Mouthguard Use and Awareness of Junior Rugby League Players in the Gold Coast, Australia: A Need for More Education

Mouthguards Based on the Shear-Stiffening Effect: Excellent Shock Absorption Ability with Softness Perception

Mouthguards are used to prevent craniomaxillofacial injuries when collisions happen during contact and high-speed sports. However, poor compliance with mouthguard wear in athletes is attributed to discomfort because of its thickness and hardness. These drawbacks significantly restrict their protective performance for oral tissues and applications during contact sports; as a result, the incidence of craniomaxillofacial injuries increases. In this study, non-Newton material is introduced into mouthguard material and then a mouthguard with shear-stiffening behavior is fabricated, which is named the shear-stiffening mouthguard (SSM). Compared with commercial mouthguard materials (Erkoflex and Erkoloc-pro), SSMs show remarkable enhancement of shock absorption ability with an approximately 60% reduction in peak force relative to commercial materials and approximately 3-fold extensive buffer time. Moreover, Young's modulus of SSMs (average 0.48 MPa) is extremely lower compared to commercial materials (22.88 MPa for Erkoflex and 26.71 MPa for Erkoloc-pro). This manifests that SSMs have not only excellent shock absorption ability but also softness perception. Moreover, SSMs show biocompatibility in vitro. In conclusion, this work provides a platform to develop a new type of thin and soft mouthguard with a shear-stiffening effect and broadens the horizon in protecting oral tissues with shear-stiffening materials.

The use of mouthguards and related factors among basketball players in Indonesia

BACKGROUND

Basketball is a sport with a higher injury rate. Regardless, few basketball players use mouthguards, which predisposes them to injuries. The use of mouthguards (UoM) could be related to several factors. This study aims to identify factors associated with UoM and to construct a model from the factors among basketball players in Indonesia.

METHODS

Through convenience sampling, a total of 286 among basketball players in Indonesia was included in this cross-sectional study. These participants filled out online a modified questionnaires regarding demographic and several factors related to UoM. The data was analyzed using chi-square test, independent-sample t-test, binary logistic regression, and structural equation modeling (SEM).

RESULTS

There were 286 players. 127 of them were males and 159 were females. Of them, 86 (30.1%) used mouthguards. Age, duration (in year), and weekly practicing basketball (in hour) were all significantly different between mouthguards users and non-users with (p = 0.005, p = 0.036 and p = 0.035), respectively. The UoM was significantly associated with level of awareness, injury experience, social support, and oral health professional (OHP) support with (p = 0.002, p < 0.001, p < 0.001 and p < 0.001), respectively. This result was also supported by a variety of variables' ORs, which range from 1.28 to 5.97. The coefficient of determination (R2) was 0.27.

CONCLUSIONS

The UoM among basketball players in Indonesia was related to several factors, including the level of knowledge, level of awareness, duration of basketball career, injury experiences, social support, and oral health professionals' support which was constructed to propose a model. The model could explain 27% of the relationship between variables and UoM among Indonesian basketball players. This model will be useful for more comprehensive initiatives to promote oral health. It might be applicable for other countries as well as other sports communities / physical activities.

Impacts of educational interventions on the knowledge of prevention and emergency management of traumatic dental injuries in 11-17-year-old martial arts athletes: a randomized controlled trial

PURPOSE

We compared the effect of an educational pamphlet and a mobile application regarding prevention and emergency management of sport-related traumatic dental injuries (TDIs) on knowledge and self-reported preventive practice of 11-17-year-old Karate and Taekwondo athletes.

METHODS

Participants were invited through an online link published by the Public Relations of the corresponding federations. They completed an anonymous questionnaire consisting of demographics, self-reported experience of TDIs, knowledge of emergency management of TDIs, self-reported preventive practice of TDIs, and the reason for not using mouthguard. The respondents were randomly allocated to pamphlet or mobile application group with the same content. Three months after the intervention, the questionnaire was completed by the athletes again. Repeated measures ANOVA and a linear regression model served for statistical analysis.

RESULTS

In pamphlet group, 51 athletes and in mobile application group 57 athletes completed both baseline and follow-up questionnaires. At baseline, the mean score was 1.98 ± 1.20 and 1.82 ± 1.24 (out of 7) for the knowledge and 3.70 ± 1.64 and 3.33 ± 1.95 (out of 7) for practice in the pamphlet and application group, respectively. In 3-month follow-up, the mean score of knowledge and self-reported practice was significantly higher compared to baseline in both groups (p < 0.001) with no statistically significant difference between the two groups (p = 0.83 and p = 0.58, respectively). Most of the athletes were very satisfied or satisfied with both types of the educational intervention.

CONCLUSION

Both pamphlet and mobile application seem to be useful to improve awareness and practice regarding TDI prevention in adolescent athletes.

Assessment of mouthguards worn by Irish children playing contact sports: an observational cross-sectional cohort study

PURPOSE

Traumatic dental injuries occur during participation in sports. Prevention of these injuries by wearing a mouthguard (MG) is desirable, especially in a paediatric population. There are several types of MG available, and their effectiveness depends on device design. The aim of this study was to examine the features of MG worn by children playing a contact sport (Gaelic football), and to determine whether these MG fulfilled recommendations for adequate dentoalveolar protection.

METHODS

A cross-sectional observational cohort study design was developed. Dentists were trained and calibrated in assessing MGs, both qualitatively (retention, extension, integrity) and quantitatively (thickness). A convenience sample of male and female subjects aged 9-16 years was selected for MG assessment via their sports clubs. Data were collected anonymously and analysed using descriptive and comparative statistics.

RESULTS

One hundred and six children presented with their MG for assessment. Two-thirds were wearing mouth-formed MG (N = 71, 66.96%). Only four were wearing custom MG (3.77%). Most MG had inadequate retention (N = 86, 81.13%) and labial extension (N = 89, 83.96%), with a significant relationship between MG type and retention. Mouthguard thickness varied widely at each site. Mouth-formed MG were significantly thicker than both stock and custom MG.

CONCLUSIONS

Mouth-formed MG were the most common type followed by stock MG. Most MG did not have appropriate retention or labial extension. Parents and coaches need to be aware of MG features that maximise protection. If mouth-formed MG are provided in this age group, education on how to adapt them is essential. Paediatric dentists should check MG routinely for appropriate fit.

Self-reported experience of orofacial injury, preventive practice, and knowledge of Iranian adolescent martial art athletes towards sports-related orofacial injuries

BACKGROUND

Increased engagement of adolescents in martial arts exposes them to a relatively high risk of experiencing orofacial injuries. We evaluated self-reported experience of orofacial injuries, preventive practice, and knowledge of management of sport-related orofacial injuries and related factors in adolescent Karate and Taekwondo athletes in Iran.

METHODS

This cross-sectional study was conducted on Iranian martial arts athletes including Karate and Taekwondo aged 11-17-year-old in 2020 via an online questionnaire. The anonymous self-administrated questionnaire had four parts: background (age, gender, duration of sports activity, training sessions per week, and previous education on orofacial injury); self-reported experience of orofacial injury; preventive practice including mouthguard and helmet use; and knowledge of emergency management of orofacial injuries. Preventive practice and knowledge scores were calculated by summing up the scores of corresponding questions (possibly range 0-7). A linear regression model and the Pearson correlation served for statistical analysis.

RESULTS

Totally, 295 athletes with a mean age of 14.56 ± 1.91 years participated in the study. A quarter (n = 74, 25.1%) of athletes stated that they had received training on prevention of orofacial injuries. Only 3.7% (n = 11) of the participants reported the use of custom-made mouthguards, and 62% (n = 183) reported a positive history of orofacial injuries. A significant relationship existed between self-reported orofacial injury and age (β = - 0.32, p < 0.001), hours of training per week (β = 0.12, p = 0.037), type of sport (β = 0.11, p = 0.049), and previous training on orofacial injuries (β = - 0.14, p = 0.010). No difference existed in the history of orofacial injury between females (n = 114) and males (n = 69) (p = 0.374). The mean score of self-reported preventive practice and knowledge of management of orofacial injuries was 3.53 ± 1.82 (out of 7) and 1.67 ± 1.10 (out of 7), respectively. Age (β = 0.19, p = 0.002) and history of orofacial injury (β = - 0.15, p = 0.010) were associated with the score of self-reported preventive practice. Female athletes (β = 0.11, p = 0.048) and athletes who exercised more per week (β = 0.15, p = 0.012) had significantly more knowledge on management of orofacial injuries.

CONCLUSION

Adolescent athletes had relatively undesirable preventive practices and a distinct lack of knowledge. The high occurrence of self-reported orofacial injuries indicates the importance of more education and stricter rules for the athlete population.

Attitudes and opinions towards the prevention of orofacial injuries among water polo coaches in Catalonia: A cross-sectional study

BACKGROUND/AIM

Although orofacial injuries are frequent in water polo, fewer than 10% of players use mouthguards. The aim of this study was to determine the degree to which coaches and sports club managers encourage mouthguard use in water polo and to explore their opinions regarding other strategies designed to reduce the prevalence of orofacial injuries.

MATERIAL AND METHODS

This was a cross-sectional study in which the coaches and sports club managers of 16 water polo clubs in Catalonia were invited to participate. An online questionnaire was administered to the coaches to obtain general data, to determine whether they had recommended mouthguard use to their players and to record their opinions on other strategies designed to reduce the prevalence of orofacial injuries. Sports club managers were interviewed about the facilities offered by their clubs for players to obtain mouthguards and about their attitudes regarding the prevention of orofacial injuries.

RESULTS

The questionnaire was administered to 72 coaches who trained 111 teams during the 2019-2020 season, together with 14 sports club managers. Coaches of only 11 teams (10%) recommended mouthguard use to their players. Two clubs (14%) offered some facilities to their players to obtain mouthguards. Interestingly, only 18% of the coaches believed that mouthguard use should be mandatory, in contrast to 50% of the sports club managers (p = 0.017; Fisher's exact test). Most coaches and sports club managers believe that a video monitoring system should be used to identify dangerous play and that orofacial injuries should be reported under a surveillance programme.

CONCLUSIONS

Few water polo coaches recommend mouthguard use to their players and very few clubs offer facilities to obtain custom-made oral protection. However, most coaches and sports club managers agree that the rules should be modified to protect players from aggressive play.

Traumatic Dental Injuries, Treatment, and Complications in Children and Adolescents: A Register-Based Study

Objective  Traumatic dental injury (TDI) is a common dental concern among children worldwide. We performed a retrospective patient register study among children under 18 years to investigate TDIs with respect to causes, treatment, and complications.

Materials and Methods  We collected information on TDIs from the original patient records of 407 child patients visiting dental clinic of Lithuanian University of Health Sciences, Kaunas, Lithuania. We analyzed all child patients’ ( n = 407) background, cause, type of TDI, treatment, complications, and time elapsed from injury to visit to the dentist.

Statistical Analysis  The χ² -test, analysis of variance (ANOVA), and Kruskal–Wallis and Mann–Whitney tests served in the statistical analyses.

Results  A total of 579 TDI cases occurred during 2010 to 2016. Lateral luxation (19.8%) and intrusion (14.8%) occurred more often in the primary than the permanent dentition ( p < 0.05). The most common cause of TDI was falling (56%). Avulsion occurred in approximately 10% of cases. Follow-up (44.5%) and tooth extraction (48.3%) were the most frequent treatments in the primary and splinting (25.3%) in the permanent teeth. Pulp necrosis was the most frequent complication in primary (92%) and permanent (54%) dentition. About 1% of the patients obtained dental care during the first hour after injury.

Conclusion  The most frequent TDIs included lateral luxation in primary teeth and enamel-dentine fractures in permanent teeth. We observed a delay in patients obtaining emergency dental care.

Effects of Custom-made Mouthguards on Cardiopulmonary Exercise Capacity

The importance of using mouthguards as well as their low acceptance rate have been demonstrated. The aim of this study was to investigate the influence of customized mouthguards on hemodynamics.. This randomized crossover study used data from 13 subjects (23.5±1.4 years). The cardiopulmonary and metabolic parameters were observed during ergometer tests without mouthguard (control) in comparison to two types of mouthguards (with and normal without breathing channels). Maximum ventilation was significantly decreased with the normal mouthguard (113.3±30.00 l ∙ min^-1) in contrast to the mouthguard with breathing channels (122.5±22.9 l ∙ min^-1) and control (121.9±30.8 l ∙ min^-1). Also the inspiration time was longer when using the normal mouthguard (0.70±0.11 s) compared to the mouthguard with breathing channels (0.63±0.11 s) and control (Co 0.64±0.10 s). Lactate was also increased under the influence of the mouthguard with breathing channels (10.72±1.4 mmol ∙ l^-1) compared to the control (9.40±1.77 mmol ∙ l^-1) and the normal mouthguard (9.02±1.67 mmol ∙ l^-1). In addition, stroke volume kinetics (p=0.048) and maximum heart rates (p=0.01) show changes. Despite equal levels of oxygen uptake and performances under all three conditions, the use of mouthguards showed differences in cardiopulmonary parameters. The use of mouthguards during exercise does not affect physical performance and can be recommended for injury prevention.

Orofacial trauma and mouthguard use in Brazilian rugby union players

BACKGROUND/AIM

Rugby union represents a high-risk sport for orofacial trauma due to its impact collisions and repetitive tackles. The aim of this study was to investigate the prevalence of orofacial trauma according to mouthguard use among a sample of Brazilian rugby union players.

METHODS

An online questionnaire was sent to the 16 best rugby union clubs in Brazil. The questionnaire contained questions about the training history of each athlete, prevalence of orofacial trauma, and details about mouthguard use. Only participants who reported using a mouthguard were selected for this analysis.

RESULTS

A total of 244 individuals were included. The prevalence of orofacial trauma was 34.4%, and 61.9% of them did not wear a mouthguard at the time of the incident. The only type of mouthguard reported was the pre-fabricated ("boil and bite" and "ready-to-wear") type. A stronger association was observed between the reason for using a mouthguard and the outcome, whereas a lower proportion of trauma was observed among individuals who claimed mandatory mouthguard use at the gym/sport (20.0%). Time since the respondent started playing rugby union and who instructed them to use a mouthguard were not associated with orofacial trauma.

CONCLUSION

Prevalence of orofacial trauma was high among this sample of rugby union players from Brazil, even with the use of pre-fabricated mouthguards. This study encourages further investigation on the use of custom-made mouthguards in rugby union and the role of coach/physical educators to reduce the prevalence of orofacial trauma.

Improving the Wearing Rate of Mouthguards in the Youth Rugby Category Affects the Total Future Mouthguard Wearing Rate

The aim of this study is to consider the hypothesis that wearing mouthguards (MGs) from a young age helps to shape players’ habit of continuing to wear MGs as adults. In addition, we consider the mandatory rule of wearing mouthguards in the youth category on the future wearing rates of mouthguards. Eighty-five Japanese male amateur rugby players were included in this study. We examined the relationship between the wearing rates of mouthguards when participants were high school students and as adults (in 2018) using a questionnaire. Collected data were classified into categories (age, mouthguard type, and applied mandatory rule or not), and their relationships were analyzed. The wearing rate of mouthguards in high school was significantly related to the wearing rate of mouthguards in adulthood (χ2 = 12.1, p < 0.01). The mandatory rule to wear mouthguards at high school was related to the wearing rates of mouthguards as adults, but not significantly (χ2 = 3.42, p = 0.06). Participants’ mouthguard wearing rates as adults were affected by their high school wearing rates. The mandatory rule of wearing mouthguards in the youth category may be somewhat effective for improving mouthguard wearing rates; however, it is more important to provide knowledge about their importance.

Oral health and microbiota status in professional rugby players: A case-control study

OBJECTIVE

Elite athletes are prone to develop oral diseases, which could increase the risk for injuries. The aim of this study was to evaluate the oral health and the composition of oral microbiota of elite rugby players compared to the general population.

METHODS

We set up a case-control study by screening 24 professional rugby players (PRG) and 22 control patients (CG) for dental and gingival examinations and performed a taxonomic analysis and a predicted functional analysis of oral microbiota.

RESULTS

The Decay, Missing and Filled (DMF) teeth index (5.54 ± 6.18 versus 2.14 ± 3.01; p = 0.01) and the frequency of gingivitis (58,33% versus 13.63%) were significantly increased in PRG compared to CG. PRG were characterized by a dysbiotic oral microbiota (Shannon Index: 3.32 ± 0.62 in PRG versus 3.79 ± 0.68 in CG; p = 0.03) with an increase of Streptococcus (58.43 ± 16.84 versus 42.60 ± 17.45; p = 0.005), the main genus implicated in caries. Predicted metagenomics of oral microbiota in rugby players was suggestive of a cariogenic metagenome favourable to the development of caries.

CONCLUSIONS

Our study shows that the oral health of PRG was poorer than the general population. PRG are characterized by a dysbiotic oral microbiota with an increase of the relative abundance of Streptococcus genus, positively correlated to the weight and negatively correlated to the diversity of oral microbiota.

CLINICAL SIGNIFICANCE

Dental screening should be included in the medical follow-up of professional rugby players as a part of their health management. New strategies such as using probiotics like Lactobacillus could help to control the dysbiosis of oral microbiota.

Is there enough evidence that mouthguards do not affect athletic performance? A systematic literature review

BACKGROUND

Although there is evidence that mouthguards prevent orofacial trauma occurrence during sport practice, the influence of this device on athletic performance has not been systematically quantified.

OBJECTIVES

We aim to systematically review the literature to determine the effect of mouthguards on athletic performance and if the type of mouthguard influences this overcome.

MATERIALS AND METHODS

A comprehensive search was performed in the Systematic Electronic Databases: Pubmed, Scopus, Web of Science and the Cochrane Library from their inception to February 2017. The publications were grouped based on their outcome: (i) the use of mouthguards; or (ii) the type of mouthguards. We conducted descriptive analyses and quality assessments of the included studies.

RESULTS

The search identified 489 citations. After screening the studies, we identified 15 trials comprising a population of 312 athletes. According to the risk of bias evaluation, nine studies were considered 'high' risk of bias, and six 'low' risk of bias. Overall, custom-made mouthguards did not interfere or improve athletes' performance when compared with the control group (without mouthguard). Custom-made mouthguards showed the smallest range of changes in players' performance compared with other types of mouthguards.

CONCLUSIONS

This systematic review provides evidence for sports professionals to advocate the use of custom-made mouthguards to prevent injury, and these devices do not impair performance. The scientific evidence should be interpreted carefully because there is a great variability in outcome measures and lack of important methodological details.