Knowledge and attitudes about sports-related dental injuries and mouthguard use in young athletes in four different contact sports-water polo, karate, taekwondo and handball

Un "boxing" the reality: Knowledge, attitude, and perception of orthodontists, dental practitioners, and orthodontic patients toward mouthguards' wear during contact sports-A cross-sectional study

INTRODUCTION

Mouthguards (MGs) have the potential to prevent contact sport-related dental injuries. However, varying perceptions of their effectiveness persist, influencing recommendations by dental professionals.

AIM

To assess the attitudes, knowledge, and perceptions of orthodontists, other dental practitioners (general dentists and other dental specialists), and orthodontic patients involved in contact sports regarding the use of MGs.

METHODOLOGY

A cross-sectional survey was designed to collect information from dental clinicians (orthodontists and other dental practitioners) and their orthodontic patients about using MGs during sports participation. A convenience sampling technique was used to recruit the participants for an online survey. A total of 107 (32 males/75 females) dental clinicians and 147 (75 males/72 females) orthodontic patients (mean age 17.5 ± 5.84 years) participated in the study. Pre-validated questionnaires, specifically designed for dental clinicians and orthodontic patients, were used. Data were analyzed using SPSS software (version 28.0; SPSS).

RESULTS

Nearly 50% of dental clinicians have recently recommended MGs to their patients in their clinical practice out of which 59% preferred the stock type; 33% of dental clinicians enquired their patients about involvement in contact sports during initial visits. The majority of orthodontic patients acquired knowledge about MGs through the Internet. More than half of orthodontic patients expressed unwillingness to pay for MGs, and 89% of orthodontic patients found using MGs during contact sports uncomfortable.

CONCLUSION

The findings provide valuable insights into the practices and attitudes of dental clinicians and orthodontic patients regarding MGs, their recommendations, and the comfort levels associated with using them during contact sports.

Faculty of sports science students, physical education teachers, and athletes' level of knowledge and attitude about mouthguards

OBJECTIVES

Traumatic dental injury occurs during sports competitions, training, and practice and can be prevented by the use of mouthguards. For this reason, this study aimed to evaluate the knowledge and attitudes of sports science faculty students, physical education teachers, and athletes about mouthguards.

METHODS

Five hundred thirty-two participants were reached via social media. In the questionnaire consisting of 20 questions, questions about the sociodemographic characteristics of the participants were asked in part 1, and questions about their level of knowledge and attitudes about the mouthguards were asked in part 2. Descriptive statistical analysis and a chi-square test were used to evaluate the data.

RESULTS

The number of people who think that mouthguards protect the athlete from traumatic dental injury is 381 (71.6%). The number of people who think that mouthguards affect the performance of the athlete is positively 228 (42.9%). To protect against traumatic dental injury, 51.48% of the participants preferred the custom-made; 39.3% of them preferred the boil-bite; 33.22% of them preferred the standard/stock type mouth guard; and 22.96% of them preferred the helmet, and 18.26% of them preferred the face mask.

CONCLUSIONS

The knowledge and attitude of sports science faculty students, physical education teachers, and athletes are low about mouthguards. Since these people who are engaged in sports have a high exposure to traumatic dental injuries, education should be given to increase their awareness about mouthguards.

Knowledge and Self-Assessment of Dental Injuries and Oral Health among Croatian Professional Water Polo Players: A Cross-Sectional Study

OBJECTIVES/AIM

The purpose of this study was to evaluate oral health knowledge, and the incidence of self-reported dental injuries incidence, the frequency of mouthguard use, oral hygiene habits, and oral health status among professional water polo players.

MATERIALS AND METHODS

During the 2022/2023 season, 114 water polo players from the Croatian First League participated in a questionnaire-based online survey. The data collected included sociodemographic and professional attributes, oral health knowledge questions, dental injury experiences, and practices related to mouthguard use. Respondents also rated their own oral health status and oral hygiene habits. The data were analyzed using descriptive statistics and a regression analysis.

RESULTS

The respondents demonstrated inadequate knowledge of oral health, with a mean score of 6.4 ± 2.6 out of 12. Better knowledge correlated positively with older age (p ˂ 0.05) and consistent flossing (p = 0.014). Additionally, 27.2% (31 of 114) of reported dental injuries were related directly to incidents which occurred while participating in water polo. These injuries occurred more frequently during games (54.8%) and often involved the anterior maxillary incisors (71.0%) due to player contact (87.1%). Awareness of mouthguards was high (93.9%), whereas their actual use was low (7.0%) because 35.1% of respondents reported discomfort wearing them. The respondents' self-assessments revealed widespread dental problems, including tooth sensitivity (13.3%), erosion (15.8%), calculus (28.1%), and pigmentation (7.9%).

CONCLUSIONS

The research results indicate a lack of adequate knowledge among the respondents regarding oral health. This deficit was not associated with oral hygiene habits or oral cavity conditions. These findings highlight the disparities in oral health awareness and practices associated with water polo participation and emphasize the importance of education and prevention efforts.

Effects of Mouthguards on Skin Damage In Vitro Study

OBJECTIVE

 Mouthguards can prevent and reduce orofacial sports traumas, which occur to the players themselves. However, the effect of mouthguards on skin damage has not been clarified. The present study's purpose was to examine whether the mouthguard can reduce or prevent skin damage caused by teeth (including the difference in mouthguard thickness).

MATERIALS AND METHODS

 Pigskins, artificial teeth, and Ethylene-vinyl acetate (EVA) mouthguard blanks with 1.5- and 3.0-mm thickness were employed. Each of the two type mouthguards was produced in 10 replicates. Mouthguard incisal thickness and collision touch angle were measured on a PC using imaging software. A pendulum-type machine was used to apply impact. Strain gauges attached to the tooth and impacted plate were used to measure mouthguards' effect on impact stress. Also, a microscope was used to observe the after impacted skin condition, and the extent of damage was assessed as a score.

RESULTS

 The pigskin was ruptured in without mouthguard (NOMG) with presenting the highest damage score, whereas the complete rupture was not seen in the 1.5 mm MG, but the damage of the skin (defeat) was observed. No tissue change was found with the 3 mmMG. In both the flat plate and impact tooth strain, no significant difference was observed between NOMG and 1.5 mmMG. However, 3 mmMG had a significantly smaller value than the other two conditions. These results are likely to be strongly influenced by the mouthguard incisal thicknesses and collision touch angles differences.

CONCLUSION

 The present study results clarified that two different thickness mouthguards reduced the skin damage, and the thicker mouthguard showed more effectiveness. Therefore, mouthguards may prevent the wearer's stomatognathic system's trauma and avoid damage to the skin of other athletes they are playing with. This effect seems to be an essential basis for explaining the necessity of using mouthguards for others besides full-contact sports.

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.

Awareness of sports-related dental emergencies and prevention practices among Libyan contact sports coaches: A cross-sectional study

BACKGROUND AND AIMS

Despite the high incidence rate of dental trauma and its possible devastating physical and psychological consequences on children, little is known about sport-related dental trauma and its prevention and management among Libyan sports coaches. The present study aimed to assess the knowledge and attitude of Benghazi contact sports coaches regarding sport-related dental trauma and its prevention and management.

METHODS

A cross-sectional study design was used. Two hundred and thirty-one contact sports coaches were recruited from different public and private youth sports centers across Benghazi. The data were collected using a self-administered questionnaire translated into Arabic and piloted to evaluate its validity and clarity. In addition, Mann-Whitney U, Kruskal-Wallis, and χ 2 tests were used to check associations between the variables.

RESULTS

A total of 151 contact sports coaches returned a completed questionnaire; the majority of coaches (74%) have seen orofacial injuries during their coaching career, whereas less than half of them (47%) personally experienced these injuries. Only one participant said he would preserve the tooth in milk, and four indicated that they would replant it. Most coaches (89.4%) knew what a mouthguard is, but 53.6% would recommend its use, and these were more likely to have previously used mouthguards (p ≤ 0.001). About 41.1% received previous training on TDIs-related emergencies. Higher knowledge scores were observed among coaches who previously received training (p = 0.023).

CONCLUSION

The findings of this study indicate low awareness of how to manage and prevent orofacial injuries among Libyan contact sports coaches, even though they commonly encounter these injuries and believe in mouthguards' effectiveness. Previous training on managing emergencies and experience appeared to influence the coaches' knowledge. Training coaches on preventing TDIs and their early management in sports fields should be an implemented policy and a prerequisite to obtaining a training license.

Knowledge about the emergency management of dental injuries among field hockey coaches

BACKGROUND/AIM

Field hockey is frequently associated with oro-dental injuries. In such acute situations, appropriate management of the injury by coaches can contribute to a better clinical outcome and prognosis. Therefore, the aim of this study was to investigate the knowledge of hockey coaches in the Netherlands about the emergency management of dental injuries.

MATERIAL AND METHODS

A 25-item questionnaire about the prevalence and management of oro-dental injuries was distributed amongst hockey coaches in the Netherlands. A sub-analysis was done regarding the knowledge on the management of dental injuries by using a 5-point scoring system.

RESULTS

Two hundred and six hockey coaches participated in this survey. A small majority (53%) of the coaches knew the treatment of choice in the event of a permanent tooth injury. The median score of coaches' knowledge regarding management of oro-dental injuries was 3.0 (2.0-4.0) points. Coaches with a (para)medical training/occupation, and coaches with >10 years of experience had significantly higher scores compared with the other groups (p < .01 and p = .03, respectively).

CONCLUSIONS

The knowledge level of hockey coaches in the Netherlands about oro-dental injuries needs to be improved, as many coaches are not aware of the appropriate first aid measures.

Utilization of mouthguards among school children in Saudi Arabia

AIM

To evaluate attitude towards mouthguard utilization among school children.

METHODS

This cross-sectional study was conducted among students of both genders, aged between 8 to 16 years, attending school in Riyadh, Saudi Arabia. A structural questionnaire was prepared consisting of questions related to the demographic details, attitude, and conception of children towards using a mouthguard. The questionnaire was sent to the school teachers to distribute among the respective school children. Descriptive statistics were used to analyze the data.

RESULTS

A total of 1116 children completed the survey form, of which 488 were female and 628 male. The prevalence of use of mouthguard among Saudi school children was found to be 3.32%. Out of the total study subjects, 72.68% of the subjects believed that mouthguards could protect them from injuries. The most common reasons for not wearing mouthguards were: they never thought about it (38.47), they felt it was not necessary (30.58%), it was expensive (11.02%), and they never had any injury (19.93%). Out of 37, 2 subjects never experienced any problem with mouthguards. The most common problems with the mouthguards were: difficulty in speech, being uncomfortable and expensive, followed by interference with breathing.

CONCLUSION

The prevalence of mouthguard use was 3.32% in Saudi school children aged between 8-16 years. The most common reason for not using it was found to be lack of knowledge. Counseling the young children interested in sports activities is the need of the hour.

Multi-Material 3D Printing of a Customized Sports Mouth Guard: Proof-of-Concept Clinical Case

A multilayer mouth guard is known to have the best protective performance. However, its manufacturing in a digital workflow may be challenging with regards to virtual design and materialization. The present case demonstrates a pathway to fabricate a multilayer individualized mouth guard in a fully digital workflow, which starts with intraoral scanning. A free-form CAD software was used for the virtual design. Two various CAM techniques were used, including Polyjet 3D printing of rubber-like soft material and silicone printing using Drop-on-Demand technique. For both methods the outer layer was manufactured from more rigid materials to facilitate its protective function; the inner layer was printed from a softer material to aid a better adaptation to mucosa and teeth. Both 3D printed multilayer mouth guards showed a clinically acceptable fit and were met with patient appraisal. Their protective capacities must be evaluated in further clinical studies.

Wearability and preference of mouthguard during sport in patients undergoing orthodontic treatment with fixed appliances: a randomized clinical trial

Background

Orthodontic patients wearing fixed appliances are susceptible to traumatic dental injuries during a wide range of sporting activities. This randomized clinical trial investigated wearability and preference of mouthguards during sporting activities in patients undergoing orthodontic treatment with fixed appliances.

Methods

A prospective three-arm crossover randomized clinical trial conducted in the UK. Thirty patients in active orthodontic treatment with fixed appliances undertaking at least 120 minutes of contact sport per 6–8-week observation period were randomly assigned to one of six mouthguard allocation sequences consisting of three mouthguard types: (MG1) custom-made laboratory constructed, (MG2) mouth-formed OPRO® Gold Braces, and (MG3) pre-fabricated Shock Doctor® Single Brace. Patients completed a nine-outcome 100-mm visual analogue scale (VAS) questionnaire relating to mouthguard wearability during sport. Once feedback was completed, subjects were allocated the next mouthguard in the sequence. At study-end, subjects were asked to identify their preferred mouthguard.

Results

Twenty-four patients (median age = 13; inter-quartile range 12–14.5 years) completed n = 72 follow-up questionnaires with most playing rugby union or field hockey. Considering VAS score as a continuous variable, for comfort, stability, hardness, ability to breathe, ability to not cause nausea, and inclination to chew, MG2 performed better than MG3. For categorization of VAS score into low (less than 80 mm) or high (at least 80 mm) wearability, for comfort, stability, ability to not cause nausea, and inclination to chew, MG1 and MG2 also rated superior to MG3. Patients preferred MG1 overall.

Conclusions

This randomized clinical trial found that during contact sport patients in fixed appliances reported superior wearability for custom-made and mouth-formed mouthguards in comparison to pre-fabricated. Overall, patients preferred custom-made mouthguards.

Clinical trials registration

ClinicalTrials.gov: NCT04588831.

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.

Cross-sectional cohort study on the use of mouthguards by children playing Gaelic football in Ireland

BACKGROUND/AIMS

Up to 40% of dental injuries in children occur during sports and may be prevented by using mouthguards (MG). The use of mouthguards is mandatory in some sporting organizations. Knowledge of the benefits of protection does not always result in mouthguard use. The aim of this observational cross-sectional cohort study was to measure and compare knowledge of 9-16-year-old Gaelic football players and their parents on MG use and compliance with MG rules.

MATERIALS AND METHODS

A convenience sample of players and their parents was identified and were assessed at their sports facility. Parents completed a questionnaire while children were asked standardized questions and MG type was verified by a dentist. Data were analysed using descriptive statistics and binary logistic regression analysis for comparison.

RESULTS

One hundred and twenty-one children with 118 parents participated in the study. According to players, MG use during competition (N = 119, 99.2%) was greater than during training (N = 97, 80.8%). As age increased, children were less likely to comply with MG rules during training (OR =0.18, p < .001). Children played a median of 2 contact sports (IQR = 1). Only 32 parents (27.1%) and 17 children (14%) reported that the child wore a MG for all sports. Only four children (3.8%) had a custom MG even though most parents (N = 87, 73.7%) believed that they provided superior protection. Knowledge of players and their parents on how to care for the MG was variable.

CONCLUSION

Compliance with the Gaelic Atheletic Association's MG rules was lower during training than competition. Children were less likely to comply with MG rules during training as they grew older. Most parents believed a custom MG would best protect their child's teeth, yet few children had a custom MG. Players and parents had variable knowledge in relation to MG hygiene.

The Influence of Customized Mouthguards on the Muscular Activity of the Masticatory Muscles at Maximum Bite and Motor Performance During Static and Dynamic Exercises

Background

Some studies have suggested that a mouthguard is a performance-enhancing device due to a remote voluntary contraction. The extent to which a mouthguard can induce this phenomenon, e.g., by potentially increasing biting, has not been clarified. This study’s aim was to investigate the muscular activity of the maxillary and peripheral musculature and motor performance during a rest and exercise test.

Methods

Our study comprised 12 active, male, professional young handball players (age 18.83 ± 0.39 years). Their performance, electromyographic (EMG) muscle activity (Σ), and lateral deviation (Δ) of the masticatory and peripheral musculature were measured during rest in a maximum bite force measurement, one-legged stand, a kettlebell swing exercise and a jump test while wearing a customized mouthguard (CMG) or not wearing one (Co).

Results

Maximum bite force measurements did not differ significantly in their mean values of muscle activity (Σ) for the masseter and temporalis muscles (Co 647.6 ± 212.8 µV vs. CMG 724.3 ± 257.1 µV p = 0.08) (Co 457.2 ± 135.5 µV vs. CMG 426.6 ± 169.3 µV p = 0.38) with versus without CMG. We found no differences in the mean activation values during a one-legged stand, the kettlebell swing, and jump test (Σ) in any of the muscles tested. Lateral deviations (Δ) wearing a CMG were significantly less in the erector spinae during the kettlebell swing (Co 5.33 ± 3.4 µV vs. CMG 2.53 ± 1.8 µV p = 0.01) and countermovement jump (Co 37.90 ± 30.6 µV vs. CMG 17.83 ± 22.3 µV p = 0.03) compared to the performance without a CMG. Jump height, rotation moment, and balance were unchanged with versus without CMG.

Conclusion

Our results at rest and during specific motor stress show no differences with or without a CMG. The improved peripheral muscular balance while wearing a CMG indicates improved muscular stabilization.

Decreased exercise capacity in young athletes using self-adapted mouthguards

PURPOSE

There is evidence of both the preventive effects and poor acceptance of mouthguards. There are various effects on performance depending on the type of mouthguard model. Hemodynamic responses to wearing a mouthguard have not been described. The aim of this study was to investigate the effects of self-adapted mouthguards with breathing channels (SAMGvent).

METHODS

In this randomized crossover study, 17 healthy, active subjects (age 25.12 ± 2.19 years) underwent body plethysmography and performed two incremental exertion tests wearing a (SAMGvent) and not wearing (CON) a mouthguard. Blood lactate, spirometrics, and thoracic impedance were measured during these maximum exercise tests.

RESULTS

The mean values using a SAMGvent revealed significantly greater airway resistance compared to CON (0.53 ± 0.16 kPa·L-1 vs. 0.35 ± 0.10 kPa·L-1, respectively; p = < 0.01). At maximum load, ventilation with SAMGvent was less than CON (118.4 ± 28.17 L min-1 vs. 128.2 ± 32.16 L min-1, respectively; p = < 0.01). At submaximal loads, blood lactate responses with SAMGvent were higher than CON (8.68 ± 2.20 mmol·L-1 vs. 7.89 ± 1.65 mmol·L-1, respectively; p < 0.01). Maximum performance with a SAMGvent was 265.9 ± 59.9 W, and without a mouthguard was 272.9 ± 60.8 W (p < 0.01). Maximum stroke volume was higher using a SAMGvent than without using a mouthguard (138.4 ± 29.9 mL vs. 130.2 ± 21.2 mL, respectively; p < 0.01).

CONCLUSION

Use of a self-adapted mouthguard led to increased metabolic effort and a significant reduction in ventilation parameters. Unchanged oxygen uptake may be the result of cardiopulmonary compensation and increased breathing efforts, which slightly affects performance. These results and the obvious preventive effects of mouthguards support their use in sports.

Prevalence of Dentofacial Injuries and Concussions Among College Athletes and Their Perceptions of Mouthguards

PURPOSE

The purpose of this study was to determine the rates of dento-facial injuries and concussions among National Collegiate Athletic Association (NCAA) division 1 college athletes and their perceptions of mouth-guards and their protection role in injury prevention.

MATERIALS AND METHODS

A specific survey regarding the experiences of dento-facial injuries and concussions, attitudes towards the mouthguards, and knowledge of dental first aid was distributed to 682 NCAA division I college athletes registered at Columbia University. The independent predictor variable was sport type (contact versus noncontact). The dependent outcome variables were dental injury rate, facial injury rate, concussion rate, mouthguard use, knowledge of dental first aid. Chi-squared and independent sample tests were used for statistical analysis.

RESULTS

The mean age of the athletes was 19.4 years (range: 17 to 22). 107 (47.6%) athletes were male. Only 62 (27.6%) athletes reported mouthguard use during gameplay. The most popular choice of mouthguard was the mouth-molded type (56.7%). Mouthguard use was significantly more prevalent among contact sport athletes (43.3% versus 1.2%; P < 0.01). Contact sport athletes were more likely to experience dental injuries (14.3% versus 0.0%; P < 0.01)., facial injuries (35.0% versus 6.2%; p < 0.01), and concussions (32.6% versus 2.4%; P < 0.01) relative to noncontact sport athletes. No significant difference was identified between contact and noncontact sport athletes with regards to knowledge of dental first aid.

CONCLUSIONS

Contact sport athletes are significantly more inclined to suffer dento-facial injuries and concussions relative to noncontact sport athletes. Thus, mouthguard use and knowledge of dental first aid should be particularly reinforced amongst contact sport athletes.

Prevalence and mechanisms of injuries in water polo: a systematic review

Objective

To summarise the information available in the literature on the prevalence of injuries in water polo and injury risk factors.

Methods

Protocol was registered on Open Science Framework. MEDLINE, CINAHL, Embase and SPORTDiscus databases were searched for keywords relating to water polo and injuries on 3 February 2021. References were searched for additional studies. Only original research papers in English or French were included, and studies without an injured group were excluded. A data extraction file was made based on the Cochrane Collaboration recommendations. Study quality was evaluated with the Newcastle-Ottawa scales for cohorts and a modified version for cross-sectional studies.

Results

The initial search yielded 581 articles, with 5 more added from reference lists, but only 41 remained after removing duplicates and applying inclusion/exclusion criteria. Thirty-one articles identified the head, fingers and shoulders as the most common sites of injury. Ten articles on mechanism of injury focused mainly on the shoulder, with degenerative changes, posture, scapular alignment, strength, flexibility and overhead shooting kinematics as the main injury risk factors. Publication types included cohort studies, cross-sectional studies, and one case series.

Conclusions

Most traumatic injuries affect the hands and the head from unexpected contact with the ball or opponents. Conversely, training injuries seem to affect mainly the shoulder area. Low level evidence suggests a correlation between shoulder injuries and lack of strength or flexibility as well as large volumes of overhead throwing. Further prospective research is needed to investigate risk factors for other body areas.

Prevalence of orofacial trauma and the attitude towards mouthguard use in handball players: A survey in Lorraine, France

BACKGROUND/AIMS

Contact sports such as handball may lead to orofacial injuries that can often be prevented by the use of a properly fitted mouthguard. Several studies have investigated orofacial injuries during contact sports in different countries, but there is a lack of data that is specific for French handball players. Therefore, the aims of this study were to determine the prevalence of orofacial injuries and the proportion of handball players using a mouthguard in Eastern France.

MATERIAL AND METHODS

Data were collected from handball players aged over 15 years old from five handball clubs in the Lorraine Region (Eastern France). A questionnaire containing 26 questions about the general characteristics of participants, orofacial injury experiences, emergency procedures following tooth avulsion, and use of mouthguards was self-administered.

RESULTS

Two hundred and sixty-three handball players, of which 76.8% (202) were males, aged 23 ± 8 years on average, with a mean playing experience of 11 ± 6 years, participated in the study. Among them, 24.7% (65) reported at least one orofacial injury. A total of 237 orofacial injuries was declared. The main types of orofacial injuries including lip, cheek and tongue injuries were reported by 18.6% of handball players (49); dental injuries were reported by 9.9% (26) and injuries to the temporomandibular joint were reported by 4.9% (13). Most participants knew about mouthguards (97.3%, 254) and considered them efficient for preventing dental injuries in handball (95.3%, 242/254), but only 3.0% (8) used them.

CONCLUSION

The prevalence of orofacial injuries among French handball players was high while mouthguards were very rarely used. Information should be provided to handball teams regarding mouthguard use and the management of dental injuries.

Mouthguards in dentistry: Current recommendations for dentists

Properly fitted mouthguards reduce the risk and severity of orofacial injury, to both hard and soft tissues, preventing thousands of dollars of trauma management. In this review, findings from recent research will be evaluated to discuss the strengths and limitations of the different types of mouthguards, including their indications by sport. Design, ideal dimensions, and other characteristics will also be explored. Additionally, patient education and motivation will be examined, with a focus on the dentist's role in this regard. Finally, in addition to proper oral hygiene, the importance of proper mouthguard maintenance and evaluation will be discussed. This review will therefore be able to act as a guide for dentists looking to provide patients of all ages with personal protective equipment and stay up-to-date on recent developments in this branch of the sports dentistry field.

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.

Thickness change and deformation of custom-made mouthguards after two years of use by Bangladeshi field hockey players

BACKGROUND/AIM

Sports mouthguards are effective devices that prevent dental trauma in sports activities. Players should change mouthguards on a regular basis because of thickness reduction and shape deformation. However, there is no guidance regarding the best timing to change mouthguards. The aims of this study were to analyze the thickness change and deformation of mouthguards after 2 years of use in Bangladesh field hockey players and to consider appropriate evaluation criteria.

MATERIAL AND METHODS

Fifty-seven field hockey players belonging to the Bangladesh Sports Education Institute participated in this study. Participants were provided with double-layered mouthguards made of polyolefin-based material using a vacuum-forming machine. Mouthguards were fabricated using 2-mm-thick sheet as the first layer and 3-mm-thick sheet as the second layer. Players used the mouthguards for 2 years. Before and after using the mouthguards, the thicknesses of nine areas were measured. In addition, the lengths of five areas were used to analyze shape deformation.

RESULTS

After 2 years, the thicknesses of all measured areas had significantly reduced, and the lengths had significantly increased. Thickness reduction of the posterior-occlusal and anterior-incisal areas and deformation of the posterior-buccal and posterior-palatal areas were significantly larger than those in other measured areas.

CONCLUSIONS

Mouthguards should be changed on a regular basis to minimize thickness reduction and deformation. Occlusal and incisal thickness and length of the buccal-posterior area and the palatal-posterior area are factors to be considered in establishing guidelines regarding the timing of mouthguard change.

Dental trauma and tongue injuries in professional alpine ski racing-A worldwide survey

BACKGROUND/AIM

Skiing is a sport with a medium risk of injuries, and injuries are increasingly common among professional alpine skiers. Examples of other medium-risk sports are for example handball, basketball, and karate. The aim of this study was to assess the frequency of dental trauma in professional alpine skiing and to determine whether the frequency of dental injuries is associated with a skier's performance level, alpine skiing discipline, and/or years of skiing experience.

MATERIAL AND METHODS

A questionnaire consisting of 17 questions was distributed to professional male ski racers to gather information about their skiing discipline (category), performance level, and injuries, particularly dental trauma.

RESULTS

A total of 161 out of 190 skiers returned the survey, with a response rate of 84.2%. Of these, 134 (83.2%) had suffered alpine ski racing-related injuries during their career and 38 (23.6%) reported skiing-related dental trauma-most commonly crown fractures (65.8%, n = 25), which mainly involved the maxillary or mandibular incisors (76.0%, n = 28). Ski racers with higher performance levels were more likely to experience dental injuries, but the difference in the frequency of dental trauma between participants in the speed versus technical category was not significant. Likewise, the number of years of ski racing experience did not impact the frequency of dental injuries. The participants rarely wore custom-made mouthguards (6.8%, n = 11). None of those who reported dental injuries were wearing a custom-made mouthguard when the injury occured. They preferred to wear chin guards, over-the-counter mouthguards, or no mouthguards.

CONCLUSION

Professional alpine ski racing has a medium risk of dental trauma, which further increases with skier performance level. The participating skiers rarely wore custom-made mouthguards.

Mouthguard use and attitudes regarding dental trauma among elite cross-country mountain biking and field hockey athletes

BACKGROUND/AIMS

Cross-country mountain biking and field hockey are two Olympic sports that pose a potential risk for dentofacial trauma. However, mouthguard use is not mandatory in either of these sports and knowledge about tooth rescue among athletes is often neglected. The aim of this cross-sectional epidemiological survey was to evaluate the prevalence of sports-related dentofacial injuries, mouthguard use, and attitudes regarding tooth rescue among cross-country mountain biking and field hockey athletes participating at pre-Olympic competitions held in Rio de Janeiro, Brazil.

MATERIALS AND METHODS

A convenience sample of 217 athletes from 33 countries participating in cross-country mountain biking (n = 82; mean age = 30.96 ± 8.52 years) and field hockey (n = 135; mean age = 19.72 ± 2.46 years) pre-Olympic competitions were examined clinically, and they answered a questionnaire regarding previous history of sports-related dentofacial injuries, attitudes toward mouthguard use, and tooth rescue.

RESULTS

There were 120 (55.30%) males and 97 (44.70%) females who participated in the study. The prevalence of facial trauma was higher in mountain biking (54.88%) than in field hockey (26.66%, P < .001). Fracture was the most prevalent facial injury in mountain biking (80%), while laceration was the most prevalent in field hockey (30.55%). Extensive dental injuries occurred more often in mountain biking (47.37%) than in hockey (12.50%). The teeth most often affected were the maxillary central incisors in both mountain biking (57.89%) and field hockey (93.75%). Mouthguard use was more frequent among field hockey athletes (41.48%) than in mountain biking (1.22%, P < .001). The overall knowledge about tooth rescue was low, and most of the athletes in both sports did not know what to do in case of an avulsed tooth.

CONCLUSIONS

Prevalence of dentofacial injuries among XCO-MTB and field hockey athletes participating at this pre-Olympic event was high. The majority of the athletes in this study did not use mouthguards and were unaware of recommendations in the case of an avulsed tooth.

Occurrence and patterns of orofacial injury in CrossFit practitioners

BACKGROUND

CrossFit is an activity that can provide positive influences on body composition and physical fitness. However, the occurrence or pattern of possible injuries, especially in the orofacial region, has not yet been studied. The aim of this study was to investigate the occurrence and patterns of orofacial injuries in CrossFit practitioners.

MATERIAL AND METHODS

This was a cross-sectional study carried out using an online questionnaire on the Google Forms platform. The volunteers were self-selected men and women who practice CrossFit and reside in Brazilian municipalities. The online survey was conducted during April 2020 and comprised 12 questions. The data were analyzed, categorized, and presented as percentages.

RESULTS

These were 65 (27.8%) participants who reported having suffered at least one episode of orofacial trauma and they were more prevalent during training sessions 58 (89.2%). Among the regions with the highest frequency of injuries, the head 23 (21%), mental protuberance 22 (19.6%), upper lip 19 (16.9%), and maxillary teeth 14 (12.5%) were the most cited.

CONCLUSIONS

The prevalence of injuries in the head region indicates a potential concern. Preference should be given to making mouthguards for the maxillary teeth, as they are significantly more affected by trauma during CrossFit when compared to the mandibular teeth.

Random forest algorithm to identify factors associated with sports-related dental injuries in 6 to 13-year-old athlete children in Hamadan, Iran-2018 -a cross-sectional study

Background

Traumatic dental injuries are one of the most important problems with major physical, aesthetic, psychological, social, functional and therapeutic problems that adversely affect the quality of life of children and adolescents. Recently the development of methods based on machine learning algorithms has provided researchers with more powerful tools to more accurate prediction in different domains and evaluate the factors affecting different phenomena more reliably than traditional regression models. This study tries to investigate the performance of random forest (RF) in identifying factors associated with sports-related dental injuries. Also, the accuracy of the RF model for predicting sports-related dental injuries was compared with logistic regression model as traditional competitor.

Methods

This cross-sectional study was applied to 356 athlete children aged 6 to 13-year-old in Hamadan, Iran. Random forest and logistic regression constructed by using sports-related dental injuries as response variables and age, sex, parent’s education, child’s birth order, type of sports activity, duration of sports activity, awareness regarding the mouthguard, mouthguard use as input. A self-reported questionnaire was used to obtain information.

Results

Fifty-five (15.4%) subjects had experienced a sports-related dental injury. The mean age of children with sports injuries was significantly higher than children without the experience of injury (p = 0.006). The prevalence of injury was significantly higher in boys (p = 0.008). Children with illiterate mothers are more likely to be injured than children with educated mothers (p = 0.045). Awareness of mouthguard and its use during exercise has a significant effect on reducing the prevalence of injury among users (p < 0.001).

Random forest model has a higher prediction accuracy (89.3%) for predicting sports-related dental injuries compared to the logistic regression (84.2%). The results of the relative importance of variables, based on RF showed, mouthguard use, and mouthguard awareness has more contributed importance in dental sport-related injuries’ prediction. Subsequently, the importance of sex and age is in the next position.

Conclusions

Using predictive models such as RF challenges existing inaccurate predictions due to high complexity and interactions between variables would be minimized. This helps to achieve more accurate identification of factors in sport-related dental injury among the general population of children.

Exploring the use of mouth guards in Muay Thai: a questionnaire survey

Objective

To identify Muay Thai participants' attitudes towards use of mouth guards and their experiences of dental trauma.

Materials and methods

An online cross-sectional survey was used to record Muay Thai participants' experiences and opinions regarding use of mouth guards. Participants were recruited from a Muay Thai gym in the north east of England.

Results

92 respondents took part in the survey. 3% reported having never worn a mouth guard, whereas 61% reported routinely wearing mouth guards during a fight. Significantly more (73%) younger participants (18-29 years) reported wearing mouth guards during fights compared to those aged 30 years and older (50%) (p < 0.05). Mouth-formed ('boil and bite') were the most frequently used type of mouth guard (60% of users), followed by custom-made mouth guards provided by a dentist (32%). Factors such as protection, breathing, good fit and comfort were all considered important in the choice of mouth guard. 14% of respondents had experienced dental injuries, with chipped/broken teeth being the most common.

Conclusion

Given the risk for dental trauma in Muay Thai, it is important that participants are advised regarding mouth guard use, particularly those that do not routinely wear them.

Associations and risk factors for dental trauma: A systematic review of systematic reviews

OBJECTIVE

We sought to revise, qualify and summarize the body of evidence based on current information on the known associations and risk factors for traumatic dental injury (TDI) occurrence with an overview of systematic reviews.

METHODS

Electronic searches were performed with no language nor date restrictions.According to the PECO strategy, systematic reviews that investigated participants (P) with (E) and without (O) the presentation of factors relating to TDI and these factors' association with TDI episodes (O) as primary or secondary outcomes were included. Quality assessment and bias control were carried out according to the AMSTAR 2 checklist. In cases of systematic review results of discordance, the Jadad decision algorithm was applied.

RESULTS

After titles, abstracts and full texts were read, 19 systematic reviews were included in this overview. Four were classified with critically low, eleven with low and four with moderate methodological quality, respectively. In all studies, 249 cross-sectional, 34 epidemiological surveys, 22 cohort, 9 case-control, 4 longitudinal, 3 ecological and 30 unspecified studies were included. Male gender, child age, greater overjet, inadequate lip coverage, anterior open bite, caries in the permanent dentition, overweight, a previous history of TDI, tongue piercing, the use of alcoholic beverages and participation in sports were all associated with a greater chance of suffering TDI.

CONCLUSIONS

Sociodemographic, clinical and environmental factors are associated with a greater chance of TDI occurrence. However, most of the systematic reviews included were of a low quality and may not provide an accurate and comprehensive summary of the available research that addresses the question of interest. Well-designed primary studies on different aspects of TDI are encouraged to provide higher quality scientific evidence.

Dental Trauma

Dental trauma and injuries to the dentition are difficult to treat because the treatment goals serve to restore esthetics and function. The oral and maxillofacial surgeon is often called on to coordinate the efforts of rehabilitation after a dentoalveolar injury. A comprehensive understanding of the ideal treatments and use of endodontic, orthodontic, periodontal, and pediatric dental colleagues leads to the best possible results with regards to a restoration of form and function. This article provides a succinct review of the oral and maxillofacial surgeon's treatment in dentoalveolar trauma. Epidemiology, treatment, and preventative measures are discussed in this article.

Association between Sports-Related Concussion and Mouthguard Use among College Sports Players: A Case-Control Study Based on Propensity Score Matching

Sports-related concussion (SRC) is a major public health concern. This study aimed to assess the association between mouthguard use and the incidence of SRC in college students through a case-control study using propensity score matching. In total, 195 of 2185 potential participants volunteered to participate in this study. We used Google Forms online to capture participants’ information, including: age; gender; height; weight; sports contact level; level of play; exposure time; frequency of mouthguard use; mouthguard type; and SRC experience. Data for 115 participants who played collision and contact sports were used for the analysis. The difference in the frequency of mouthguard use was assessed between matched pairs and the overall association between SRC and mouthguard use was evaluated. In the matched groups, those who had not experienced SRC wore a mouthguard more frequently than those who had experienced SRC (7/28 vs. 1/28; p = 0.051). Logistic regression analysis showed there was a significant negative association between the frequency of mouthguard use and the incidence of SRC (odds ratio 0.101; p = 0.041). Within the limitations of this study, these results suggest that mouthguard use may offer some benefit in preventing SRC.

Experience with mouthguards and prevalence of orofacial injuries among field hockey players in Catalonia

BACKGROUND/AIM

Orofacial injuries are a serious problem in field hockey. The aim of this study was to determine the prevalence of orofacial injuries in field hockey players in Catalonia, the frequency of mouthguard use, the types of mouthguards used and the degree of interference with oral function.

MATERIAL AND METHODS

In this cross-sectional study, 325 field hockey players (28% women) from all age categories completed a questionnaire about orofacial injuries occurring during their sporting lives, including dental injuries, oral lacerations and episodes of acute temporomandibular disorder (TMD) pain. The questionnaire also asked about the experience of using a mouthguard, the type of mouthguard used and any adverse effects of use. The degree of interference with oral function was compared by type of mouthguard (mouth-formed, custom-made and pre-fabricated mouthguards) using the Kruskal-Wallis test.

RESULTS

Half of the players (50.2%) reported at least one orofacial injury during their sporting lives. The mean number of oral lacerations, TMD pain episodes and dental injuries were 1.59, 0.24 and 0.18, respectively. In total, 310 players (95.7%) had tried a mouthguard, and of these 269 (86.8%) and 283 (91.3%) still used a mouthguard habitually during training and competition, respectively. Only 11 players (3.5%) had tried all three types of mouthguards, and 71 players (22.9%) had tried two types of mouthguard. By type, 217 players (70.0%) had tried mouth-formed (boil-and-bite) mouthguards, 156 (50.3%) had tried custom-made mouthguards and 30 (9.7%) had tried pre-fabricated mouthguards. Custom-made mouthguards were rated as more comfortable than the mouth-formed type (P < .05).

CONCLUSIONS

The prevalence of orofacial injuries among field hockey players is relatively high. Most players habitually use a mouthguard during training and competition, typically preferring custom-made or a mouth-formed types. Custom-made mouthguards were considered the most comfortable.

Knowledge regarding avulsion, reimplantation and mouthguards in high school children: Organised sports-related orodental injuries

Purpose:

To assess knowledge, awareness and attitude of high school children involved in various sports activities regarding avulsion, reimplantation and mouthguard use.

Materials and Methods:

An interview-based study was conducted among high school children in the age group of 8–16 years (n = 1105). A questionnaire was given to children and parents which included questions based on knowledge of children regarding avulsion, reimplantation, consequences of losing teeth, mouthgards and their usage and preferred media for tooth transportation. The research proposal was submitted to the ethics committee and the study design was approved. Data analysis included descriptive statistics and Statistical Package for the Social Sciences (SPSS) software.

Results:

Only 37.6% of the children knew that their teeth can be completely knocked out with injury and 20.1% knew that a knocked-out tooth can be replanted. The preferred media for tooth transportation were gauze/cotton (27.2%), handkerchief (17.5%), paper (14%), water (13.8%) and cellophane (1.3%), i.e. 81.3% of the children preferred dry transport media. Among the children playing contact sport, 53.8% did not know about mouthguards and the rest 46.2% knew about it, but most of them never used it.

Conclusion:

Considering the lack of awareness among children, as well as the people around them, there appears to be a crucial need for education of public and to determine dental manpower and dentists to increase awareness.

Prevalence of dentofacial injuries among combat sports practitioners: A systematic review and meta-analysis

BACKGROUND/AIM

Combat sports might result in injuries to the face and teeth. However, it is unclear how often they occur and which sports presents the highest rates. The aim of this study was to investigate the prevalence of dentofacial injuries in combat sports participants.

MATERIAL AND METHODS

A systematic review was performed. Six main electronic databases and three grey literature databases were searched. Studies were blindly selected by two reviewers based on pre-defined eligibility criteria. Studies that evaluated the prevalence of dentofacial injuries (teeth, alveolar bone, jaw, lips, and/or cheekbones) among combat sports participants were considered eligible. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The software r statistics version was used to perform all meta-analyses. Cumulative evidence of the included articles was evaluated using GRADE criteria (Grading of Recommendations Assessment, Development and Evaluation).

RESULTS

From 1104 articles found on all databases, 27 were finally included. Eighteen studies were judged at low, seven at moderate, and two at high risk of bias. The following sports were investigated: boxing, capoeira, fencing, jiu-jitsu, judo, karate, kendo, kickboxing, kung fu, muay thai, sumo, taekwondo, wrestling, and wushu. Results from the meta-analysis suggested a dental pooled prevalence of 25.2% (12.3%-40.8%, i²  = 100%) and dentofacial pooled prevalence of 30.3 (18.1%-44.1%, i²  = 100%). Considering the sports' categories individually, jiu-jitsu had the highest pooled prevalence of dentofacial injuries (52.9% [37.9%-67.8%, i²  = 92%]), while judo was the sport with the lowest pooled prevalence (25.0% [7.6%-48.2%, i²  = 98%]). Among Panamerican sports, boxing had the highest prevalence of dental injuries (73.7% [58.7%-86.3%, i²  = 0%]). For dentofacial injuries, the GRADE criteria were considered low.

CONCLUSIONS

Overall pooled prevalence of dentofacial injuries in combat sports was approximately 30%. Raising awareness regarding the frequency of these injuries might encourage the use of protective devices and reduce complications related to these incidents.