Art-1_Taraboanta

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                                                                                                                                                          Original Articles
EVALUATION OF THE SALIVARY PARAMETERS IN
FACIAL MASK WEARERS DURING COVID-19 PANDEMIC
                   1a                        1b                     1c                                   1d                1e
Ionuț Tărăboanță , Simona Stoleriu   , Gianina Iovan                     , Angela Cristina Ghiorghe           , Irina Nica      ,
                              1f                1g
Andra Claudia Tărăboanță-Gamen , Sorin Andrian

¹Department of Odontology, Periodontology and Fixed Prosthodontics, Faculty of Dental Medicine, "Grigore T. Popa" University of Medicine and Pharmacy
of Jassy, Jassy, Romania
aDDS, PhD Student; e-mail: ionut-taraboanta@umfiasi.ro; ORCIDiD: https://orcid.org/0000-0001-5452-916X
bDDS, PhD, Associate Professor; e-mail: stoleriu_simona@yahoo.com; ORCIDiD: https://orcid.org/0000-0001-5427-6027
cDDS, PhD, Professor; e-mail: gianina.iovan@umfiasi.ro; ORCIDiD: https://orcid.org/0000-0001-7255-4406
dDDS, PhD, Associate Professor; e-mail: cristina.ghiorghe@umfiasi.ro; ORCIDiD: https://orcid.org/0000-0002-1636-6686
eDDS, PhD, Assistant Professor: irina.nica@umfiasi.ro; ORCIDiD: https://orcid.org/0000-0003-1189-0785
fDDS, PhD Student; e-mail: andra-claudia.gamen@umfiasi.ro; ORCIDiD: https://orcid.org/0000-0003-0510-6149
gDDS, PhD, Professor: sorin.andrian@umfiasi.ro; ORCIDiD: https://orcid.org/0000-0002-9271-6123



ABSTRACT                                                                           https://doi.org/10.25241/stomaeduj.2021.8(4).art.1

Introduction The COVID-19 pandemic situation forced governments to impose various measures to reduce
the spread of the virus. The most used method is to wear facial masks, which can be found under several
commercial forms. Wearing facial masks has caused a lot of controversy and rumors. Among them, many
patients and practitioners have complained of a dry mouth after wearing different types of facial masks for
a variable period of time. The aim of this study was to analyze the quantitative (un-/stimulated salivary flow
rate) and qualitative (pH and buffer capacity) changes in saliva in mask wearers.
Methodology Forty subjects were selected for this study. All of them wore alternatively no mask, a surgical
mask for 2 hours, and FFP2 mask for 2 hours (groups 1, 2, and 3). Saliva samples were collected from all the
subjects in the groups and analyzed to determine the values of un-/stimulated salivary flow rate, the pH, and
buffer capacity using GC Saliva-Check Buffer (GC Corporation, Japan). Descriptive and analytical statistics
were performed using ANOVA and Bonferroni post-hoc test.
Results For unstimulated saliva samples, between groups 1 and 3, statistically significant differences were
recorded, with a significance level of 0,02<p=0,05. For stimulated saliva, salivary pH or buffer samples, no
significant differences were found between groups.
Conclusion Wearing FFP2 masks for two hours showed a reduction in salivary flow rate compared to subjects
who did not wear facial masks. Wearing surgical masks did not produce changes in salivary flow rates, pH or
buffer capacity.

KEYWORDS
Mask; COVID-19; Saliva; pH; Buffer Capacity.

1. INTRODUCTION                                                                methods to reduce the spread of the disease. The
                                                                               lack of effective treatments against the virus, as
The first cases of the novel coronavirus 2019                                  well as its rapid and uncontrollable evolution,
(COVID-19) appeared in Wuhan, China, in December                               forced the authorities to impose a series of non-
2019. The rapid spread of severe acute respiratory                             pharmacological measures to limit the spread of the
syndrome coronavirus 2 (SARS-CoV-2) forced the                                 virus, such as maintaining hand hygiene, keeping
World Health Organization (WHO) on March 11,
                                                                               social distance and wearing facial masks [1,2]. The
2020 to announce a global pandemic situation [1],
disrupting and creating difficulties for governments                           existence of solid evidence that the SARS-CoV-2
and national health systems in managing it [2].                                virus would be transmitted by air has strengthened
Throughout this period, the scientific communities                             the belief that the use of face masks would be an
around the world have been looking for some                                    effective way to reduce the spread of the virus [2,3,4].

           OPEN ACCESS This is an Open Access article under the CC BY-NC 4.0 license.
           Peer-Reviewed Article
 Citation: Tărăboanță I, Stoleriu S, Iovan G, Ghiorghe AC, Nica I, Tărăboanță-Gamen AC, Andrian S. Evaluation of the salivary parameters in facial mask
 wearers during COVID-19 pandemic. Stoma Edu J. 2021;8(4):233-238
 Received: December 01, 2021; Revised: December 11, 2021; Accepted: December 16, 2021; Published: December 20, 2021
 *Corresponding author: Dr. Simona Stoleriu, 16, Universității Str., RO-700115 Jassy, Romania
 Tel.: +40745106066; Fax: +40.232.211.820; e-mail: stoleriu_simona@yahoo.com
 Copyright: © 2021 the Editorial Council for the Stomatology Edu Journal.




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                    Tărăboanță I, et al.
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                    Since the beginning of the pandemic, protective             26.05.2021) approved by the Ethics Committee of
Original Articles   masks have been recommended as protective                   “Grigore T. Popa” University of Jassy, Jassy Romania.
                    measures due to the fact that the transmission of           The selection of subjects was made in accordance
                    the virus is mainly respiratory. Countries have issued      with the inclusion and exclusion criteria presented in
                    instructions and guidelines on the use of protective        Table 1.
                    masks. In Romania, they must comply with the                Table 1. Selection of the subjects: inclusion and exclusion criteria.
                    Personal Protective Equipment Regulation and
                    with the relevant European standard EN 149. If they          Inclusion criteria                  Exclusion criteria
                    are manufactured in accordance with the current              - Patients aged between 20 and      - Patients with general
                    standards wearing a facial mask was considered one           30 years                            pathologies that affect salivary
                                                                                 - Patients without associated       activity
                    of the most effective ways to stop the spread of the
                                                                                 general pathologies                 - Patients with chronic
                    virus.                                                       - Adult female / male volunteer     alcoholism
                    Facial masks are devices that completely or partially        - Agreement signed and dated        - Patients with viral infections -
                    cover the face with the role of protection against           for participation in the study      C / B virus, HIV / AIDS
                    pollutants or pathogenic microorganisms. Surgical            - Ability to understand the         - Patients who have an
                    masks also known as medical mouth-nose protection            purpose and type of the study       uncooperative attitude
                                                                                 - Willingness to cooperate with
                    (MNP) are devices that partially cover the face and          the doctor and to comply with
                    act as protection against pathogenic microorganisms          the requirements of the study
                    reducing the risk of spreading drops during
                    expiration. Surgical masks are not watertight and           2.2. Study design
                    cannot provide complete protection to the wearer            For each subject, salivary parameters: unstimulated
                    [5].
                                                                                salivary flow rate, stimulated salivary flow rate, pH
                    FFP2 face masks (Filtering Face Piece) also known
                                                                                and buffer capacity were determined using GC Saliva
                    as N95 masks, provide 95% protection against
                                                                                Check Buffer test kit, GC Corporation, Japan, (LOT
                    pathogenic microorganisms. FFP2 masks may or
                                                                                no. 2003102) at the same time of day (between 11-
                    may not be equipped with a valve. Masks without
                    valves ensure effective protection of the external          12 AM), in three different days. On the first day of
                    environment while masks with valves allow the               testing, salivary parameters were evaluated in all
                    exhaled air to escape without being filtered [4,5].         subjects without wearing any mask (group 1), on the
                    A number of studies have shown harmful effects              second day of testing after wearing a surgical mask
                    of wearing a face mask on the cardio-respiratory            for 2 hours (group 2) and on the third day of testing
                    system or on the neurological system [1,6], but no          after wearing a FFP 2 mask for 2 hours (group 3). The
                    studies have yet been conducted to evaluate the             individuals were recommended to follow the same
                    effects of wearing a face mask on saliva parameters.        schedule, to consume the same food and the same
                    Saliva has a multitude of functions that maintain the       amount of liquids and use the same dental hygiene
                    body homeostasis, but among them we focused on              products and methods on each day of three testing
                    functions in the oral cavity. Saliva is very important in   days. The subjects were asked to avoid eating two
                    protecting dentition by salivary mucin or proline-rich      hours before the salivary tests. Unstimulated salivary
                    glycoproteins pellicle, has a remineralizing role due to    flow rate was initially assessed. From the collected
                    the content of calcium, phosphate and fluoride ions,        saliva, the evaluations of the buffer capacity and
                    buffering capacity due to bicarbonate and phosphate         salivary pH were performed, and finally the stimulated
                    and antibacterial role due to the presence of IgA, IgG,     salivary flow was evaluated, after the subject chewed
                    IgM or some enzymes [7]. Therefore, any quantitative        a piece of paraffin.
                    or qualitative change in saliva could impair the
                    protective capacity of saliva on the dentition.             2.3. Salivary tests
                    Therefore, the aim of this study is to evaluate the         The quantitative determination of stimulated and
                    quantitative and qualitative parameters of saliva in
                                                                                unstimulated salivary flow rate, buffer capacity and
                    surgical mask and FFP2 wearers during the COVID-19
                                                                                salivary pH were performed using the methodology
                    pandemic.
                                                                                presented in table 2.
                    2. MATERIALS AND METHODS
                                                                                2.4. Facial masks
                    2.1. Subjects                                               The study participants wore two different types of
                    The present study was conducted between June                facial masks:
                    1st, 2021 - September 30th, 2021, on a number of            1. surgical masks (AVE, Romania) with three layers:
                    40 subjects aged between 20 and 30 years old (18            Outer layer-non-woven synthetic material - 20 g/sq;
                    females and 22 males) all of them being students            Middle layer-fused synthetic material, white; Inner
                    of the Faculty of Dental Medicine, "Grigore T. Popa"        layer-non-woven synthetic material, white - 20 g/
                    University of Iasi. The subjects were informed about        sqm
                    the procedures, they agreed to voluntarily participate      2. FFP 2 masks (3M Aura 9320+, MN, USA) with four
                    in the study and signed an ethical agreement (no. 84/       layers.



 234                Stoma Edu J. 2021;8(4): 233-238                                                pISSN 2360-2406; eISSN 2502-0285
Salivary Parameters in Facial Mask Wearers
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                                                                                                                                                 Original Articles
 Table 2. Description of the saliva testing methodology.
 Parameters       Methodology
 to evaluate
 Stimulated       The assessment was performed using a
 salivary flow    sialometer in which the patient eliminated
                  the accumulated saliva at every minute, for
                  a total period of 5 minutes. Stimulation of
                  salivary secretion was done with a paraffin
                  gum. The gum was by chewed by the
                  subjects for 5 minutes during the whole
                  period of stimulated saliva collection,
                                                                     Figure 1. Boxplot presentation of the distribution of the values recorded
                  according to the manufacturer’s instructions.
                                                                    in groups 1, 2 and 3 for unstimulated saliva samples.
                  The measurement was made by three
                  investigators. The values are expressed in ml/    For stimulated saliva samples, the mean values and
                  min.                                              standard deviation of group 1 was 10.95 (SD ±2,58),
 Unstimulated     The assessment was made using a sialometer        for group 2 it was 10.93 (SD ±2,31) and for group 3 it
 salivary flow    in which the patient eliminated the               was 10.92 (SD ±1,95). Analyzing the mean variation,
                  accumulated saliva at every minute, for a total   we can see that the values obtained in group 1
                  period of 5 minutes. The measurement was          decrease in group 2 and the values recorded in group
                  made by three investigators. The values are       2 decrease in group 3 (Fig. 2). Between groups 1, 2
                  expressed in ml/min.                              and 3 no statistically significant differences were
 Buffer           The assessment was made using an indicator        recorded for a significance level of p=0.05.
 capacity         strip for buffer capacity on which a drop of
                  unstimulated saliva was placed. The color
                  modification was optically assessed by three
                  investigators. green – 4 points
                  green/blue – 3 points
                  blue – 2 points
                  red/blue – 1 point
                  red – 0 points.
                  The points were counted and the result
                  determined the buffering capacity score:
                  0 – 5 points as very low buffering ability
                  6 – 9 points as low                                Figure 2. Boxplot presentation of the distribution of the values recorded
                  10 – 12 points as normal/high                     in groups 1, 2 and 3 for unstimulated saliva samples.
 Salivary pH      The assessment was performed using
                  a pH indicator strip on which a drop of           For salivary pH, the mean values and standard
                  unstimulated saliva was placed. The color         deviation of group 1 was 6.72 (SD ±0,19), for group
                  modification was optically assessed by three      2 it was 6.81 (SD ±0.24) and for group 3 it was 6.83
                  investigators.                                    (SD ±0.23). Analyzing the mean variation, we can see
                                                                    that the values obtained in group 1 increase in group
                                                                    2 and the values recgroups 1, 2 and 3 no statistically
2.5. Statistical analysis                                           significant differences were recorded for a significance
The data were stored in the Office Excel program and                level of p=0.05.
the statistical analysis was performed using IBM SPSS               For salivary pH, the mean values and standard devia-
26 program. To determine the differences between                    tion of group 1 was 6.72 (SD ±0,19), for group 2 it was
                                                                    6.81 (SD ±0.24) and for group 3 it was 6.83 (SD ±0.23).
the study groups we used the repeated measures
                                                                    Analyzing the mean variation, we can see that the
ANOVA statistical test and the Bonferroni post-hoc                  values obtained in group 1 increase in group 2 and the
test.                                                               values recorded in group 2 increase in group 3 (Fig. 3).
                                                                    Between groups 1, 2 and 3 no statistically significant
3. RESULTS                                                          differences were recorded for a significance level of
For unstimulated saliva samples, the mean values                    p=0.05.
and standard deviation (SD) of group 1 was 3.53 (SD
±0,68), for group 2 was 3.19 (SD ±0,58) and for group
3 was 3.06 (SD ±0,52). Analyzing the mean variation,
we can see that the values obtained in group 1
decrease in group 2 and the values recorded in group
2 decrease in group 3 (Fig. 1). Between groups 1 and
3, statistically significant differences were recorded,
with a significance level of 0,02<p=0.05. Between
groups 1 and 2, and groups 2 and 3, no significant                   Figure 3. Boxplot presentation of the distribution of the values recorded
differences were recorded.                                          in groups 1, 2 and 3 for salivary pH.




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                                                                                                 caries risk did not find significant correlations between
Original Articles
                                                                                                 them [7,16]. This conclusion is explained by the fact
                                                                                                 that bicarbonate and other buffering components do
                                                                                                 not come into direct contact with the surface of the
                                                                                                 teeth as they are covered by a layer of bacterial film
                                                                                                 or biofilm [7,17].
                                                                                                 Another symptom of mask wearers is halitosis,
                                                                                                 also called “mask breath” caused by volatile
                                                                                                 sulfur compounds in the oral environment or by
                     Figure 4. Boxplot presentation of the distribution of the values recorded   the remaining fermentable food residues on the
                    in groups 1, 2 and 3 for buffer capacity.                                    dorsum of the tongue or on the dental surfaces and
                                                                                                 accentuated by oral dryness [8,18].
                    4. DISCUSSION
                                                                                                 Wearing the facial mask not only produces
                    In this study we evaluated the rate of unstimulated                          imbalances in the oral environment, but also affects
                    and stimulated salivary flow, buffer capacity and                            the perioral teguments, causing their dehydration and
                    salivary pH in subjects wearing or not a surgical mask                       potentiating the bacterial action that will cause cracks
                    and a FFP2 mask. The results indicate a reduction                            or ulcerations of the tegument or angular cheilitis
                    in the resting salivary flow in FFP2 mask wearers                            [8,19].
                    compared to subjects that did not wore any type of                           Some recent studies have described a number
                    mask, and these findings are supported by a recent                           of recommendations to combat oral imbalances.
                    review study conducted by Muley-Itke that described
                                                                                                 Therefore, in addition to a rigorous oral hygiene that
                    the phenomenon of "Mask mouth" as being a
                    result of prolonged wearing of the facial mask. This                         must include 2-3 toothbrushes, the use of mouthwash
                    condition can be a consequence of hyposalivation due                         and dental floss to combat the phenomenon of "mask
                    to oral breathing that is a common behavior in facial                        mouth", the surgical masks must be changed after
                    mask wearers and is associated with an increased                             3 hours of wearing because the humidity expired
                    incidence of oral disorders, such as periodontal                             degrades them. Oral breathing should be avoided
                    disorders, halitosis or an increased carious risk.                           as much as possible when the mask is applied. The
                    Another justification may be poor hydration while                            mask must be applied correctly, as tightly as possible
                    wearing a mask that may be associated with general                           and used only once. To avoid perioral skin lesions, it
                    dehydration. Dental or periodontal diseases have an
                    increased incidence in oral respiratory patients, as                         is recommended to use creams with moisturizing and
                    the mouth has a very high exposure to air flow, which                        emollient effect [20-22].
                    decreases the rate of salivary flow [8,9].
                    A number of studies have shown a significant increase                        5. CONCLUSION
                    in the amount of acidogenic and aciduric bacteria such
                    as Streptococcus mutans and Lactobacilli in patients                         Unstimulated salivary flow rate decreases in persons
                    with oral breathing or those with xerostomia. [8,10].                        wearing FFP2 mask when comparing to the persons
                    Other authors have described in patients with                                who wear no mask, but it remains unaffected by
                    hyposalivation or oral respiration, an increase in
                                                                                                 surgical mask wearing.
                    bacterial plaque indices as well as a reduction in
                    the buffer capacity of saliva and an increase in                             Stimulated salivary flow rate, salivary pH or buffer
                    susceptibility to gingival inflammation or periodontal                       capacity are not influenced by any type of face masks.
                    disease [8,10,11].
                    The decrease of the salivary flow rate will                                  AUTHOR CONTRIBUTIONS
                    consequently decrease the antibacterial components
                    increasing the potential for the development of                              IT: conception and design of the study, acquisition of data,
                    bacterial or fungal infections, such as candidiasis.                         statistical analysis and interpretation of data, drafting the article,
                    Decreasing the concentration of lysozyme, lactoferrin,
                                                                                                 final approval of the version to be submitted. SS: drafting the
                    lactoperoxidase or histatin will weaken the saliva's
                    defense capacity [8,12,13,14].                                               article, revising the article critically for important intellectual
                    Saliva has multiple roles: to ensure surface cleaning,                       content. GI: acquisition of data, analysis and interpretation of
                    substance clearance and an optimal pH by buffer                              data. AG: acquisition of data, analysis and interpretation of
                    capacity. In buffering effect, an important role is                          data. IN: acquisition of data, analysis and interpretation of data.
                    played by the bicarbonate-carbonic acid system,                              ACTG: acquisition of data, analysis and interpretation of data. SA:
                    salivary phosphate and proteins [7,15].                                      conception and design of the study, revising the article critically
                    Maldupa et al. described a different composition of                          for important intellectual content, final approval of the version to
                    unstimulated saliva when comparing to the stimulated
                                                                                                 be submitted.
                    one. Increased saliva production will decrease the
                    concentration of potassium and phosphate and
                    will increase the values of sodium, chloride and                             ACKNOWLEDGMENTS
                    bicarbonate [7]. Most studies that evaluated the links                       The authors would like to thank all the participants in the study
                    between the saliva buffer capacity and the patient's                         who demonstrated their availability to collaborate in this study.




 236                Stoma Edu J. 2021;8(4):233-238                                                                  pISSN 2360-2406; eISSN 2502-0285
Salivary Parameters in Facial Mask Wearers
                                                                                                                                                www.stomaeduj.com



REFERENCES




                                                                                                                                              Original Articles
1. Pezzini A, Padovani A. Lifting the mask on neurological             12. Loeb M, Dafoe N, Mahony J, et al. Surgical mask vs N95
manifestations of COVID-19. Nat Rev Neurol. 2020 Nov;16(11):636-       respirator for preventing influenza among health care workers:
644. doi: 10.1038/s41582-020-0398-3                                    a randomized trial. JAMA. 2009 Nov 4;302(17):1865-1871. doi:
Full text links PubMed Google Scholar                                  10.1001/jama.2009.1466
2. Li T, Liu Y, Li M, et al. Mask or no mask for COVID-19: a public    Full text links PubMed Google Scholar WoS
health and market study. PLoS One. 2020 Aug 14;15(8):e0237691.         13. Radonovich LJ, Simberkoff MS, Bessesen MT, et al. N95 respi-
doi: 10.1371/journal.pone.0237691                                      rators vs medical masks for preventing influenza among health
Full text links PubMed Google Scholar                                  care personnel: a randomized clinical trial. JAMA. 2019 Sep
3. Van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and         3;322(9):824-833. doi: 10.1001/jama.2019.11645
surface stability of SARS-CoV-2 as compared with SARS-CoV-1.           Full text links PubMed Google Scholar WoS
N Engl J Med. 2020 Apr 16;382(16):1564-1567. doi: 10.1056/             14. Su N, Marek CL, Ching V, et al. Caries prevention for patients
                                                                       with dry mouth. J Can Dent Assoc. 2011 Jan 1;77(b85):1-8.
NEJMc2004973
                                                                       Full text links PubMed Google Scholar
Full text links PubMed Google Scholar Scopus WoS
                                                                       15. Jensdottir T, Nauntofte B, Buchwald C, et al. Effects of sucking
4. Yu IT, Li Y, Wong TW, et al. Evidence of airborne transmission of
                                                                       acidic candy on whole-mouth saliva composition. Caries Res.
the severe acute respiratory syndrome virus. N Engl J Med. 2004        2005;39(6):468-474. doi: 10.1159/000088181
Apr 22;350(17):1731-1739. doi: 10.1056/NEJMoa032867                    Full text links PubMed Google Scholar WoS
Full text links PubMed Google Scholar                                  16. Sullivan A. Correlation between caries incidence and
5. Matuschek C, Moll F, Fangerau H, et al. Face masks: bene-           secretion rate/buffer capacity of stimulated whole saliva in
fits and risks during the COVID-19 crisis. Eur J Med Res. 2020         5-7-year-old children matched for lactobacillus count and
Dec;25(1):1-8. doi: 10.1186/s40001-020-00430-5                         gingival state. Swed Dent J. 1990 Jan 1;14(3):131-135.
Full text links PubMed Google Scholar                                  Full text links PubMed Google Scholar WoS
6. Fikenzer S, Uhe T, Lavall D, et al. Effects of surgical and FFP2/   17. Bassoukou IH, Nicolau J, Dos Santos MT. Saliva flow rate,
N95 face masks on cardiopulmonary exercise capacity. Clin Res          buffer capacity, and pH of autistic individuals. Clin Oral Investig.
Cardiol. 2020 Dec;109(12):1522-1530. doi: 10.1007/s00392-020-          2009 Mar 1;13(1):23-27. doi: 10.1007/s00784-008-0209-5
01704-y                                                                Full text links PubMed Google Scholar WoS
Full text links PubMed Google Scholar Scopus WoS                       18. Mummolo S, Quinzi V, Dedola A, et al. Oral microbiota in
7. Maldupa I, Brinkmane A, Mihailova A. Comparative analysis of        mouth-breathing patients. J Oral Hyg Health. 2020;8(2).
CRT Buffer, GC saliva check buffer tests and laboratory titration      Full text links Google Scholar
to evaluate saliva buffering capacity. Stomatologija. 2011 Jan         19. Triana BE, Ali AH, León IG. Mouth breathing and its
1;13(2):55-61.                                                         relationship to some oral and medical conditions:
Full text links PubMed Google Scholar Scopus                           physiopathological mechanisms involved. Rev Haban Cienc Méd.
8. Muley-Itke P. "Mask Mouth" - A new malady affecting oral            2016;15(2):200-212.
health in the COVID era. Annals of International Medical and           Full text links Google Scholar
Dental Research. 2021,7(4):16-22.                                      20. Konda A, Prakash A, Moss GA, et al. Aerosol filtration
Full text links                                                        efficiency of common fabrics used in respiratory cloth masks.
                                                                       ACS Nano. 2020 Apr 24;14(5):6339-6347. doi: 10.1021/
 9. Tschoppe P, Wolgin M, Pischon N, Kielbassa AM. Etiologic
                                                                       acsnano.0c04676
factors of hyposalivation and consequences for oral health.
                                                                       Full text links PubMed Google Scholar WoS
Quintessence Int. 2010 Apr;41(4):321-33. PMID: 20305867.
                                                                       21. Verbeek JH, Rajamaki B, Ijaz S, et al. Personal protective
Full text links PubMed Google Scholar Scopus WoS                       equipment for preventing highly infectious diseases due to
10. Mummolo S, et al. Salivary markers and microbial flora in          exposure to contaminated body fluids in healthcare staff.
mouth breathing late adolescents. Biomed Res Int. 2018 Mar             Cochrane Database Syst Rev. Apr 15;4(4):CD011621
5;2018:8687608. doi: 10.1155/2018/8687608. PMID: 29693018;             doi: 10.1002/14651858.CD011621.pub4
PMCID: PMC5859862.doi:10.1155/2018/8687608                             Full text links PubMed Google Scholar WoS
Full text links PubMed Google Scholar Scopus WoS                       22. Smith JD, MacDougall CC, Johnstone J, et al. Effectiveness of
11. Kawabata Y, Ekuni D, Miyai H, et al. Relationship between          N95 respirators versus surgical masks in protecting health care
prehypertension/hypertension and periodontal disease: a                workers from acute respiratory infection: a systematic review and
prospective cohort study. Am J Hypertens. 2016 Mar 1;29(3):388-        meta-analysis. CMAJ. 2016 May 17;188(8):567-574. doi: 10.1503/
396. doi: 10.1093/ajh/hpv117                                           cmaj.150835
Full text links PubMed Google Scholar Scopus WoS                       Full text links PubMed Google Scholar WoS




                                                                                      Ionuț TĂRĂBOANȚĂ
                                                                                            DDS, PhD student
                                                             Discipline of Cariology and Restorative Dentistry
                                                                  Faculty of Dental Medicine “Grigore T. Popa”
                                                University of Medicine and Pharmacy of Jassy Jassy, Romania


CV
Ionuț Tărăboanță graduated from the Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy Jassy,
Jassy, Romania in 2016. Since 2016 he has been a PhD student at the Discipline of Cariology and Restorative Dentistry. Since 2018
he has been working as Assistant Lecturer at the same discipline. His fields of interest are the study of saliva and dental materials.




Stoma Edu J. 2021;8(4):233-238                                                            pISSN 2360-2406; eISSN 2502-0285                     237
                    Tărăboanță I., et al.
www.stomaeduj.com




                    Questions
Original Articles
                    1. What is the recommended time to wear a mask before it is necessary to change it?
                    qa. 1 hour;
                    qb. 5 hours;
                    qc. 3 hours;
                    qd. 30 minutes.

                    2. What is the meaning of FFP2?
                    qa. Frontal Filtering Piece;
                    qb. Filtering Face Piece;
                    qc. Face Filtering Product;
                    qd. Free Filtering Piece.

                    3. The decrease of the salivary flow rate will consequently:
                    qa. Decrease the antibacterial components;
                    qb. Decrease the growing potential of the bacteria;
                    qc. Increase the concentration of lysozyme;
                    qd. Increase the concentration of lactoferrin.

                    4. The most important role in buffering capacity is played by:
                    qa. Lactoperoxidase;
                    qb Bicarbonate;
                    qc. Lactobacilli;
                    qd. Histatin.




                      https://www.gnydm.com/




 238                Stoma Edu J. 2021;8(4): 233-238                            pISSN 2360-2406; eISSN 2502-0285