The Impact of Sport Training on Oral Health in Athletes

Enhancing mouthguard longevity: Impact of surface treatment against aging from brushing and disinfectant exposure

BACKGROUND/AIMS

The study aimed to assess the surface characteristics of sports mouthguards under mechanical stresses during cleaning, either by brushing or immersion in disinfectant solutions.

MATERIAL AND METHODS

Ethylene-vinyl acetate samples, 4 mm thick, were randomly assigned to cleaning methods: control (C-no cleaning), brushing with water (B.W), brushing with neutral liquid soap (B.S), brushing with toothpaste (B.T), immersion in distilled water for 10 min (I.W), immersion in 2.25% sodium hypochlorite solution for 10 min (I.SH), and immersion in sodium bicarbonate solution for 5 min (I.SB). All cleaning methods were applied for 28 days. Surface roughness average (Ra) and wettability were measured at baseline for the control group (n = 9), and after cleaning for all the other groups.

RESULTS

One-way ANOVA with Tukey tests (5% significance) indicated significant differences among groups (p < .05). The I.SB group had higher surface roughness than B.S and B.T (p < .05). B.W showed the lowest wettability, significantly lower than B.T, I.W, and I.SB (p < .05). I.SB exhibited the highest wettability, significantly different from sodium hypochlorite, neutral liquid soap, brushing with water, and control groups (p < .05). The sodium bicarbonate immersion group (I.SB) demonstrated greater statistical variation, displaying higher susceptibility to aging compared to brushing with neutral liquid soap.

CONCLUSION

Cleaning mouthguards with a toothbrush, water, and neutral liquid soap emerged as the most promising method, causing minimal surface changes in the material.

Effect of different materials for conventional and 3D-printed models on the mechanical properties of ethylene-vinyl acetate utilized for fabricating custom-fit mouthguards

BACKGROUND/AIM

The interaction between the ethylene-vinyl acetate (EVA) with distinct materials utilized for obtaining dental models can affect the performance of resulting mouthguards. This study attempted to evaluate the effect of different materials for conventional (dental stone) or 3D-printed (resin) models on EVA's physical and mechanical properties and surface characteristics.

MATERIAL AND METHODS

EVA sheets (Bioart) were laminated over four model types: GIV, conventional Type IV dental stone model (Zhermak); ReG, resin-reinforced Type IV dental stone model (Zero Stone); 3DnT, 3D resin printed model (Anycubic) without surface treatment; 3DT, 3D-printed model (Anycubic) with water-soluble gel (KY Jelly Lubricant, Johnson & Johnson) coating during post-curing process. The EVA specimens were cut following the ISO 37-II standard (n = 30). Shore A hardness was measured before and after plasticization on the contact (internal) or opposite (external) surfaces with the model. The breaking force (F, N), elongation (EL, mm), and ultimate tensile strength (UTS, MPa) were measured using a universal testing machine. Macro-photography and scanning electron microscopy were adopted for classifying the EVA surface alteration. Data were analyzed by one-way ANOVA with repeated measures, followed by Tukey's test (α = .05).

RESULTS

Plasticization significantly decreased Shore A values for the tested EVA regardless of the model type (p < .001). Higher F, El, and UTS values were verified for the EVA with 3DT and GIV models compared to ReG and 3DnT (p < .001). 3DnT models resulted in severe surface alteration and a greater reduction of the mechanical properties of the EVA.

CONCLUSION

The interaction of EVA with 3D resin-printed models without surface treatment or resin-reinforced Type IV dental stone models significantly affected the physical and mechanical properties of this material. The utilization of water-soluble gel coating during the post-curing process of 3D resin printed models improved the mechanical properties of the EVA, similarly when this material was plasticized over conventional Type IV dental stone model.

Use of mouthguards in Latin American field hockey athletes during the ODESUR 2022 Games

BACKGROUND/AIMS

Athletes are susceptible to oral injuries. To reduce the incidence and severity of oral trauma, a custom-made mouthguard, a device positioned in the mouth to prevent damage to teeth and surrounding structures, is recommended. In field hockey, according to the international rules of this sport, using mouthguards is not mandatory, but it is recommended to wear them at all times while practicing this discipline. We aimed to determine characteristics and differences regarding mouthguard usage among field hockey players from different countries participating in the XII ODESUR Games.

METHODS

We conducted a cross-sectional study that included 78 voluntary hockey athletes that met the inclusion criteria. The questionnaire used was validated by Panam Sports, collecting information on the type of mouthguard (custom-made or prefabricated), and the time of use of the mouthguard (range of 5 years).

RESULTS

Of the total number of athletes, 96% used mouthguards, of which 64% were custom-made type, and 32% were prefabricated (p < .001). Custom-made mouthguards were used by 100%, 89%, and 64% of athletes in Argentina, Chile, and Peru, respectively, while only 40% of athletes in Paraguay and Uruguay used them. It has also been observed that more than 50% of the individuals have not controlled and replaced their intraoral devices for more than 10 years.

CONCLUSIONS

Our results reveal a problem with a public health dimension and thus invite the standardization of guidelines with an educational approach to promoting and adopting good sports practices. This report is the first on using mouthguards in high-performance athletes during an international multisport event.

Dental Health Benefits of Swimming in Chlorinated Water

Poor oral health is an important concern for athletes, as it can affect both general health and athletic performance. The aim of this study is to investigate the effects of activity in chlorinated water on oral health in elite swimmers compared to non-swimming athletes. This cross-sectional study included 101 swimmers and 100 other athletes aged 13-26 years with a minimum training intensity of five hours per week (for at least the preceding two years). Oral health was assessed using the approximal plaque index (API) and the decayed/missing/filled teeth (DMFT) index. A DIAGNOcam was used to detect caries. Results show that swimmers were younger (15 years vs. 18 years), were more likely to be female (54% vs. 17%), and had a lower body mass index (20.1 kg/m2 vs. 21.9 kg/m2) and a lower juice consumption (9% vs. 24%). Non-swimmers had significantly more decayed, missing, or filled teeth due to caries and plaque. In conclusion, by comparing elite swimmers and athletes competing in different sports, we have shown that competitive swimmers have a lower incidence of dental caries and plaque. Further research is needed to test our findings and to understand this relationship in greater detail.

The Impact of Competitive Sports on Oral Health: Exploring Their Relationship with Salivary Oxidative Stress in Children

This article explores the correlation between salivary biomarkers, such as glutathione peroxidase (GPX), total antioxidant capacity (TAC), and superoxide dismutase (SOD), and their association with oral health for children in competitive sports. Saliva has emerged as a valuable resource for evaluating physiological and pathological conditions due to its non-invasive collection method and easy storage. This study examines the potential of GPX, TAC, and SOD as salivary biomarkers for assessing the impact of competitive sports on children's oral health. It discusses the potential implications of increased oxidative stress due to intense physical activity and the role of antioxidant defense mechanisms in maintaining oral health. In total, 173 children aged between 6 and 17 were divided into three groups, 58 hockey players, 55 football players, and 60 in the control group, and examined to assess their oral hygiene and dental and periodontal health. Saliva was collected, centrifuged, and the supernatant was analyzed for the relevant biomarkers. The findings seem to suggest that salivary biomarkers, like GPX, TAC, and SOD, might serve as indicators of the physiological response to competitive sports in children, as well as indicators of oral health, especially dental cavities, and periodontal disease. Statistical analysis showed significant differences between the groups, with better values for athletes, regardless of age, sex, or activity type. Understanding the relationship between salivary biomarkers and competitive sports in children can have significant implications for monitoring and optimizing the health and performance of young athletes. Further research is needed to establish the specific associations between these biomarkers and the effects of several types and intensities of sports activities on oral health in children.

The Oral Microbiome Profile of Water Polo Players Aged 16-20

OBJECTIVES

Chlorine has a strong antibacterial property and is the disinfectant most frequently used in swimming pools. Therefore, the microbiota community in the oral cavity of those who practice water sports is assumed to be special due to their regular immersion in water. Adverse changes in the composition of oral cavity microbiota may have serious health consequences. We aimed to compare the oral microbiome between water polo players and non-athletes. We hypothesized that the oral cavity microbiota community differed between water polo players and non-athletes.

MATERIALS AND METHODS

Altogether, 124 water polo players (62 males and 62 females, aged between 9 and 20 years) and 16 non-athlete youths (control group, eight males and eight females, aged between 16 and 20 years, mean age + SD = 17.1 + 1.4 years) who participated in body structure examinations voluntarily agreed to participate in the study. In a randomly selected subsample of water polo players (n: 29, aged between 16 and 20 years, mean age + SD = 17.3 + 1.0 years), saliva samples were also collected. Saliva samples were collected from all non-athlete youths (n: 16, aged between 16 and 20 years). The oral microbiome was determined from a saliva sample, and DNA was isolated using the QIAmp DNA Blood Mini Kit. The 16S rRNA gene amplicon sequencing method was used to analyze the microbiome community. PCR primers were trimmed from the sequence reads with Cutadapt. R library DADA2 was used to process reads in the abundance analysis.

RESULTS

In general, Streptococcus, Veilonella, and Prevotella genera constituted more than 50% of the oral microbiome community in the two participant groups combined (n = 45). The oral microbial profile had significant sexual dimorphism and differed between water polo players and the non-athletes. Compared to females, males had a higher (p < 0.05) relative abundance of the Atopobium (medium effect size) and Pravotella_7 (very large effect size) genera and a lower (p < 0.05) relative abundance of the Fusobacterium (large effect size), Gemella (large effect size), and Streptococcus (large effect size) genera. Compared to non-athletes, water polo players had higher (p < 0.05, medium effect size) relative abundance of the genus Veillonella and lower (p < 0.05, large effect size) relative abundance of the genus Gemella.

CONCLUSIONS

The results suggest that regular water training can unfavorably alter the composition of the oral microbial community.

Study on the Influence of Regular Physical Activity on Children's Oral Health

The benefits of physical activities conducted systematically on the harmonious development, intellectual performance, and general health of children are unanimously accepted. This study's aim is to determine whether differences in oral health between young athletes and children not engaged in competitive sports are present. A total of 173 children aged between 6 and 17 years, 58 hockey players, 55 football players, and 60 in the control group were divided into groups according to their activity, age, and biological sex and examined for oral hygiene and dental and periodontal health, using clinically determined indices. Statistical analysis showed significant differences between the groups, with lower (better) values for athletes, regardless of age, sex, or activity. Oral hygiene showed the most relevant differences for males aged 14 to 17, as did the index for dental health. Periodontal health, on the other hand, was significantly better for females aged 6 to 13. Based on this data, the beneficial influence of regular physical activity also has an impact on oral health. Identifying the mechanisms behind this needs to be explored in depth and may be a topic for further research.

Disinfection and Isotonic Drinks' Influence on Hardness and Color Stability of Ethylene-Vinyl-Acetate Copolymer Mouthguards Used in Martial Arts: An In Vitro Study

This in vitro study aimed to evaluate the hardness and color change of an ethylene-vinyl-acetate copolymer (EVA) material for mouthguards after exposition to different cleaning agent solutions and isotonic drinks. Four hundred samples were prepared and divided into four equinumerous groups (n = 100), in which there were 25 samples from each color of EVA (red, green, blue and white). The hardness, using the digital durometer, and the color coordinates (CIE L*a*b*), using the digital colorimeter, were measured before the first exposition and after 3 months of exposition to spray disinfection and incubation in the oral cavity temperature, or immersion in isotonic drinks. The values of Shore A hardness (HA) and color change (ΔE-calculated by Euclidean distance) were statistically analyzed using the Kolmogorov-Smirnov test, multiple comparison ANOVA/Kruskal-Wallis and appropriate post-hoc tests. Statistically significant changes in color and hardness between the tested groups were demonstrated after the use of agents predestined for disinfecting the surface of mouthguards on the tested samples. There were no statistically significant differences in color and hardness between the groups immersed in isotonic sport drinks potentially consumed by competitors practicing combat sports using mouthguards. Despite the changes in color and hardness after the use of disinfectants, the deviations were minor and limited to specific colors of the EVA plates. The intake of isotonic drinks practically did not change either the color or the hardness of the samples, regardless of the tested color of the EVA plates.

The association between dental caries and physical activity, physical fitness, and background factors among Finnish male conscripts

Studies on measured physical fitness and oral health are sparse. The aim of this study was to investigate the associations between self-reported physical activity and measured physical fitness and oral health of young men. The study population consisted of 13,564 Finnish male conscripts who had mandatory clinical oral examinations and physical fitness tests at the beginning of military service in 2011. Finally, around 10,800 conscripts had physical fitness test outcomes available and a total of 8552 conscripts answered a computer-based questionnaire on background factors. Decayed Tooth (DT) and Decayed, Missing, or Filled Tooth (DMFT) indices, outcomes of surveys and fitness tests were used in analyses by cross-tabulation and multivariable logistic regression model (odds ratios [OR] with 95% confidence interval [CI]) were calculated. Regularly exercising conscripts had a reduced need for dental restorative treatment than those reporting no physical activity (p < 0.0001). The proportion of participants with sound dentition (DT = 0) increased steadily with increasing physical activity (39.0-59.4%). Good measured physical fitness was a protective factor against increased dental restorative treatment need. A low prevalence of smoking and low use of alcohol and energy drinks were associated with frequent exercise, whereas consumption of sport drinks and snuff use were common among those who exercised frequently. Good measured physical fitness and self-reported physical activity are associated with reduced caries burden. There is a need for information about the harms of tobacco products and the benefits of a healthy diet, even for the increased energy needs of the physically active.

The Significance of Oral Inflammation in Elite Sports: A Narrative Review

Recently, there has been intense discussion about sports dentistry and potential interactions between oral health and athletes' performance. This narrative review aims to provide a comprehensive overview of the available literature about oral inflammation in sports. For this purpose, it presents the most common types of oral inflammation (gingivitis, periodontitis, pericoronitis, apical periodontitis), and their prevalence in athletes. Both the impact of oral inflammation on performance and causes for oral inflammation in athletes are discussed by presenting current literature. Finally, international recommendations for dental care in sports are presented. Several studies stated a high prevalence of oral inflammation in athletes, especially of gingivitis (58-97%) and periodontitis (41%). Also, many athletes report oral pain (17-30%) and a negative impact of oral health on training (3-9%). Besides this, a systemic impact of oral inflammation is discussed: In periodontitis patients, blood parameters and physical fitness are changed. In athletes, associations between muscle injuries and poor oral health are reported. There are deficits in oral health behavior. Furthermore, systemic changes due to physical stress could influence oral tissues. Overall, complex bidirectional interactions between competitive sports and oral inflammation are possible. Regular dental examinations and prevention strategies should be implemented in sports.

Home Oral Care Domiciliary Protocol for the Management of Dental Erosion in Rugby Players: A Randomized Clinical Trial

People performing regular physical activity are at high risk of dental erosion especially in cases of high sport drinks intake. Biomimetic hydroxyapatite-based oral hygiene products, like toothpastes and mouthwashes, have been investigated in recent years for their remineralizing activity on the teeth. The aim of the present study was to evaluate the efficacy of two different oral hygiene protocols, respectively consisting of the combination of a hydroxyapatite-based toothpaste plus mouthwash (Trial group) or toothpaste alone (Control Group). At baseline (T0), as well as at 15 days (T1), 30 days (T2) and 90 days (T3), the following clinical indexes were assessed: Basic Erosive Wear Examination (BEWE), Schiff Air Index (SAI), Visual Analogue Scale (VAS), Plaque Index (PI) and Bleeding Index (BI). In general, for all the indexes assessed, a progressive intragroup reduction was noticed from the baseline to the subsequent timepoints, with no intergroup differences. Accordingly, the use of the hydroxyapatite-based toothpaste, alone or in combination with the mouthwash containing hydroxyapatite as well, is an effective method for the domiciliary management of dental erosion in physically active individuals like rugby players.

Shock Absorption Behavior of Elastic Polymers for Sports Mouthguards: An In Vitro Comparison of Thermoplastic Forming and Additive Manufacturing

Background. There are several in vitro testing options to investigate the efficacy of sports mouthguards. None of these represent everyday situations, but the effects of simple laws of physics can be observed. This enables the comparison of conventional materials for mouthguards towards fabrications from additive manufacturing. Methods. A ball-drop experiment measured the maximum force and temporospatial distribution of a vertical impact on six material groups and a reference group (No-MG). Three conventional materials (ethylenvinylacetate) with 1, 2, and 3 layers were compared with additively manufactured (AM) specimens of comparable layering with a respective thickness of 4 mm, 5 mm, and 6.8 mm. Results. A maximum force of 8982.35 N ± 305.18 (No-MG) was maximum damped to 2470.60 N ± 87.00 (conventional 6.8 mm) compared with 5585.09 N ± 203.99 (AM 6.8 mm) Thereby, the ratio between shock absorption per millimeter was best for 4 mm thickness with means of 1722 N (conventional) and 624 N (AM). Conclusions. Polymer layers demonstrated a force reduction up to 71.68%. For now, additively processed resins of comparable hardness and layering are inferior to conventional fabrications.

Stress Concentration of Hybrid Occlusal Splint-Mouthguard during a Simulated Maxillofacial Traumatic Impact: 3D-FEA

Mouthguards (MG) are protective devices that can reduce the risks of facial trauma. However, many athletes do not use them. Additionally, MG wear with coincidental parafunctional activity has not been considered. The aim of this study was to evaluate the stress distribution as a consequence of a direct impact comparing a conventional MG with a novel hybrid appliance (HMG). Using computer-aided design (CAD) software, a human skull was modeled with the teeth inserted into their respective alveolus. The models were divided according to the MG type (conventional or hybrid). The geometries were exported to the computer-aided engineering (CAE) software and the materials were considered isotropic. Fixation was defined at the base of the maxilla. The load was applied using a hockey puck. The total deformation (mm) and the von Mises stress (MPa) results were obtained for the MGs (conventional and hybrid), upper teeth, lower teeth, and maxillary bone. Despite the presence of an MG, it is still possible to observe generated stress in all structures. However, the hybrid design was more efficient than the conventional design in reducing the displacement during the impact and consequently the stress on the upper teeth, lower teeth, and maxillary bone. Higher stress magnitude was more concentrated at the inner portion of the hybrid design than the conventional device. The HMG appliance decreased the stress concentration in the teeth and in the bone, limiting the areas susceptible to injuries to the regions directly impacted by the hockey puck. Although the novel HMG may mitigate injury, some stress will still result, and any possible injury should be evaluated by a dental professional.

Photodynamic Antibiofilm and Antibacterial Activity of a New Gel with 5-Aminolevulinic Acid on Infected Titanium Surfaces

The use of a new gel containing aminolevulinic acid and red light (ALAD–PDI) was tested in order to counteract bacterial biofilm growth on different titanium implant surfaces. The varying antibacterial efficacy of ALAD–PDI against biofilm growth on several titanium surfaces was also evaluated. A total of 60 titanium discs (30 machined and 30 double-acid etched, DAE) were pre-incubated with saliva and then incubated for 24 h with Streptococcus oralis to form bacterial biofilm. Four different groups were distinguished: two exposed groups (MACHINED and DAE discs), covered with S. oralis biofilm and subjected to ALAD + PDI, and two unexposed groups, with the same surfaces and bacteria, but without the ALAD + PDI (positive controls). Negative controls were non-inoculated discs alone and combined with the gel (ALAD) without the broth cultures. After a further 24 h of anaerobic incubation, all groups were evaluated for colony-forming units (CFUs) and biofilm biomass, imaged via scanning electron microscope, and tested for cell viability via LIVE/DEAD analysis. CFUs and biofilm biomass had significantly higher presence on unexposed samples. ALAD–PDI significantly decreased the number of bacterial CFUs on both exposed surfaces, but without any statistically significant differences among them. Live/dead staining showed the presence of 100% red dead cells on both exposed samples, unlike in unexposed groups. Treatment with ALAD + red light is an effective protocol to counteract the S. oralis biofilm deposited on titanium surfaces with different tomography.

Biomechanical Behavior Evaluation of a Novel Hybrid Occlusal Splint-Mouthguard for Contact Sports: 3D-FEA

Background: Orofacial injuries are common occurrences during contact sports activities. However, there is an absence of data regarding the performance of hybrid occlusal splint mouthguards (HMG), especially during compressive loading. This study amid to evaluate the biomechanical effects of wearing a conventional custom mouthguard (MG) or the HMG on the teeth, bone, and the device itself. Methods: To evaluate the total deformation and stress concentration, a skull model was selected and duplicated to receive two different designs of mouthguard device: one model received a MG with 4-mm thickness and the other received a novel HMG with the same thickness. Both models were subdivided into finite elements. The frictionless contacts were used, and a nonlinear analysis was performed simulating the compressive loading in occlusion. Results: The results were presented in von-Mises stress maps (MPa) and total deformation (mm). A higher stress concentration in teeth was observed for the model with the conventional MG, while the HMG design displayed a promising mechanical response with lower stress magnitude. The HMG design displayed a higher magnitude of stress on its occlusal portion (7.05 MPa) than the MG design (6.19 MPa). Conclusion: The hybrid mouthguard (HMG) reduced (1) jaw displacement during chewing and (2) the generated stresses in maxillary and mandibular teeth.

Effects of Complex Electromagnetic Fields on Candida albicans Adhesion and Proliferation on Polyacrylic Resin

(1) Background: The objectives of this study were to evaluate the effect of several sessions of the antibacterial protocol of complex electromagnetic fields (CMFs) on planktonic Candida albicans and fungal ability, after treatment with CMFs, to adhere and proliferate on acrylic resin materials. (2) Methods: Planktonic overnight cultures of Candida albicans were subjected to different entities of CMFs treatments. Four test groups were compared: “p1”: treated only with the first program of the antibacterial protocol; “p1–p5” subjected to the first five programs; “1 antibacterial” received one complete session of the protocol and “2 antibacterial” received two complete sessions. After the treatments, the number of colony forming units (CFUs) were recorded. Then, C. albicans broth cultures were cultivated on polyacrylic resin discs and evaluated for CFUs and subjected to scanning electron microscope (SEM) analysis. (3) Results: Microbiological analysis showed that CMFs promoted a significant reduction of C. albicans CFUs when the protocol “p1–p5” was applied. No statistically significant differences between test groups were observed if the time of exposure to CMFs was increased. SEM observations and CFUs showed that CMFs treatments have the ability to reduce C. albicans adherence and proliferation on discs. (4) Conclusions: The CMFs showed an antifungal effect as well as a decrease in C. albicans adhesion on polyacrylic resin.

A Review of Evidence-Based Recommendations for Pericoronitis Management and a Systematic Review of Antibiotic Prescribing for Pericoronitis among Dentists: Inappropriate Pericoronitis Treatment Is a Critical Factor of Antibiotic Overuse in Dentistry

This work provides a narrative review covering evidence-based recommendations for pericoronitis management (Part A) and a systematic review of antibiotic prescribing for pericoronitis from January 2000 to May 2021 (Part B). Part A presents the most recent, clinically significant, and evidence-based guidance for pericoronitis diagnosis and proper treatment recommending the local therapy over antibiotic prescribing, which should be reserved for severe conditions. The systematic review includes publications analyzing sets of patients treated for pericoronitis and questionnaires that identified dentists’ therapeutic approaches to pericoronitis. Questionnaires among dentists revealed that almost 75% of them prescribed antibiotics for pericoronitis, and pericoronitis was among the top 4 in the frequency of antibiotic use within the surveyed diagnoses and situations. Studies involving patients showed that antibiotics were prescribed to more than half of the patients with pericoronitis, and pericoronitis was among the top 2 in the frequency of antibiotic use within the monitored diagnoses and situations. The most prescribed antibiotics for pericoronitis were amoxicillin and metronidazole. The systematic review results show abundant and unnecessary use of antibiotics for pericoronitis and are in strong contrast to evidence-based recommendations summarized in the narrative review. Adherence of dental professionals to the recommendations presented in this work can help rapidly reduce the duration of pericoronitis, prevent its complications, and reduce the use of antibiotics and thus reduce its impact on patients’ quality of life, healthcare costs, and antimicrobial resistance development.