Long-term survival of salivary streptococci on dental devices made of ethylene vinyl acetate

Mouthguard use, hygiene, and maintenance practices among combat and team sports athletes: A comparative study

This study aimed to investigate the attitudes of combat and team sports athletes towards the use, storage, and hygiene conditions of mouthguards, with the goal of understanding disparities in usage and maintenance practices and their implications for oral health. A cross-sectional study was conducted involving 394 athletes (316 combat athletes and 78 team athletes). Participants completed a 28-question survey assessing their knowledge, attitudes, and practices regarding mouthguard use, hygiene, and maintenance. The survey included questions on demographic data, mouthguard usage habits, cleaning methods, and storage practices. Combat sports athletes exhibited significantly higher rates of mouthguard use (100%) compared to team sports athletes (29.5%) (chi square [χ2] = 258.971, p<0.001). Significant differences were also found in cleaning (χ2 = 252.195, p<0.001) and storage practices (χ2 = 14.195, p = 0.002), with combat athletes demonstrating better adherence to recommended guidelines. Common complaints about mouthguards included difficulties with speaking (χ2 = 7.792, p = 0.005) and breathing (χ2 = 11.431, p = 0.001), with combat athletes reporting fewer issues. The study highlights the need for increased awareness and education on mouthguard use among team sports athletes. Dentists and coaches play a crucial role in promoting proper mouthguard use, hygiene, and maintenance to prevent sports-related dental injuries. Emphasis should be placed on the benefits of custom-made mouthguards for improved comfort and protection.

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.

Effects of cleaning sports mouthguards with ethylene-vinyl acetate on oral bacteria

Background

Sports mouthguards, worn in the oral cavity to prevent sports injuries, are constantly exposed to various microorganisms that cause oral infections. Hence, the optimal cleaning methods for sports mouthguards have been thoroughly examined. In this study, we evaluated the efficiency of cleaning effects with a mouthguard cleaner (MC) on microbial biofilm formation in sports mouthguards in vitro and in vivo.

Methods

We evaluated the cleaning effects of the discs produced by ethylene-vinyl acetate (EVA) on bacterial biofilms formed by the commensal bacterium Streptococcus oralis, the cariogenic bacterium Streptococcus mutans, and the opportunistic pathogen Staphylococcus aureus in vitro. EVA discs with biofilm were subjected to sterile distilled water (CTRL) and ultrasonic washing (UW), followed by treatment with MC and sodium hypochlorite (NaClO) as positive controls. Thereafter, the viable bacterial cell counts were determined. The bacteria adhering to the sheets before and after the treatment were observed under an electron microscope. The degree of cleanliness and measurement of viable microbial cell counts for total bacteria, Streptococci and Candida, opportunistic fungi, were evaluated on the used experimental sports mouthguards with and without UW and MC treatment in vivo.

Results

The number of bacterial cells significantly decreased against all the tested biofilm bacteria upon treatment with MC, compared with CTRL and UW. Electron microscopy analysis revealed the biofilm formation by all bacteria on the EVA discs before cleaning. We observed fewer bacteria on the EVA discs treated with MC than those treated with CTRL and UW. Furthermore, the degree of cleanliness of the used experimental sports mouthguards cleaned using MC was significantly higher than that of the CTRL-treated mouthguards. Moreover, the viable microbial cell counts on the used experimental sports mouthguard were considerably lower than those on the CTRL ones.

Conclusion

The cleaning effect of MC against oral bacteria was more effective than that of UW. MC treatment might have a potential future application as a cleaning method for sports mouthguards to protect athletes from oral infection.

A new composite made from Luffa Cylindrica and ethylene vinyl acetate (EVA): Mechanical and structural characterization for its use as Mouthguard (MG)

The use of Mouthguards (MGs) in contact sports is an interesting biomedical topic. MGs are protective personal equipment made principally from the copolymer ethylene vinyl acetate (EVA). EVA is a thermoplastic whose thickness and rigidity are variables of concern for a good shock energy absorption capability in an MG. A natural fiber polymer composite is an interesting attempt for tackling these variables. Luffa cylindrica (luffa) is a sponge gourd that grows in 3D structure, which is used mainly as an ornament, a filling, or is trimmed for its use as a bathing product. In this work, a new EVA-luffa composite (EVLc) was made from commercial EVA sheets and luffa mat acting as reinforcement. FTIR, DSC, and TGA tests of EVA revealed its nature compared to literature data. A mechanical testing was applied to eight EVLc ASTM D-638 type V dumbbells (D1-D8) that showed low tensile strength values compared to EVA resistance ranges in literature. SEM images of EVLc's D1-D8 confirmed good adhesion between the reinforcement and matrix without surface treatment, and a descriptive statistical analysis indicated an intrinsic variation.

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.

Antibacterial effect of a disinfectant spray for sports mouthguards on Streptococcus sobrinus

BACKGROUND

Mouthguard (MG) disinfectant sprays are available for maintaining MG hygiene. The effect of these sprays against Streptococcus sobrinus is still unknown. The purpose of this study was to evaluate the antibacterial effect of an MG disinfectant spray against S. sobrinus using the modified ISO 22196 standard.

MATERIALS AND METHODS

In this in vitro study, we used the following treatment groups for antibacterial testing: MG spray-1 (left in spray for 30 s), MG spray-2 (60 s), and control (n = 4). All analyses were performed at a statistically significant level (P = 0.05) using JMP^® 14.

RESULTS

The log colony-forming units of the MG spray-2 group were significantly lower than those of the other groups. The antibacterial activity of MG spray-2 against S. sobrinus was >2.1.

CONCLUSION

We confirmed the antibacterial effect of the MG spray against S. sobrinus, and it was influenced by the treatment duration, with the optimum effect at a longer duration.

The Vaginal Microbiota, Bacterial Biofilms and Polymeric Drug-Releasing Vaginal Rings

The diversity and dynamics of the microbial species populating the human vagina are increasingly understood to play a pivotal role in vaginal health. However, our knowledge about the potential interactions between the vaginal microbiota and vaginally administered drug delivery systems is still rather limited. Several drug-releasing vaginal ring products are currently marketed for hormonal contraception and estrogen replacement therapy, and many others are in preclinical and clinical development for these and other clinical indications. As with all implantable polymeric devices, drug-releasing vaginal rings are subject to surface bacterial adherence and biofilm formation, mostly associated with endogenous microorganisms present in the vagina. Despite more than 50 years since the vaginal ring concept was first described, there has been only limited study and reporting around bacterial adherence and biofilm formation on rings. With increasing interest in the vaginal microbiome and vaginal ring technology, this timely review article provides an overview of: (i) the vaginal microbiota, (ii) biofilm formation in the human vagina and its potential role in vaginal dysbiosis, (iii) mechanistic aspects of biofilm formation on polymeric surfaces, (iv) polymeric materials used in the manufacture of vaginal rings, (v) surface morphology characteristics of rings, (vi) biomass accumulation and biofilm formation on vaginal rings, and (vii) regulatory considerations.

The Impact of Sport Training on Oral Health in Athletes

Athletes' oral health appears to be poor in numerous sport activities and different diseases can limit athletic skills, both during training and during competitions. Sport activities can be considered a risk factor, among athletes from different sports, for the onset of oral diseases, such as caries with an incidence between 15% and 70%, dental trauma 14-70%, dental erosion 36%, pericoronitis 5-39% and periodontal disease up to 15%. The numerous diseases are related to the variations that involve the ecological factors of the oral cavity such as salivary pH, flow rate, buffering capability, total bacterial count, cariogenic bacterial load and values of secretory Immunoglobulin A. The decrease in the production of S-IgA and the association with an important intraoral growth of pathogenic bacteria leads us to consider the training an "open window" for exposure to oral cavity diseases. Sports dentistry focuses attention on the prevention and treatment of oral pathologies and injuries. Oral health promotion strategies are needed in the sports environment. To prevent the onset of oral diseases, the sports dentist can recommend the use of a custom-made mouthguard, an oral device with a triple function that improves the health and performance of athletes. During training, the sports dentist must monitor the athletes and the sports examination protocol must be implemented with the inclusion of the clinical examination, quantitative and qualitative analysis of saliva and instructions on the use, cleansing and storage of the mouthguard.

Microbial Contamination and Disinfection of Sport Mouthguard: In Vitro Study

Mouthguards in Ethylene Vinyl Acetate (EVA) should be sanitized to prevent alteration of oral microbiota. The present study determined, in vitro and by SEM observation, the decontaminating effect of different substances on EVA mouthguards previously contaminated with saliva and broth culture of Enterococcus faecalis ATCC 29212 and Candida albicans CH 34 (clinically isolated). Subsequently, the mouthguards were subjected to the following treatments: (A) Untreated; (B) 5 min with sterilized distilled water (H₂O d); (C) 5 min with H₂O₂; (D) 5 min with a physiological solution; (E) toothbrush and fluoride toothpaste; (F) 5 min with 0.5% NaOCl; (G) 5 min with Oral Care Foam™; (H) 5 min with Bite Sept™. The highest efficacy against E. faecalis was demonstrated by H₂O₂ (84.19% bacterial load reduction). H₂O₂ and Oral Care Foam™ showed a greater reduction of salivary cell load. The highest efficacy against C. albicans was demonstrated by 0.5% NaOCl which caused a 92.95% reduction of cell load. In conclusion, hydrogen peroxide, 0.5% sodium hypochlorite and the solution Oral Care Foam™ allowed to obtain an optimum disinfection of the mouthguard. SEM observation showed that different substances demonstrated a decontaminating effect decreasing the microbial communities on the EVA surface.

Antimicrobial activity of ethylene-vinyl acetate containing bioactive filler against oral bacteria

We developed an ethylene vinyl acetate (EVA) containing surface pre-reacted glass-ionomer (S-PRG) filler, as a new mouthguard material for preventing intraoral bacterial infection. We examined its physical properties, antimicrobial activity against a major cariogenic bacterium Streptococcus mutans and a periodontopathogen Porphyromonas gingivalis, and its cytotoxicity toward human gingival epithelial cells. S-PRG filler was added to EVA copolymer at 5, 10, 20, or 40 wt% and was processed into disc-shaped test specimens. Only minor differences between the Shore hardness and rebound resilience properties of EVA materials with and without the S-PRG filler were observed. The specimens with S-PRG filler showed bacteriostatic activity toward S. mutans and P. gingivalis and inhibited S. mutans biofilm formation. No cytotoxicity against the gingival epithelial cells was observed. Our findings show that EVA containing S-PRG filler has antimicrobial activity toward pathogenic oral bacteria and may be an effective material for maintaining the oral health of athletes.

Functionalization of ethylene vinyl acetate with antimicrobial chlorhexidine hexametaphosphate nanoparticles

Ethylene vinyl acetate (EVA) is in widespread use as a polymeric biomaterial with diverse applications such as intravitreal devices, catheters, artificial organs, and mouthguards. Many biomaterials are inherently prone to bacterial colonization, as the human body is host to a vast array of microbes. This can lead to infection at the biomaterial’s site of implantation or application. In this study, EVA was coated with chlorhexidine (CHX) hexametaphosphate (HMP) nanoparticles (NPs) precipitated using two different reagent concentrations: CHX-HMP-5 (5 mM CHX and HMP) and CHX-HMP-0.5 (0.5 mM CHX and HMP). Data gathered using dynamic light scattering, transmission electron microscopy, and atomic force microscopy indicated that the NPs were polydisperse, ~40–80 nm in diameter, and aggregated in solution to form clusters of ~140–200 nm and some much larger aggregates of 4–5 μM. CHX-HMP-5 formed large deposits on the polymer surface discernible using scanning electron microscopy, whereas CHX-HMP-0.5 did not. Soluble CHX was released by CHX-HMP-5 NP-coated surfaces over the experimental period of 56 days. CHX-HMP-5 NPs prevented growth of methicillin-resistant Staphylococcus aureus when applied to the polymer surfaces, and also inhibited or prevented growth of Pseudomonas aeruginosa with greater efficacy when the NP suspension was not rinsed from the polymer surface, providing a greater NP coverage. This approach may provide a useful means to treat medical devices fabricated from EVA to render them resistant to colonization by pathogenic microorganisms.

Influence of sport mouthguards on the ecological factors of the children oral cavity

BACKGROUND

The use of fixed and/or removable dental devices is an attributable factor that may affect the oral cavity homeostasis. The aim of this study was to monitor the oral environmental changes caused by dental devices, as sports mouthguards with the aid of a chair-side test.

METHODS

Sixty children with sports-mouthguards were analyzed at baseline (T0), after 6 months of dental devices use (T1), after a year (T2) and after almost 6 months without using it (T3). At T0, a clinical monitoring was performed and the DMFT index was recorded. At each time of observation, the following parameters were recorded: FMPS, FMBS, unstimulated-flow rate, saliva consistency, resting pH, stimulated saliva, buffer capacity, the CFU/ml of Streptococcus mutans.

RESULTS

In 60 subjects, mean age 9.9 ± 1.2, mean value of DMFT 1.55 ± 1.29,dmf-t 3.43 ± 1.21, FMPS and FMBS values increased significantly at T2. The values of unstimulated flow rate vary significantly within the observation times. The pH value and the buffering capacity reduced significantly at T2. The tests for the detection of S. mutans were negative in all the subjects in several observation times. All patients regularly used fluoridated toothpaste and comply with normal standards of oral hygiene; but over time the patients lost their initial motivation.

CONCLUSIONS

Sport treatment with dental devices dues to changes in oral ecological factors: increases FMPS, FMBS and reduces the buffering capacity and the salivary pH. The use of removable devices increases the retentive plaque surfaces and inhibits the protective effect of saliva.The so-called "chair-side" tests were able to easily monitor patients and to determine the risk of oral disease during sport treatment.