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Working in dental hygiene during COVID-19; It’s uncomfortable!

These days, hygienists wear head-to-toe PPE that they change between appointments, an arduous, uncomfortable ritual that requires them to remove the shields, goggles, masks, gloves, gowns, and boots, and replace them with disinfected or clean ones.

“It’s like changing out of a spacesuit,” Dr. Todd Bertman of Advanced Dental Arts in Manhattan was quoted describing the experience. “It’s annoying as hell but this is what it kind of comes down to until we find a vaccine.”

The discomfort associated with face masks

According to a study cited by CS Los Angeles, dental hygienists were listed as the most vulnerable to contracting the COVID-19 virus of all non-healthcare workers.  They are repeatedly exposed to aerosols, which place them at heightened risk of contracting the virus — as such, wearing face masks, and other protective clothing is mandatory.  

The social media images of healthcare workers, with bruising and facial marks from the extended use of PPE during COVID-19 pandemic, are distressing. Many have dark circles around their eyes and an evident weariness in their expression. And these images don’t even tell the whole story.

This is the new normal for hygienists. And guess what? It’s uncomfortable. Apparently, many find themselves touching on their face frequently because the mask itches, or they need to adjust it.  

For those that wear glasses, their lenses are fogging up. As if that is not enough, breathing becomes quite tricky. A deep inhale must be reciprocated with a deep exhale. You can guess how tiresome that is if it’s being done repeatedly!

All of this uneasiness and discomfort gets worse during humid days and when sweat comes into the mix. In short, the experience of wearing a mask in the operating room — which every hygienist needs to do for the obvious reasons — is miserable.  

But some hygienists are now trying to devise ways on how to cope with this new normal. Perhaps part of that process is getting used to the discomfort. “It feels as if I have a malarial swamp trussed on my jaw,” that’s how some likened it on Twitter. Another dryly branded the experience “sweltering in place.” Even worse, another simply called it “putrid.”  

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Skin problems associated with PPE

Discomfort aside, a study conducted by the Journal of American Academy of Dermatology showed that 97% of health workers based in two different COVID-19 units exhibited PPE-related skin damage. The effects increased when PPE was donned continuously for more than six hours, particularly with N95s and goggles.

Facial skin problems from the shields, goggles, and masks arise due to extended moisture build-up, pressure, and chaffing. The nasal bridge is the most affected part since it is a bony prominence containing little soft tissue beneath the skin. Other facial parts mostly affected include the area across the cheekbones, the backs of the ears as a result of mask elastics, and the forehead in the case of shields.  

It is also worth noting that hygienists and other healthcare workers can contact dermatitis and eczema on the hands from the regular hand washing/sanitizing and wearing gloves for many hours. What’s more, the lack of air circulation due to wearing gowns every time can cause rashes, skin irritation, and redness on the rest of the body.

Managing PPE-related discomfort and skin problems 

Ensure your mask fits comfortably

Discomfort usually occurs when a mask is not correctly or properly fitted. Always ensure that your mask isn’t sitting too tight or loose. Make the required adjustments before seeing your patients. Notably, replace your mask immediately if it becomes wet, soiled, or starts to feel uncomfortable.  

Relieve pressure regularly 

If possible, take your face shield, goggles, or mask off after every four hours. Relieving the pressure even for a moment to allow for normal blood flow will reduce the discomfort and might even prevent unnecessary skin damage.

Moisturize often

After your shift, gently wash your neck and face with soap and clean water. Then apply a quality moisturizer.  Equally, make it a habit of applying moisturizer before wearing your PPE.

Use a barrier cream for extra protection.

A barrier cream can offer you additional protection if you will be donning PPE for an extended period. This is particularly necessary if you have underlying skin damage or condition.

For example, you can use a barrier cream on your face, hands, or areas you think will come into contact with the PPE. These creams shield the skin from friction and moisture, and some come in the form of convenient wipes.  

Apply dressings when necessary

You can also opt to use moisture-absorbing and protective dressings on parts where there is friction or pressure. Before taking this step, though, inform an infection control specialist to confirm if the proposed dressing can impact the effectiveness of your PPE.

Keep in mind that you can use different types of dressings and cutting patterns for different facial parts, but this can be explained in detail by a wound specialist.

Manage heat rashes

Hygienists who have to wear gowns for extended periods can experience this red, itchy rash, commonly referred to as intertrigo dermatitis. It is usually caused by friction, moisture trapped in skin folds, and lack of ventilation. 

To prevent such a condition, ensure you dry off well after showering. Avoid chafing and tight clothing and wear moisture-absorbing undergarments. You can also use cornstarch or talcum powder to help keep these areas dry.  

In case of a more severe infection on any part of the body, get a prescription for an antifungal or antibiotic ointment, and probably a mild topical steroid. 

Protect your ears

There are some DIY hacks you can try to reduce the ulceration or irritation the masks’ elastic loops cause to the backs of your ears. This may involve having buttons on caps or using headbands that you can secure the elastic onto. But while doing this, ensure you don’t pull the face mask tightly, as it can amplify the pressure on your face.

Surgical face masks with ties that can be fastened at the back of the head are believed to cause less irritation; hence, it would be beneficial to consider this option.

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Always stay hydrated

Ensure that you take lots of water before and after work and during breaks. Dry skin is likely to become damaged or irritated — think of dry, cracked lips during winter.

Final thoughts

Regardless of how uncomfortable masks and gowns are, hygienists will agree that they don’t have any other option but to wear them. But besides the tips we have mentioned above, making enough PPE for hygienists can help lessen their challenges. When the availability of PPE is not a problem, hygienists can change them as frequently as possible or on as-need-basis, reducing the discomfort levels.

 “Yes, it is uncomfortable, but it is the only way.” For the foreseeable future, this will be a popular saying amongst dental hygienists and dentists.  

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