Maseczki z punktu widzenia lekarza stomatologa
Rozważając kwestię maseczek, należy koniecznie najpierw dowieść naukowo i doświadczalnie, że taka forma profilaktyki jest rzeczywiście skuteczna. Aby móc to stwierdzić, potrzebujemy rzetelnych badan naukowych, które mogłyby potwierdzić lub zaprzeczyć tezie dotyczącej skuteczności masek, jako ochrony przez infekcją wirusową, zarówno osoby, która takową maseczkę stosuje, jak i osoby, która ma bliski kontakt z osoba takiej maseczki używającą, czyli zasłaniająca nią twarz.
- Sprawdźmy badania, które określają skuteczność maseczek, w zapobieganiu rozprzestrzeniania się wirusów. https://www.who.int/publications-deta… pod tym adresem znajduje się stanowisko WHO, w kwestii stosowania maseczek. „Jednak obecnie nie ma dowodów na to, że noszenie maski (medycznej lub innej) przez osoby zdrowe w Przestrzeni publicznej w tym powszechne maskowanie społeczności, może zapobiec zakażeniu wirusami układu oddechowego, w tym COVID-19.
- Badania: Cowling B (2010r.: żadne z podanych przeglądów badan nie wykazało korzyści z noszenia maseczki- zarówno w przypadku pracowników służby zdrowia, jak i ich rodzin.
- Faisal Bin Reza (2018 , przeprowadzono 17 badań spełniających niezbędne warunki (RTC). Żadne z nich nie wykazało jednoznacznego związku między noszeniem maseczki a/ używania respiratorów, a ochroną przed infekcją grypową.
- Smith JD (2016 r.), Znaleźliśmy 6 badań spełniających warunki stawiane randomizowanym badaniom kontrolnym klinicznym. W wyniku ich metanalizy, nie znaleźliśmy widocznych różnic między używaniem masek ochronnych N95, a maseczkami chirurgicznymi, w kwestii ryzyka min. infekcji grypowej.
- Radonowich LJ (2019), Spośród 2872 uczestników zrandomizowanych badań klinicznych, które ukończyło 2371 respondentów. Porównanie stosowania przez personel medyczny ambulatoryjny masek N95 i medycznych, nie wykazało istotnych różnic zachorowalności na potwierdzoną laboratoryjnie grypę.
- Ani RKI, WHO, CDC, , EDC, nie przedstawili danych naukowych potwierdzających skuteczność masek w miejscach publicznych ( w sensie zmniejszenia szybkości rozprzestrzeniania się wir. SARS COV2 ), ponieważ takie dane nie istnieją. – prof. Med. Ines Kappstein specjalista w zakresie mikrobiologii, wirusologii i epidemiologii.
Skoro więc nie ma badań, które mogłyby potwierdzić skuteczność używania maseczek, jako ochrony przed rozprzestrzenianiem się wirusów, w tym wirusa SARSCOV2, pozostaje pytanie, czy używanie takowych maseczek, czy to bawełnianych, chirurgicznych, czy N95, pozostaje obojętne dla naszego zdrowia. Odpowiedź na to pytanie jest o tyle istotna, ponieważ pomoże nam stwierdzić, czy przetrwałe używanie maseczek można stosować dla ewentualnej, potencjalnej ochrony, głównie psychicznej, czy też powoduje ono raczej szkody dla zdrowia osoby jej używającej. Inaczej mówiąc, czy używanie maseczek przynosi więcej szkody, niż pożytku, czy tez nie.
- Chciałem skupić się wyłącznie na tym, co jako stomatolog mogę zaobserwować w praktyce leczenia pacjentów oraz oprzeć się na doniesieniach innych stomatologów, którzy zaobserwowali zmiany w obrębie układu stomatognatycznego, które zaczęły się pojawiać w trakcie trwania tzw. pandemii oraz w trakcie przedłużającego się nakazu stosowania maseczek zasłaniających usta i nos w przestrzeni publicznej.
- Jak podają dane American Dental Association, pandemia spowodowała aż 59-procentowy wzrost przypadków zgrzytania zębami (bruksizmu), 53-procentowy wzrost przypadków urazów zębów np. pęknięcia lub złamania oraz 53-procentowy wzrost objawów związanych z zaburzeniami skroniowo-żuchwowymi (temporomandibular disorders – TMD), takich jak ból szczęki przy nagryzaniu czy trzaski i przeskakiwanie w stanie skroniowo-żuchwowym. Badanie przeprowadzone wśród 1800 osób z Polski i Izraela potwierdziło ogólne nasilenie objawów zgrzytania zębami, zaciskania szczęk i bólu szczęki podczas pandemii. Najbardziej narażone okazały się kobiety i osoby w wieku 35-55 lat. W tej grupie 48 proc. ankietowanych zgłosiło objawy TMD, 46 proc. zaciskanie szczęk po przebudzeniu, a 50 proc. miało epizody zgrzytania zębami w nocy.
- Pęknięcia zębów. Początkowo pęknięcia ograniczają się do zewnętrznej warstwy szkliwa, by stopniowo obejmować głębsze warstwy, w tym zębinę. – Zgrzytające zęby rozpoznamy początkowo po startym szkliwie i ich bardziej żółtym odcieniu, szczególnie na powierzchniach żujących trzonowców oraz ubytkach przyszyjkowych. Dodatkowo zęby mogą przemieszczać się w łuku np. wychylać do przodu, wydawać się krótsze, pojawić się może także nadwrażliwość. Ostatecznie w wyniku patologicznego zgrzytania może dojść do złamań, uszkodzeń prac protetycznych np. mostów czy koron, rozchwiania czy nawet utraty zębów – wyjaśnia dr Stachowicz.
- Pogłębienie wad ortodontycznych, głównie wad doprzednich ( przodozgryz, przodożuchwie, zgryz krzyżowy w odcinku przednim , ale i bocznym). Jest to związane z nienaturalnymi ruchami doprzednimi żuchwy i zaburzonym torem oddechowym, z nasileniem oddychania przez usta, w miejsce oddychania przez nos, zgrzytaniem i zaciskaniem zębów. Te wszystkie zmiany dostrzegalne są szczególnie u dzieci i młodzieży.
- Dodatkowym najczęstszym powikłaniem dermatologicznym , jednak rozpoznawanym w pierwszej kolejności przez stomatologa, jest trądzik i inne trądzikopodobne zmiany skórne w obrębie twarzy, szczególnie pojawiające się w obrębie dolnej części policzków oraz wokół ust.
- Zmiany składu i ilości oraz lepkości śliny, w tym suchość w jamie ustnej, co z kolei wpływa na stopień naturalnego oczyszczania powierzchni zębów, nawilżenia śluzówki jamy ustnej oraz wpływa na kondycję tkanek przyzębia oraz podłoża protetycznego u pacjentów stosujących zwłaszcza ruchome uzupełnienia protetyczne. Te zmiany prowadzą do szybszego tworzenia i odkładania osadu, a następnie kamienia nazębnego, który to kamień jest głównym czynnikiem wywołującym schorzenia tkanek przyzębia. Suchość w jamie ustnej sprzyja niszczeniu tkanej zęba, rozwojowi próchnicy. U osób protezowanych natomiast, zmiana składu śliny prowadzić może do pogorszenia utrzymania protez zębowych, do powstawania odleżyn, zmian grzybiczych, które mogą nie tylko utrudniać, ale nawet uniemożliwiać użytkowanie ruchomych uzupełnień protetycznych.
American Dental ASSociation, nie podaje maseczek jako główny czynnik wywołujący zmiany patologiczne w obrębie układu stomatognatycznego oraz zmiany w zakresie zachowań i patologicznych ruchów wykonywanych w stawach skroniowo- żuchwowych, warto jednak przyjrzeć się dokładniej mechanizmom, jakie sprzyjają powstawaniu powyżej przedstawionym zaburzeniom.
American Dental Association, jako główny czynnik tych wszystkich zmian, podaje przewlekły stres związany z przedłużającą się pandemią. Jest w tym dużo racji. Pozostaje jeszcze rozwiązanie zagadki, jakie są przyczyny wystąpienia tegoż stresu i czy tylko on ma na te patologiczne zmiany wpływ.
Korzystając z wywiadu i badania pacjentów odnośnie ich nawyków i zachowań, które uległy zmianie od marca roku 2020, porównując badania naukowe oraz wieloletnie doświadczenie medyczne w zakresie czynników, które mają wpływ na funkcjonowanie różnych organów i układów w ciele ludzkim, możemy wyróżnić kilka zasadniczych odmiennych postaw i zachowań:
- Noszenie maseczek zasłaniających ust i nos
- Dłuższy czas przebywania w mieszkaniu, szczególnie w przypadku dzieci. Co za tym idzie mniej przebywania na powietrzu, mniej kontaktu z rówieśnikami i innymi osobami
- Pogorszenie nawyków żywieniowych i higienicznych w odniesieniu do dbałości o jamę ustną. Więcej podjadania, rzadsze mycie zębów. Dodatkowo stosowanie używek (alkohol, papierosy, słodycze, napoje energetyczne), które dodatkowo wpływają na utratę minerałów i witamin oraz przyczyniają się do pojawienia się czy nasilenia refluksu żołądkowego, a ten z kolei poprzez kwasy żołądkowe dostające się do jamy ustnej, przyspiesza rozwój próchnicy oraz erozję szkliwa zębów.
- Mniej ruchu fizycznego, a jednocześnie wydłużony czas przebywania w pozycji siedzącej, bardzo często przed komputerem. Szczególnie w przypadku dzieci w wieku szkolnym, wprowadzenie zdalnego nauczania pogłębiło problem z ekspozycję na promieniowanie ekranów komputerów oraz nasilenie wadliwej postawy, która sprzyja wysuwaniu żuchwy.
Wszystkie powyższe czynniki, powodują zwiększenie stresu, jako reakcji organizmu na działanie czynników zaburzających jego naturalne funkcjonowanie. W związku z powyższym możemy zauważyć, że w rzeczywistości to nie sama pandemia wpłynęła na stan zdrowia naszej jamy ustnej, ale raczej wszelkiego typu obostrzenia i zalecenia, które w związku z tą pandemią wprowadził rząd i które to obostrzenia nadal podtrzymuje.
- Przyjrzyjmy się więc jaka rolę w powstawaniu wymienionych wcześniej zmian patologicznych w obrębie układu stomatognatycznego, pełni używanie maseczek. Aby to lepiej zanalizować, chciałbym wcześniej przytoczyć jeszcze kilka badań pokazujących wpływ stosowania maseczek na kondycję całego organizmu. Pozwoli to nam uświadomić jak poważne zmiany biochemiczne zachodzą w organizmie człowieka pod wpływem długotrwałego zasłaniania ust i nosa.
- https://pubmed.ncbi.nlm.nih.gov/26179… https://pubmed.ncbi.nlm.nih.gov/28278… badania, które pokazują jak niedotlenienie organizmu wpływa na zmniejszenie odporności organizmu, przez spowolniene, zmniejszenie produkcji czynników zapalnych, które warunkują walkę z infekcją.
- http://scielo.isciii.es/pdf/neuro/v19… https://pubmed.ncbi.nlm.nih.gov/18500… badania określające wpływ noszenia maseczek min. przez chirurgów, na spadek ich kondycji psych- fizycznej ( wzrost tętna, zmęczenie, bóle głowy, złe samopoczucie)
- https://www.ncbi.nlm.nih.gov/pubmed/1… badanie pokazujące jak noszenie maseczki powoduje niedotlenie organizmu. Wspomnę, że spadek saturacji do poziomu poniżej 90% jest wskazaniem do hospitalizacji. Kilkugodzinne stosowanie maseczki powoduje spadek saturacji nawet poniżej tej wartości. Co ciekawe, okazuje się, że długotrwałe poddanie organizmu na czynniki hamujące dopływ tlenu sprawia, że po początkowych objawach niedotlenienia, w postaci zmęczenia, bólów głowy itp., następuje pozorna adaptacja, która polega na tym, że organizm przestaje dawać objawy typowe dla niedotlenienia, które występują na początku, a przechodzi w stan niedotlenienia, w którym destrukcji niedotlenionych komórek układu nerwowego, nie towarzyszą objawy ostrzegawcze w postaci zmęczenia, senności, bólów i zawrotów głowy itp.
Analiza badań określających wpływ zasłaniania ust przy pomocy maseczek, na kondycję organizmu pokazuje, że maseczki wpływają na zmniejszenie odporności organizmu i możliwości walki z czynnikami patogennymi oraz jego zdolności do samo regeneracji.
Przyjrzyjmy się jaką reakcję organizmu wywołuje niedotlenienie organizmu, jeśli chodzi o zachowanie człowieka. Zmniejszona podaż tlenu wywołuje reakcje obronną, która ma prowadzić do pogłębienia oddechu celem zaczerpnięcia większej ilości powietrza. Jeśli jest to utrudnione jeśli istnieje przeszkoda ku wykonaniu tej czynności prowadzi do różnego rodzaju reakcji obronnych, czy reakcji „walki o oddech”.
- Jak zostało to wykazane, maseczka powoduje niedotlenienie organizmu. Aby zwiększyć podaż tlenu naturalną reakcją jest zdjęcie maseczki, która stanowi przesłonę utrudniająca jego dopływ. Dochodzi do ruchów wysuwających żuchwę, które mają na celu odepchnięcie maski od twarzy i zwiększenie przestrzeni do dopływu świeżego powietrza. Wraz z tymi ruchami następuje zwiększona praca mięśni żwaczy orz mięśni skrzydłowych wraz z jednoczesnym nasileniem ustnego toru oddychania, a zmieszenie oddychania przez nos, jako utrudnione przez maseczkę. Nasilenie pracy mięsni wysuwających żuchwę oraz ruchów żuchwy, nasila już istniejące objawy zgrzytania lub zaciskania szczęk i powoduje pojawienie się takowych para funkcji u osób, które ich nie miały do tej pory.
- Stres wywołany trudnością w dostępie do powietrza, czyli wywołany przeszkodą w oddychaniu, jaką jest maseczka nasila bruksizm, które to schorzenie jako jeden z głównych czynników etiologicznych wywołujących go, ma właśnie stres. Konsekwencją bruksizmu natomiast jest starcie zębów, pęknięcia zębów, utrata zębów, zmiany patologiczne w obrębie SSŻ, powodujące ścieranie powierzchni stawowych, bóle, trzaski, przeskakiwanie głowy stawowej. To w konsekwencji prowadzi nie tylko do bólu w samym SSŻ, ale tez do bólów głowy, ucha, a następnie zmęczenia , zmniejszenia koncentracji, spadku wydolności.
- Zmniejszona podaż tlenu, powiązana z zasłonięciem ust, czyli utrudnieniem odpływu wydychanego powietrza, prowadzi do wytworzenia wilgotnego środowiska, zanieczyszczonego przez toksyny i metabolity usuwane w naturalnych warunkach wraz z wydychanym powietrzem. Tworzy to środowisko do namnażania się patogenów, które zwiększają ryzyko infekcji, rozwoju grzybicy jamy ustnej, a w konsekwencji infekcji gardła i dalszych odcinków układu oddechowego. Prowadzi do zmiany ilości i składu chemicznego śliny. To wywołuje zapalenia przyzębia, nasilenie rozwoju próchnicy, zmiany zapalne błony śluzowej dziąseł, policzków, języka, powstawanie aft, odleżyn u pacjentów protetycznych. Następstwem tych zmian jest dyskomfort, który sprzyja zaburzeniom odżywiania, szczególnie pokarmów stałych i twardych, w miejsce płynnych i lepkich, które oklejają zęby i sprzyjają zaleganiu jedzenia, utrudniają doczyszczenie przestrzeni międzyzębowych i samych zębów, a ostatecznie sprzyja rozwojowi próchnicy zębów. U pacjentów protetycznych sprzyja niedożywieniu chociażby poprzez zaniechanie używania protez zębowych, czy też utrudnienie rozdrabniania pokarmu przy bolącym podłożu protetycznym i w konsekwencji obciążeniu układu pokarmowego nierozdrobnionym mechanicznie pokarmem.
- Maseczka zasłaniająca twarz zmniejsz dotlenienie skóry twarzy. Wilgotne środowisko pod maseczką, zmiana toru przepływu wydychanego powietrza, powoduje drażnienie skóry i nasilenie zmian skórnych, w tym trądzikowych.
- Opisane wcześniej mechanizmy, przyczyniające się do nasilania objawów bruksizmu, które w połączeniu z innymi czynnikami jak para funkcje, nieprawidłowa postawa ciała nasilona przez zwiększony czas przebywania przed ekranem monitora, prowadzą do nasilenia lub wystąpienia wad ortodontycznych, głównie poprzednich.
Podsumowując analizę korzyści i skutków stosowania maseczek zasłaniających usta i nos trudno jest stwierdzić, że istnieją jakiekolwiek powody ku temu, aby takowe maseczki stosować. Badania naukowe oraz doświadczenie stomatologiczne pokazują natomiast, że przy braku korzyści polegających na zmniejszenie transmisji zakażenia, występuje cały szereg negatywnych następstw z samego chociażby zakresu stomatologii. Zasadnym jest więc nie stosowanie przewlekłego zakrywania ust i nosa i w ten sposób zadbanie o zdrowie i bezpieczeństwo nasze i przyszłych pokoleń.
Na koniec coś dla rozluźnienia ☺
Podam jedno wskazanie do stosowania masek zasłaniających usta, choć niekoniecznie nos. Braki zębowe, zwłaszcza pacjentów protetycznych, jako sposób ukrycia tych braków. Podkreślić jednak należy, że takie stosowanie masek może być tylko czasowe, do momentu uzupełnienia takowych braków przy pomocy uzupełnień protetycznych.
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