection control and dental practices, protecting both patients and providers. But choosing the right masks depends on the type of procedure. Are you performing a dry procedure with no aerosols? Or are you performing an aerosol-generating procedure? Understanding the standards, the mask types, and proper usage ensures compliance, safety, and professional credibility with your patients. So as we jump into our topic today, I'm going to ask Steve and Mary to share a little bit about why and just how do we start wearing masks in dentistry? Have we always worn masks in dentistry, Mary?

SPEAKER_01 1:07

No, we have not always worn masks in dentistry. And I think all of us come from the days of, as some people call them, the wet finger days of dentistry and not wearing face masks. And I have shared on our podcast before that when I was a chair side assistant before OSHA and before the Bloodborne Pathogen Standard, which was one of our first standards requiring face masks for splatters or spatters or splashes, I had respiratory infections all the time, all the time. And it just didn't occur to me. Now I just think about those years as the duh years. Why didn't I realize that I needed some respiratory protection? But no, we didn't always. We started wearing them in the early 1980s when we started hearing about HIV and AIDS. And we really didn't know how exactly HIV or AIDS could be transmitted in a dental setting. So we the CDC came out with some early guidance back in uh 1993 with some guidelines. Bloodborne pathogen standard came out in 1991, and the bloodborne pathogen standard said that we needed to wear face masks to protect ourselves from splashes or splatter of um or spray or droplets of blood or other potentially infectious materials. But then backing up to the hazard communication standard, which actually preceded the blood-borne pathogen standard, we are required to wear PPE and respiratory protection when there are dusts and mists that could be harmful to the respiratory system. So we didn't really pay that much attention to the PPE until the AIDS epidemic. But of course, COVID kind of blew it out of the water. And we'll talk a little bit more about that in a minute because I think Leslie has some really good information for us to understand about ratings of face masks.

SPEAKER_00 3:32

That's right, Mary. There's what's called the American Society for Testing and Materials, and it's an organization that develops and uh publishes technical standards for a wide range of products, including medical and dental face masks. And the ASTM standards specify the requirements for mask performance, including filtration efficiency, fluid resistance, breathability, and these standards help that ensure that masks provide consistent and reliable protection in healthcare settings. Now, most of us have heard of the different levels of masks, and mass levels refer to the classification of surgical masks based on their performance and filtration efficiency, fluid resistance, and breathability. And these levels will help dental professionals select the appropriate masks for the different procedures and exposure risks. So, for example, level one, these are for procedures with low amounts of fluid exposure. These masks have a bacterial filtration efficiency and particulate filtration efficiency of 95% or higher and a fluid resistance of 80 millimeters of mercury. And that's actually a measurement that measures the fluid resistance of a mask. Now, a level one mask is a mask that would likely be used in procedures. For example, if you're in your dental lab and you're maybe grinding on an appliance or you're polishing something, that's a great mask. It's a great dust filter. Then we have a level two mask, and these are for procedures with moderate amounts of fluid exposure. These masks have a bacterial filtration efficiency and particulate filtration efficiency of 98% or higher and a fluid resistance of 160 millimeters of mercury. Again, that's measuring moisture. And these masks have a fluid resistance of 120 millimeters of mercury, which is again, remember, that's the fluid resistance. Now, when we get to a level three mask, I don't think very many people in dentistry had heard of a level three mask until we had COVID hit. I had only heard about it maybe four or five years before COVID when hygienists were asking me about the best type of mask for when they're performing procedures with lasers, which became very popular for hygienists to use 10, 15 years ago. And they were concerned about that laser flume. So a level three mask was something that they had brought up to their employers, and many of the dentists were not aware that there were different levels of mask protection. They were asking for a better mask for when they performed laser procedures. And so a level three mask is for procedures with moderate to heavy amounts of fluid exposure. So if you think about that crown prep where you have a lot of water going or you have ultrasonic scalar going a majority of the appointment time, those are higher levels of fluid exposure. So these masks have a bacterial filtration efficiency and particulate filtration efficiency of 98% or higher. And a fluid resistance, here's the real difference. The fluid resistance is 160 millimeters of mercury. Again, that's much higher than a level two mask. While the 98% matches the bacterial filtration and particulate filtration efficiency, it is more fluid resistant. So a level three mask has, again, been brought to great popularity during COVID as a more uh efficient mask to use. I I remember when I wore uh a level one mask and a level two mask and a level three mask, and I had had a demonstration where we talked about the different levels of mask protection. And I would hand out samples of level one, level two, and level three to my audiences and ask them to try them on. Well, uh kind of a funny story is uh one time during COVID when I put a mask on at a speaking engagement, I accidentally put a level three mask on rather than a level one or two. And I had the most difficult time breathing after about five or ten minutes because I wasn't used to the filtration efficiency and the moisture efficiency. It was a little bit harder to breathe through than a level one or a level two mask. It wasn't anywhere near the same as an N95 respirator, so not to be mistaken for that, but uh it was certainly something that I did notice immediately.

SPEAKER_02 8:25

Leslie, that's some great information because um it's important, I think, that our listeners understand a little bit of the background on how the masks are approved, especially for those who may be newer to our field. And I'd also like to add to that that if your mask doesn't have any rating at all, we should not be used in a dental setting. Masks should also be approved by the Food and Drug Administration, and therefore they need to have the rating, one of these late that you described, Leslie, one, two, or three on the box. I'll never forget when I walked into an office one time and they had these cute masks, they were colorized to match the themes of their uniforms and whatnot, but they were buying them from a well-known uh store or gas station on the side of the highway. So be careful where you're buying everything. They have to be purchased from a credible dental source, not an online retail place. It needs to become from a dental uh vendor. And so we think about the different masks. Mary, let's go even higher and go to the next level, past a level three, and let's talk about N95s. They were sure the rage during COVID, weren't they?

SPEAKER_01 9:32

Absolutely they were. And if we look at the particle filtration efficiency and the bacterial filtration efficiency of an ASTM level three and an N95 respirator, there aren't a lot of differences except that a respirator seals around your face and you only breathe in and out through that respirator. So even though the particle filtration efficiency may be high on a surgical face mask, you're still breathing in some of those particles through gaps on the sides or gaps underneath, or even gaps at the top. So we need to be very aware of the need for N95 respirators during times when we're doing aerosol-generating procedures, like especially using an ultrasonic scaler or an air polisher. Um and we also are working in an area where respiratory infection rates are very high, whether it's COVID or influenza or measles or whatever it is, because the ultimate protection that you're gonna get, or that higher level of protection you're going to get is going to be from an N95 respirator. So the N95 respirator, as I said before, will seal around your face and they have to be fit tested to make sure it's the right size for your face. And they draw in the particles and they trap them in bacteriostatic layers. So you can't inhale them all the way through the mask. What a face mask will do is filter out whatever the rating is, it'll filter out that size of a particle that's their minimum or maximum filtration rate, but some of those particles will still get through. There's not enough layers of material to stop the other smaller um particles, which are called the most penetrating particle size or MPPS, which is 300 nanometers. So it's a pretty small tiny little particle. And we know that an N95 respirator will filter out 95% of those particles, including those most penetrating particle sizes. So people don't like the feel necessarily of wearing an N95 respirator because they can't breathe very easily through it. But there's a reason why, so that you're not breathing in those contaminants. And it's not a requirement from OSHA, but it is still a recommendation from the Centers for Disease Control and Prevention that they be used for aerosol generating procedures. But a couple of things to keep in mind. One is just like face masks, they are one-time use only. We don't reuse from patient to patient. And KN95 respirators, which are not certified or excuse me, not rated by ASTM, they are not certified through the National Institute for Occupational Safety and Health, are not allowed in this country to be used in healthcare. And another little tip, when if you're wearing a face mask, if you're wearing a respirator, there's typically only one way to put that respirator on. In some cases, people put their face masks on upside down. So when you put a face mask on, whether it's a level one, two, or three, the pleats on that face mask should always be facing down so that there's not a little ledge for particles to get trapped or moisture to get trapped from aerosols in those pleats. Now, some of the face masks, when you put them on, will spread the pleats out. And that is okay as long as there's not a little ledge sitting there for particles to uh to settle into. So again, the the biggest difference between a respirator and a surgical face mask is the fit and the seal.

SPEAKER_02 14:00

Those are some really important points because I know how dedicatedly the Divas individually and collectively did during COVID, how we address this with teams to help them understand the need to wear an N95 respirator because of being able to filter out that COVID particle. And it's really important that our listeners really understand the difference. And actually, I still know a few practitioners that are still wearing an N95 mask and they have no plans of going back. So it's an individual preference, but uh highly recommended. Leslie, one of the things that Mary spoke about was the gaps in the mask, you know, it not being not fitting properly. Um can you please talk about the repercussions of wearing masks incorrectly or choosing the wrong type of mask?

SPEAKER_00 14:41

Absolutely, Linda. You know, when you wear a mask, first of all, we've got to cover our noses. I think that during COVID, everybody learned how not to wear a mask. And if you're not wearing your PPE properly, the message it sends to the patient is, I can't protect myself. I don't know enough to protect myself. And and that's gonna convey to the patient thinking, well, how can they protect me if they can't protect themselves? So we want to make sure that we're wearing our mask properly. Uh, there's a little bar at the top of the mask where inside the mask material, that bar can be crimped around the nose. Um, and as Mary mentioned, there shouldn't be any gaps where you're breathing in around the sides of the mask. While the mask doesn't filter everything out like an N95 would, uh, it does filter out some, as we mentioned, with the various different uh filtration efficiency. So if you have gaping holes on the sides of the mask, then you're not doing yourself any favor because you're breathing in without it being filtered. And in some cases, masks have a bar at the bottom. So if you can find the mask that has the bar at the bottom, one that comes to mind is one that Crosstex made, where you could uh crimp not only the top, but you could stretch it, and then you could uh stretch it, meaning that you pull from the top and pull from the bottom, and then you could you could form that bar, that little nice flexible bar at the bottom of the mask around your chin. So that helps to really do a great job of of uh having you breathe in and out through the mask. And I know that Mary mentioned the the type of masks that uh are available, and uh we talked about in earlier in the podcast uh not buying your mask from a from an outside resource. You want to make sure that you are buying a mask that is considered a medical device, so that you have something that you can count on, that your patients can count on. And I think a lot of times people maybe give a little bit too much credit to their masks and thinking that this mask is protecting me fully from whatever I'm exposed to, which is not the case. They're designed to protect from splashes and spatters. So that's the large droplets and some of the larger bacteria and viruses. So true respiratory protection comes from an N95 respirator. So again, when there's circulating viruses or respiratory viruses in the community, then you might want to bump that up to wearing a mask that you can count on, which is really not called a mask at all. It's called a respirator.

SPEAKER_02 17:16

Thank you, Leslie, for helping to resement that point and helping our listeners to be reminded of that important information. And when we talk about not wearing the masks correctly, one of my pet peeves, and then one of the fastest ways to diminish the professionalism in your office is to wear your mask under your chin. And not necessarily, of course, during a procedure, divas, but we've seen that. It's more so as soon as you finish the procedures, taking off your gloves and taking your clean hand or somewhat clean hand because you haven't sanitized it yet, perhaps, and touching the front of a contaminated mask and pulling it below your chin so you can speak to your patient. Okay. And then forgetting the chin is under your and then forgetting the mask is under your chin and walking around the practice. And you go to the break room, you take the patient to the front, and it just sends a negative message because patients won't know whether you're wearing a clean or a dirty mask. And if it's a clean mask, you don't need to wear a clean mask around the office. And if it's dirty, it should not leave the operatorium, right, Leslie?

SPEAKER_00 18:14

That's absolutely right, Linda. And you know, it just brings me back to the early days when we didn't know what we didn't know. And we started wearing masks. I remember that that mask went from patient to patient and we get stuffed into the pocket of our clinical jacket. And uh, you know, uh it it it's just we've come so far. I know we discussed this earlier as uh divas offline. We said, you know, what we didn't know that we should have known when we were first starting out in dentistry or as we grew up in the profession, and I know that cross-contamination and and mask use and not changing masks, we didn't understand that the mask would cease to protect us after a bit of time because we've already had been breathing into it and the moisture efficiency and whatnot. Our exhalation has some moisture. And so if even during a procedure, if you're wearing a mask for a long period of time, uh the experts tell us that that it doesn't work as well because we've built out the moisture layer uh layer on the inside of the mask. So changing a mask in mid-procedure is something that we may want to consider too is uh protecting ourselves a little bit better.

SPEAKER_01 19:25

Thank you, Leslie. Mary. One other thing that came to mind as we're talking about this, I have a number of clients that I work with, um, and we have our very own Diva Leslie, who wears a hearing aid, and sometimes the earloop face masks will interfere with the fit of the hearing aids. So I see many of these people go to a molded mask to wear that just has one um head strap. Not all the molded masks have ASTM ratings, so you've got to do your research and find out um whether the masks that you're purchasing um to accommodate that need have an ASTM rating. And I know we've talked about this a little bit among ourselves before. I don't like the confusion of people having levels one through three and select whichever face mask they like for any procedure. I tell all the practices I work with, only order level three masks because I want you to have the highest level of protection and not have people say, Well, I can't breathe as good in that level three, so I'm gonna use a level one, which isn't going to protect them as well. So it's it's about patient safety, but it's also about your safety. And one of the things that we're seeing in the chemical hazard world now are a lot of cases of respiratory issues, silicosis, and um pulmonary fibrosis from exposure to fine dust particles. And so we need to be even more conscious of how we protect ourselves, not just from potentially infectious aerosols, but from powders and dust and so forth that we're exposed to.

SPEAKER_02 21:13

Great tips, Mary, as we begin to wrap up this podcast. Thank you so much. It's not just wearing the mask in the operatory, but the dull lab is important to bear in mind as well. Thank you, Divas, for this engaging combination of scientific information and practical applications about masks, because we put on a mask every day when we're working and seeing patients. And it's something that we can sometimes take for granted and not realize really the depth and the background of the mask and why they're serving us well and why they're or maybe why they're not. And as Mary mentioned in the very beginning, with the blood-borne pathogen standard, it's to protect us from splatter, particularly blood. But the other potentially infectious materials is defined by OSHA as including saliva. Because even if there's no blood in that saliva, it has potentially infectious material when you think about all the bacteria in a person's mouth. So knowing your mask is really important. As the compliance divas, we bring clarity and simplicity to compliance by navigating the regulatory world to keep you on course. We invite you to subscribe to our podcast through the compliance divas channels and in your favorite podcast channel. And also you can submit questions to support at the compliancedeivas.com. And don't forget to drop down at the end of this podcast in your wherever channel you're in and leave us a message or a rating or some feedback. We'd love to hear from you. And we look forward to seeing you next episode.