Professional karate-do and mixed martial arts fighters present with a high prevalence of temporomandibular disorders

Occupations associated with treatment seeking and biopsychosocial functioning at a tertiary orofacial pain clinic: A cross-sectional study

BACKGROUND

The aim of this study was to describe whether certain occupations were over- or underrepresented and to compare biopsychosocial functioning by types of occupation and employment status among adults seeking orofacial pain (OFP) treatment.

METHODS

The authors extracted self-reported employment status, occupation, and biopsychosocial functioning from initial appointment records of 444 treatment-seeking adults at a university-affiliated OFP clinic. The authors categorized occupations in major and minor occupational groups according to the 2018 Standard Occupational Classification. The authors compared proportions between their sample and the corresponding state level, using a ratio and 95% CI (1.00 = equal representation in sample vs state, < 1.00 = underrepresentation, > 1.00 = overrepresentation).

RESULTS

Among major occupational categories, health care practitioners and technical occupations were the most common in the study sample (22.4%) and the second most overrepresented (ratio, 3.20; 95% CI, 2.59 to 3.97) after the arts, design, entertainment, sports, and media occupations (ratio, 3.95; 95% CI, 2.15 to 7.26). Among minor occupational categories, teachers and instructors were the most common in the study sample (11.2%) and the most overrepresented (ratio, 90.71; 95% CI, 65.67 to 125.30), followed by managers (ratio, 43.87; 95% CI, 29.61 to 64.99) and photographers (ratio, 40.89; 95% CI, 10.23 to 163.4). No differences were observed in biopsychosocial functioning between major occupational categories. However, those not working due to health reasons or disability had worse biopsychosocial functioning (insomnia, anxiety and depression, life satisfaction, sleep health, pain intensity, pain-related interference; all P < .034) than those who were employed.

CONCLUSIONS

Several occupations are strongly over- and underrepresented among adults seeking OFP treatment. Differences were not explained by biopsychosocial functioning.

PRACTICAL IMPLICATIONS

Future research should attempt to identify and address the underlying mechanisms of association between occupation and seeking care for OFP.

Cranio-Maxillofacial Injuries in Mixed Martial Arts

PURPOSE

To describe a case of a maxillofacial trauma that occurred during a mixed martial arts (MMA) match and to perform a literature review of maxillofacial injuries related to MMA match to determine whether preventive models are applicable.

METHODS

The authors described a maxillofacial injury with orbital and optic nerve involvement that happened during a professional MMA match. A literature review on maxillofacial trauma in MMA was conducted on Scopus and Pubmed with specific keywords.

RESULTS

Open reduction and internal fixation of the maxillofacial complex fractures with right eye optic neuropathy following an MMA match is described. Six articles were selected for the description of trauma in the maxillofacial complex associated with MMA fights.

DISCUSSION

Literature has paid little attention to injuries during MMA matches. The most common injury locations that emerged from the literature review were the head, face, and neck. Middle facial third injuries were the most common type. Frequently the injury involved the ophthalmic area.

CONCLUSIONS

The timing of maxillofacial trauma in MMA is critical. Protective devices should be strongly promoted to prevent catastrophic consequences.

Clinical findings and self-reported oral health status of biathletes and cross-country skiers in the preseason - a cohort study with a control group

This cross-sectional study aimed to compare clinical oral conditions as well as the self-reported oral health status of biathletes and cross-country skiers (A) to age- and gender-matched non-athletic controls (C). Thirty-one A and 68 C were examined in 2020 regarding caries experience (DMF-T), partially erupted wisdom teeth, non-carious tooth wear (erosion), dental plaque biofilm, gingival inflammation, periodontal screening (PSI), salivary active matrix-metalloproteinase-8 (aMMP-8) test and screening for temporomandibular disorders (TMD). Questionnaires recorded periodontal symptoms, TMD symptoms and oral health behaviour. Group A had a lower prevalence of carious teeth and positive aMMP-8 tests, but more of them had severe gingivitis and signs of periodontitis. Both groups reported similar oral health behaviour. Only in group C, associations between aMMP-8 and periodontal findings as well as clinical findings and self-reported symptoms of TMD were identified. Group A showed a high prevalence of oral inflammation and seemed to be less aware of oral symptoms. Clinical examination seems to be necessary for periodontal/TMD screening of athletes.

Effects of Contact Sports on Temporomandibular Disorders: An Observational Study

The study investigated the prevalence of temporomandibular disorders in 100 competitive athletes in contact sports, equally grouped by the practiced game: Soccer (SoG), Rugby (RG), American Football (AFG), Boxing (BoG), Basketball (BaG), compared to a randomly control group of 20 non-athletes (CG). Symptoms and signs were examined according to the standardized Diagnostic Criteria for Temporomandibular Disorders through a questionnaire and clinical evaluation. Arthralgia showed significant differences between RG and CG and between AFG and CG (p < 0.05). Study groups reported masticatory muscle pain during function, neck and shoulder pain more frequently than CG, except for BoG. Closing click was significantly more present in study groups than CG, while crepitation was significantly higher only in RG and AFG. The deviation was wider in SoG, RG and AFG compared to CG (p < 0.05). Tukey’s multiple comparisons test showed a statistically significant reduction in right laterotrusion in RG vs. CG (p < 0.05); the comparison showed a decrease in right laterotrusion in RG vs. SoG and BoG (p < 0.05), a decrease in endfeel in RG vs. CG, BaG and AFG (p < 0.05). The data seem to support a relationship between the prevalence of TMD symptoms and signs in competitive athletes in contact sports, especially in RG and AFG compared to CG.

Impact of sports on temporomandibular dysfunction: a comparison of competitive and recreational female athletes as well as female non-athletes

Objectives

The present study was conducted to investigate the correlation between (competitive) sports and the occurrence of temporomandibular dysfunctions (TMD) by comparing the prevalences in competitive, recreational, and non-athletic women.

Materials and methods

A total of 138 women between the ages of 18 and 45 were interviewed about symptoms of TMD by means of a questionnaire. Based on their athletic performance level, the participating women were classified as competitive athletes, recreational athletes, or non-athletes (each group n = 46).

Results

Symptoms of TMD were notably less frequent in competitive female athletes (52.2%) than in recreational female athletes (63.0%) and female non-athletes (60.9%). With increasing training load, the prevalence of TMD decreased in both the competitive and recreational female athlete groups.

Conclusions

Athletic activity in general seems to have a positive effect on the occurrence of TMD. Competitive female athletes appear less likely to suffer from symptoms of TMD than recreational athletes and non-athletes. One possible explanation for this could be the better supervision by qualified trainers and physiotherapists in competitive sports.

Clinical relevance

Patients should be motivated to engage in sports as a protective measure against symptoms of TMD. However, it is important to ensure that they are properly instructed by experienced personnel in order to avoid unphysiological strain and negative consequences.

Orofacial conditions and oral health behavior of young athletes - a comparison of amateur and competitive sports

PURPOSE

This retrospective cross-sectional study aimed to evaluate oral health status (dental, periodontal and functional) and oral health behavior in young German athletes including the comparison of competitive (CA) and amateur sports (AA).

METHODS

Data of CA (German national teams, perspective and youth squads) and AA aged between 18 and 30 years with an available oral examination in 2019 were included. Clinical examination: caries experience (DMF-T), non-carious wear (erosion, BEWE), partially erupted wisdom teeth, gingival inflammation (PBI), plaque index, periodontal screening (PSI), and temporomandibular dysfunction (TMD) screening. Questionnaires: oral health behavior, periodontal symptoms.

RESULTS

88 CA (w = 51 %, 20.6 ± 3.5 years) of endurance sports and 57 AA (w = 51%, 22.2 ± 2.1 years) were included. DMF-T was comparable (CA: 2.7 ± 2.2, AA: 2.3 ± 2.2; p = 0.275) with more D-T in CA (0.6 ± 1.0) than AA (0.3 ± 0.7; p = 0.046; caries prevalence: CA: 34 %, AA: 19 %; p = 0.06). Both groups had low severity of erosion (BEWE about 3.5). CA had more positive TMD screenings (43 % vs. 25 %; p = 0.014). In both groups, all athletes showed signs of gingival inflammation, but on average of low severity (PBI < 1). More CA needed complex periodontal treatment than AA (maximum PSI = 3 in 40% vs. 12%; p < 0.001). Oral health behavior was comparable (daily tooth brushing, regular dental check-ups in > 70%).

CONCLUSIONS

Young German athletes (CA and AA) generally showed signs of gingival inflammation and needed to improve their oral health behavior. CA showed slightly increased oral findings (more D-T, periodontal and TMD screening findings) than AA, but similar oral health behavior. This may imply an increased dental care need in competitive sports.

INVESTIGATION OF PLANTAR PRESSURE AND PLANTAR IMBALANCES IN THE STATIC PHASE OF KARATE DO ATHLETES

The study aims to investigate the parameters offered by the baropodometric examination on a group of athletes practicing the martial art Karate Do (20 subjects, 16 girls and 4 boys, average age 13.55 ± 2.74, height 163 cm ± 8.47 , weight 54.50 kg ± 8.84, BMI (body index mass) of 20.46 ± 2.90 and seniority in sports activity of 5.27 years ± 2.74). The purpose of the research is to determine the changes related to the value of the plantar surfaces, the pressures for the dominant and non-dominant lower segments, the positioning of the pressure center in relation to the support polygon and the imbalances in the sole of the foot. The testing was performed using the FreeMed baropodometric platform and the FreeStep by Sensor Medica software, in the last week of February 2021, at the Research Center for Human Performance within the Faculty of Physical Education and Sports, “Dunărea de Jos” University from Galați. Results: Placing the maximum pressure point / P.max in the forefoot area is an exception, only one case being reported with this distribution, the rest having P.max located at the rearfoot level. Comparison of the averages between the variables recorded for the left foot vs. the right foot highlights higher values of the dominant / right foot, but these differences are significant only for the values of the plantar pressure in the forefoot area and for the total load on the entire plantar surface / total load (p <.05). The comparison between the averages of the surfaces and the loads of each separate foot (for the forefoot and rearfoot areas) highlights major differences only for the values of the contact surfaces, the forefoot area being significantly larger than the rearfoot area (p <.05). Close average values with small and insignificant differences are reported for each foot between the forefoot and rearfoot areas when comparing the body pressure / load percent and weight ratio percent, indicating a balanced pressure distribution between the front and back area for each leg. The investigation was also useful by detecting the existing imbalances at the plantar level, for one or both legs, being also reported cases of hollow, flat and mixed foot. These plantar disturbances can negatively affect all the overlying / upper joints, but especially the body posture, thus being able to cause pain in the lumbar region, limiting the performance activity and causing even the withdrawal of the athletes. We recommend that after identifying the syndromes at the ankle joint, to implement personalized plantar supports, which should be introduced in sports shoes in order to balance the architecture of the foot sole. Keywords: karate do, plantar pressures, baropodometric analysis, load, rearfoot, forefoot, maximum pressure,

Effects of competitive sports on temporomandibular dysfunction: a literature review

OBJECTIVES

The German Society of Craniomandibular Function and Disorders recommends that patients suffering from temporomandibular dysfunctions should practice sports in order to compensate for everyday stress. This raises the question as to what extent competitive athletes develop temporomandibular dysfunctions or whether their athletic activities protect them. With the present literature review, the authors intend to give an overview of the currently available publications on this topic.

MATERIALS AND METHODS

A literature research in the PubMed and Google Scholar databases was performed to filter out the currently available publications on the topic 'sports, and temporomandibular dysfunction.

RESULTS

Out of 114 available articles, seven met the inclusion criteria. Two other relevant articles were found in the list of references, so that in total, nine publications were picked for the review. In case numbers ranging from eight to 347 subjects, a temporomandibular dysfunction was detected with a prevalence between 11.7% and 100% for athletes and between 11.11% and 14.3% for non-athletes. Different kinds of sports were evaluated, all of them contact sports: basketball, handball, wrestling, boxing, karate, mixed martial arts, field hockey, water polo, and soccer. One study compared athletes with and without consumption of anabolic steroids, regardless of the type of sport. The level of athletic performance varied across the different studies.

CONCLUSIONS

Currently, studies dealing with the effect of competitive sports on temporomandibular dysfunction are scarce. Inconsistent methodological procedures permit only limited comparability.

CLINICAL RELEVANCE

A general trend, however, can already be discerned: professional athletes suffer from temporomandibular dysfunctions more frequently than non-athletes.

Injuries to the Stomatognathic System in Brazilian Jiu-Jitsu Athletes

As a contact sport, Brazilian jiu-jitsu requires the fighter to expose his/her stomatognathic system to the adversary, making him/her more susceptible to oral and maxillofacial injuries and disorders. The aim of the present study was to determine the prevalence of injuries and disorders of the stomatognathic system and associated factors among practitioners of Brazilian jiu-jitsu. A total of 179 athletes were interviewed and submitted to a physical examination. The majority was male, in the beginner category and had participated in competitions. Athletes with more experience had a higher frequency of orofacial injuries (PR = 1.77; 95% CI: 1.01–1.38), such as oral mucous lacerations and skin abrasions in the facial region, which mainly occurred during training sessions. A mouthguard is not mandatory for the sport and many athletes (both beginners and more experienced athletes) do not use one due to difficulty breathing with the device. A prefabricated (type II) mouthguard was the most common among the athletes who used this equipment, although it does not offer adequate protection. Athletes on more advanced levels wore mouthguards significantly more often (PR = 1.96; 95% CI: 1.11–2.45). In conclusion, more experienced jiu-jitsu athletes had a higher frequency of orofacial injuries, such as lacerations and abrasions, and are more likely to wear a mouthguard. However, longitudinal studies are needed in order to assess the possible causes and risks.

Injuries in karate: systematic review

OBJECTIVES

to identify all studies of Karate injuries and assess injury rates, types, location, and causes.

METHODS

Six electronic and four grey literature databases were searched. Two reviewers independently assessed titles/abstracts, abstracted data and assessed risk-of-bias with the Newcastle-Ottawa scale. Average injury rates/1000AE (AE = athletic-encounter) and/1000minutesAE, injury location and type weighted by study size were calculated.

RESULTS

In competitions rates of injury/1000AE and/1000 minutesAE were similar for males (111.4/1000AE, 75.4/1000 minAE) and females (105.8/1000AE, 72.8/1000 minAE). Location of injury rates/1000AE for males were 44.0 for head/neck, 11.9 lower extremities, 8.1 torso and 5.4 upper extremities and were similar for females: 41.2 head/neck, 12.4 lower extremities, 9.1 torso and 6.3 upper extremities. Injury rates varied widely by study. Rates/1000AE for type of injury were contusions/abrasions/lacerations/bruises/tooth avulsion for males (68.1) and females (30.4); hematomas/bleeding/epistaxis males (11.4) and females (12.1); strains/sprains males (3.5) and females (0.1); dislocations males (2.9) and females (0.9); concussions males (2.5) and females (3.9); and fractures males (2.9) and females (1.4). Punches were a more common mechanism of injury for males (59.8) than females (40.8) and kicks similar (males 19.7, females 21.7). Weighted averages were not calculated for weight class or belt colour because there were too few studies. Nineteen injury surveys reported annual injury rates from 30% to rates ten times higher but used different reporting methods. Studies provided no data to explain wide rate ranges.

CONCLUSIONS

Studies need to adopt one injury definition, one data-collection form, and collect comprehensive data for each study for both training and competitions. More data are needed to measure the effect of weight, age and experience on injuries, rates and types of injury during training, and for competitors with high injury rates. RCTs are needed of interventions such as training and feedback of performance data to reduce injury rates.

Immunological Modulation in Long-Term Karate Practitioners

Karate is a Japanese martial arts system with potential physical and psychological benefits. However, karate has been scarcely investigated from a psychobiological perspective, and its effects on the immune system remain virtually unknown. We designed the present study with the aim of analyzing the effects of karate practice on immunological parameters. 27 healthy male volunteer subjects participated in the study, 15 in the experimental group and 12 in the control. Experimental subjects were all karate players who had practiced this martial art for a minimum of three years attending regular lessons at a karate training center, in the evening, two to three days per week. Blood samples for the quantification of immunological parameters (total leukocytes, neutrophils, monocytes, eosinophils, basophils, lymphocytes, IgG, IgA, and IgM) were taken in both groups. A t-test for independent groups was performed in each dependent variable; a value of p<0.05 was considered to be significant. Karate practitioners exhibited a significantly higher number of total leukocytes (p<0.02), monocytes (p<0.01), and lymphocytes (p<0.01), a higher percentage of monocytes (p<0.01), and greater serum concentrations of IgG (p<0.02) and IgM (p<0.01). Our findings show that long-term karate practice is related to a broad modulation of immune parameters, including total and specific leukocyte counts, as well as immunoglobulin concentrations. This peculiar immunomodulatory profile, apart from its psychobiological relevance, may have noteworthy clinical implications.

Injuries Sustained by the Mixed Martial Arts Athlete

Context:

Mixed martial arts (MMA) is rapidly growing in popularity in the United States and abroad. This combat sport joins athletes from a wide variety of martial art disciplines, each with characteristic and distinguishing injury profiles, together in competition. Because of increasing participation by professionals and amateurs alike, injuries sustained by MMA athletes have been on the rise.

Evidence Acquisition:

A review of relevant publications using the search term mixed martial arts and each of its component combat sports (eg, Muay Thai, Brazilian jiu-jitsu) from 1980 through 2015 was completed using PubMed and Google Scholar.

Study Design:

Clinical review.

Level of Evidence:

Level 5.

Results:

The majority of studies on MMA injuries evaluate those sustained during competition, which range in incidence from 22.9 to 28.6 per 100 fight-participations. Striking-predominant disciplines such as boxing, karate, and Muay Thai have high rates of head and facial injuries, whereas submission-predominant disciplines such as Brazilian jiu-jitsu, judo, and wrestling have high rates of joint injuries.

Conclusion:

Numerous studies have evaluated injuries in athletes who participate in MMA and its component disciplines during competition but much remains to be discovered about injuries sustained during training and in specific patient populations such as adolescents and women.