Dental Asia January/February 2024

CLINICAL FEATURE
The harmful effects of masks include
increased irritability and headaches, 18
face mask dermatitis, 19 increased rates
of caries and gingivitis, 20 and bacterial
and fungal contamination. 21 Alterations in
oxygen and carbon dioxide blood levels
and changes in respiratory physiology
and function among other harmful effects
of masks including their ineffectiveness
are comprehensively discussed by Dr J
Meehan in, ‘An Evidence Based Scientific
Analysis of Why masks are Ineffective,
Unnecessary, and Harmful’. 22
It has been reported that each surgical
and N95 face mask releases more than a
billion nanoplastics and microplastics. 23
Although their pathological effects are
unknown, these miniscule particles have
been detected in the nasal mucosa and
blood of mask wearers. 23,24 The possibility
exists of titanium dioxide, a potential
carcinogen, being inhaled from the
synthetic fibres of face masks. 25
By 2021, surgical and N95 masks were
major components of eight million
tonnes of COVID-related plastic waste. 26
In landfills these plastics leach toxic
chemicals and their disposal in the
oceans leads to ingestion by seabirds
and marine animals. The environmental
and ecological degradation from this
humongous mass of mask induced
pollution is unfathomable.
If masks were a drug or new surgical
treatment, they would not be approved
as their identified harms outweigh any
tangible benefits.
COCHRANE REVIEW
The Cochrane Collaboration, based in
London, England, is an independent
not-for-profit international network of
researchers. By adopting meta-analytical
methods which limit biases, random
errors and increases the statistical power
of its conclusions, the Collaboration has
earned a global reputation for providing
the highest standard in evidence-based
healthcare. 27
Randomised trials, the gold standard
for medical research, are a major focus
of the Collaboration. Such a trial for
masks would consist of the subjects
being divided at random into two
groups: one with masks, one without
masks, balanced by age, sex, and
other pertinent characteristics. The
Collaboration has been conducting
meta-analysis reviews on physical
interventions, including masks, to
reduce respiratory viral transmissions
since 2006.
The latest review of 11 new and 67
previous randomised trials involving
a total of 610,872 participants was
released in January 2023. 28 It is a
comprehensive, detailed 324-page
report including results pertinent to the
H1N1 pandemic, SARS, and COVID-19.
Significant findings are as follows:
First, moderate degree of certainty
that wearing masks compared to not
wearing masks in the community
makes little to no difference to the
outcome of influenza-like and COVID-
19-like illness.
Second, moderate degree of certainty
that wearing masks compared to not
wearing masks in the community
makes little or no difference to the
outcome of laboratory-confirmed
influenza/SARS-CoV-2.
Third, moderate degree of certainty
that the use of N95/P2 respirators
compared to surgical masks probably
makes little to no difference for the
objective and more precise outcome
of laboratory-confirmed influenza
infection.
Fourth, there were no clear differences
between the use of medical/surgical
masks compared with N95/P2
respirators in healthcare workers
when used in routine care to reduce
respiratory tract infection.
Fifth, there is a moderate level of
confidence in the accuracy of the
above findings; and lastly, potential
harms of wearing masks were rarely
reported and poorly measured.
Accepting that the Cochrane Reviews
are based on sophisticated statistical
analyses of human behaviour, the latest
review supports the results of previous
ones that — with as much certainty
as it is possible to have — masks and
respirators provide neither meaningful
nor observable benefits regarding the
prevention of respiratory infections.
IN SUPPORT OF THE COCHRANE
REVIEW
On 7 Apr 2023, St George’s Hospital
London, released the results of a
study which showed that surgical
mask use made no appreciable
difference in reducing hospital acquired
COVID-19 infections. The results of
this investigation was presented at the
April 2023 meeting of the European
Congress of Clinical Microbiological
and Infectious Diseases. 29
CONCLUSION
The enthusiastic intuitive adoption of
mask mandates because “they must do
some good” ignored the effects of viral
desiccation and size, dismissed the
absence of any historical and scientific
support, and disregarded their obvious
harms.
Mandating mask use must be
supported by the highest level of
evidence. This requires clinically
derived substantiation that masks
and respirators categorically prevent
the transmission of respiratory viral
infections. The recent Cochrane review
demonstrates that such validation does
not exist.
Regulatory authorities must admit
that any advantages that might accrue
from masks and respirators are
outweighed by many countervailing
factors, the most important of which
are their harmful effects and the lack
of evidence that they are effective.
They would not survive a risk/benefit
analysis. Failure to appreciate these
facts is indicative of the arrogance of
those advocating mask mandates and
their total ignorance of the scientific
database.
DENTAL ASIA JANUARY / FEBRUARY 2024 35