Incidence of orofacial injuries in high school sports

Traumatic dental injuries in high school athletes in the United States of America from 2005 to 2020

BACKGROUND/AIM

Participation in sports activities is a source of dental injury. Despite recommendations for the use of mouthguards, athletes underutilize them. The aim of this study was to provide estimates of dental injuries, the mechanism of injuries and the utilization of mouthguards in high school sports.

MATERIALS AND METHODS

This study was a secondary analysis of an existing dataset of a convenience sample of the National High School Sports-Related Injury Surveillance Study. Data of athletic exposures, dental injuries, mouthguard usage, and mechanism of injury from the 2005/2006 to the 2019/2020 academic years were analyzed.

RESULTS

During the study period, there were 459 dental injuries in 49,987,927 athletic exposures resulting in a dental injury rate of 0.9 per 100,000 athletic exposures (AE). Slightly more than half of the traumatic dental injuries were sustained during competition (n = 256; 55.8%) and the rest (n = 200; 43.6%) were sustained during practice. The rate of dental injury in competition was 3.6 times higher than the rate in practice (RR: 3.6, 95% CI: 3.0-4.4). Dental injuries comprised 0.4% of the total 108,574 injuries sustained by athletes. Among girls' sports, field hockey had the highest rate (3.5 per 100,000 AE) and among boys' sports, basketball (2.4 per 100,000 AE) had the highest rate of dental injury. The most common mechanism of injury was contact with another player (276; 60.4%) followed by contact with apparatus (146; 31.9%). In the majority of dental injuries (308; 75.1%), the athlete was not wearing a mouthguard when the dental injury was sustained.

CONCLUSIONS

Dental injuries were a small proportion of all injuries sustained by high school athletes. The majority of dental injuries were sustained when the athlete was not wearing a mouthguard.

Orthodontic and oral health literacy in adults

Objective

The primary aim of the study was to determine levels of literacy in both oral health and orthodontics in an adult population. The secondary study aim was to investigate differences in literacy between males and females.

Methods

Participants included individuals 18 years or older seeking dental treatment at the East Carolina University (ECU) School of Dental Medicine. To determine levels of oral health literacy (OHL) and orthodontic literacy (OrthoL), validated instruments were administered, including the Rapid Estimate of Adult Literacy in Medicine and Dentistry, the Oral Health Literacy Instrument and its separate scales, and a questionnaire on orthodontic literacy. Summary statistics were computed, and statistical significance was set at 0.05.

Results

One hundred seventy-two individuals participated in the study and had a mean age of 55.03 (range:18–88). Greater than 70% of the sampled population exhibited inadequate or marginal oral health knowledge. Additionally, greater than 70% of the sample possessed no more than an 8th grade reading level, with regard to basic medical and dental terms. Higher education was weakly associated with higher OrthoL and OHL. Higher age was also weakly associated with lower OrthoL and OHL. Males on average exhibited significantly higher OHL (p < .05) but there were no OrthoL differences between males and females. Dental visit frequency was not associated with OrthoL or OHL.

Conclusion

Low levels of OrthoL and OHL were observed in the study. While males demonstrated a higher level of OHL than females, neither age nor the occurrence of dental appointments significantly influenced levels of literacy.

Sports-related Orofacial Injuries in Children: Awareness and Experience among Sports Coaches in Delhi Region of India

Background

Sports activities are the most important entity of human life for the holistic well-being of an individual. At the same time, it exposes them to a high risk of orofacial injuries.

Aim

The study assessed the level of knowledge, attitudes, and awareness of orofacial injuries in children among sports coaches.

Materials and methods

The sample of this descriptive cross-sectional study consisted of 365 sports coaches across various sports academies in the Delhi region. A questionnaire-based survey was conducted and descriptive analysis was performed. The comparative statistics were computed using the Chi-square test and Fischer exact test. A p-value of <0.05 was considered statistically significant.

Results

Among participating coaches, 74.5% of the coaches agreed on the risk of trauma during sports activities that they supervise. The most common type of injury reported by the coaches was 'cut lip, cheek, and tongue' (72.6%), followed by 'broken/avulsed tooth' (44.9%). The mechanism of injury was mainly due to falls (48.8%). Nearly 65.5% of coaches were not aware of the possibility of replantation of an avulsed tooth. Also, coaches exhibited poor knowledge about an ideal storage media for carrying an avulsed tooth to the dentist. The majority (71%) of coaches agreed that their academies had no tie-ups with nearby dental clinics/hospitals.

Conclusion

The sports coaches exhibited inadequate knowledge about the primary management of orofacial injuries and were unaware of the possibility of re-implantation of an avulsed tooth.

Clinical significance

This study also highlights the need for educating coaches about emergency management of orofacial injuries and postponement in immediate treatment or inappropriate treatment due to lack of knowledge may lead to the futile outcome of the treated injured teeth.

How to cite this article

Tokas A, Sood S, Bhatia HP, et al. Sports-related Orofacial Injuries in Children: Awareness and Experience among Sports Coaches in Delhi Region of India. Int J Clin Pediatr Dent 2022;15(4):450-454.

Moderate and Severe Injuries at Five International Olympic-Style Wrestling Tournaments during 2016-2019

As a contact sport, wrestling may result in injuries. Based on the severity, they are classified as mild, moderate, severe and critical. All injuries occurring at international competitions are documented in a cloud-based surveillance system. The purpose of this study was to analyze the incidence and characteristics of moderate and severe (including critical) wrestling injuries that occurred during five international Olympic-style wrestling competitions in 2016-2019. Three Wrestling World Championships and two European Wrestling tournaments were organized by the Hungarian Wrestling Federation in 2016-2019. A total of 2483 wrestlers in three Olympic wrestling styles have competed in 3007 matches. Data from all injuries were recorded and analyzed to define rates, locations, types and severity, and to compare with previous reports. A total of 53 wrestlers sustained 55 injuries, which is equivalent to an overall injury incidence rate of 9.1‰ (9.1/1000 athletic exposures). Greco-Roman and Women Wrestling had the same injury incidence rate, while Freestyle had a lower one (9.5‰ versus 8.5‰). The injury proportion by regions and anatomic locations were on head and face 29.1%, spine and trunk 16.4 % and the upper-and-lower extremity injuries equally 27.3%. The most common types of injuries included ligament lesions, joint injuries, skin lacerations, and contusions. Five wrestlers (0.8‰) sustained strangulation or concussion. Wrestling injury rates during United World Wrestling competitions are not high, but when happen they can be serious. Despite relatively low incidence rate of injuries, there is a need for continuous education for medical teams, referees and coaches to avoid wrestling injuries.

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.

Prevalence of orofacial injuries in wheeled non-motor sports athletes: A systematic review and meta-analysis

BACKGROUND/AIMS

As the popularity of sports activities grows, so do the number of sport-related injuries. Furthermore, sports that use equipment or vehicles that modify the speed of the player can present more serious injuries. The aim of this systematic review was to identify the overall prevalence of orofacial trauma in wheeled non-motor sports athletes.

METHODS

The search strategy was applied in eight electronic databases (Embase, LILACS, Livivo, PEDro, PubMed, Scopus, SportDiscus, and Web of Science). Additionally, a complementary search of the gray literature (Google Scholar, OpenGrey, and ProQuest Dissertations & Theses Global), reference lists of included articles, and studies indicated by experts on the subject was done. The included articles were observational studies with sufficient data of orofacial trauma (type and anatomical site) in wheeled non-motor sport athletes, regardless of the competition level. Risk of bias was assessed by using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. The meta-analysis was performed using R Statistics software, and the strength of cumulative evidence was assessed by The Grading of Recommendations Assessment, Development, and Evaluation.

RESULTS

From 4042 identified studies, after the removal of duplicates and phase one of selection (title and abstracts screening), 251 studies remained for phase two (full-text screening). Five articles were finally included. One study was considered to have a low risk of bias and four had a moderate risk of bias. The cumulative prevalence of orofacial injuries in wheeled non-motor sport athletes was 21.7% (CI: 8.7-34.7; I² :97.6%) and the prevalence of dental injuries in these sports was 7.5% (CI:4.3-10.7; I² :61.9%). The certainty in cumulative evidence was considered to be very low.

CONCLUSION

About 22% of the wheeled non-motor sport athletes have suffered orofacial injuries. The most prevalent type of injury was classified as dental trauma.

Determinants for traumatic orofacial injuries in sport: Extrinsic factors in a scoping review

BACKGROUND/AIM

Sports practices carry a risk for orofacial injuries and, to avoid them, preventive measures are necessary. The aim of this study was to investigate a web of extrinsic determinants for orofacial trauma in sports.

MATERIALS AND METHODS

Through a scoping review, eight extrinsic risk factors for sports-related orofacial trauma emerged from the thematic analysis. These were sports modality, sports philosophy, competition rules, level of competition, accessory equipment, environmental conditions, acting regimen, pitch conditions, and human resources. The data collection was conducted on seven databases, using terms based on health science descriptors and keywords related to orofacial trauma and sports.

RESULTS

From the 1155 articles found, 157 were selected based on eligibility criteria and classified according to the mentioned factors. After the full reading of the articles, the most cited risk factor was sports modality while acting regimen and environmental factors were the least mentioned. Therefore, a scheme following the web of determinants was constructed with the purpose of establishing a risk profile, which was based on the interactions between the determinants and on the frequency that they were mentioned as contributors to injury. From this, it was observed that each traumatic event is possibly a result of the interrelationships among the eight suggested determinants.

CONCLUSION

Sports modality was the most cited extrinsic determinant observed in the literature, while environmental conditions and acting regimen were the least cited. In addition, more than establishing the determinants, it is necessary to comprehend how they relate, once preventive strategies should intercede on these relations, to help reduce sports injuries.

National Athletic Trainers' Association Position Statement: Preventing and Managing Sport-Related Dental and Oral Injuries

OBJECTIVE

To provide athletic trainers, health care professionals, and all those responsible for the care of athletes with clinical recommendations for preventing and managing sport-related dental and oral injuries.

BACKGROUND

Participation in competitive sports continues to grow at both the interscholastic and intercollegiate levels. Therefore, exposure to, and the incidence of athletic-related injury, including orofacial injury, will also likely increase. At the time of this writing, the leading governing agencies for interscholastic (National Federation of State High School Associations) and intercollegiate (National Collegiate Athletic Association) sports require only protective orofacial equipment (eg, mouthguards) for 5 and 4, respectively, of their sanctioned sports. Although orofacial injuries represent a small percentage of all sport-related injuries, the financial burden associated with these injuries (eg, tooth avulsion) can exceed $15 000 over an adult life. Therefore, effective management of sport-related dental injuries is critical to the long-term financial, physical, and emotional health of people who have experienced dental trauma.

RECOMMENDATIONS

Based upon the current evidence regarding sport-related orofacial injury, we provide recommendations related to planning considerations, education, and mouthguard efficacy, material, fabrication, and care considerations. Additionally, suggested best practices for managing sport-related dental injury are also given for athletic trainers and other health care professionals.

The knowledge, attitude and practices of male sports participants to sports-related dental trauma in Khobar and Dammam, Saudi Arabia - A pilot survey

The risk of dental trauma may increase during sports participation. The purpose of this study was to evaluate the knowledge, attitude, and practices of sports participants concerning sports-related dental trauma and associated emergency/preventive practices. The study included 124 male subjects over 18 years of age participating in contact and non-contact sports in three clubs in the Eastern Province, Saudi Arabia. A questionnaire was used to assess past experience of dental trauma related to sports in addition to the use of a mouth guard and knowledge of related emergency procedures. Outcomes were compared between individuals practicing direct and non-direct contact sports. One third of the participants had experienced dental trauma while playing sports, mostly crown fracture, mobility, and avulsion. Their knowledge of first aid and emergency procedures was inadequate. A significantly higher proportion of non-direct contact sport participants sought the help of a dentist for themselves or others (P = 0.04 and 0.003, respectively). Only 33.9% used mouth guards, with higher odds of mouth guard use associated with participating in direct contact sports and believing a tooth can be lost during sports practice (odds ratio = 5.59 and 5.37, respectively). Educational programs are needed to increase the awareness in sports participants of the risk of dental trauma during sports participation, to improve their knowledge of first aid procedures, and to increase the use of mouth guards.

Mouthguard BITES (behavior, impulsivity, theory evaluation study): what drives mouthguard use among high school basketball and baseball/softball athletes

Although mouthguards are effective, inexpensive, easy to use, and readily available, this form of protective equipment has been underutilized. "Impulsive delay discounting" (an index of impulsive behavior) among high school athletes may help explain their decision making regarding use of protective equipment such as mouthguards. We investigated the relationship between high school baseball, softball, and basketball players' mouthguard use, impulsive delay discounting, and the precaution adoption process model (a behavior change theory). A convenience sample of boys' and girls' basketball and baseball/softball players at 21 high schools in the Greater Columbus, Ohio, metro area completed a self-administered survey that captured their demographic information, knowledge, attitudes, and beliefs regarding mouthguard use, impulsive delay discounting, and precaution adoption process model stage. We surveyed a total of 1636 students (55.9 % male, 43.8 % female, 0.3 % unknown). Only 12.3 % reported using a mouthguard either every time or sometimes during practice or competition. The primary reasons reported for not wearing mouthguards were they were not required to (65.3 %) and that the athletes could not breathe or talk while wearing one (61.5 %). These reasons were consistent across sex and sport. Most athletes reported that their coaches (87.3 %) and parents (64.5 %) had never talked to them about wearing a mouthguard. Lower precaution adoption process model stage was significantly associated with higher impulsivity (p < 0.001) and higher delayed discounting (p = 0.016) after adjusting for school, sport, and sex. Voluntary mouthguard use among high school athletes playing basketball and baseball/softball remains low despite the risk of dental injury in these sports. Effective, evidence-based, targeted, and tailored interventions to improve adolescent athletes' use of mouthguards to prevent sports-related dental injuries should be based on the specific behavioral and social factors influencing each athlete's decision making regarding use of mouthguards.

Face masks and basketball: NCAA division I consumer trends and a review of over-the-counter face masks

OBJECTIVES/HYPOTHESIS

This study aims to: 1) determine the current consumer trends of over-the-counter (OTC) and custom-made face mask usage among National Collegiate Athletic Association (NCAA) Division I athletic programs; and 2) provide a literature review of OTC face guards and a classified database.

STUDY DESIGN

Literature review and survey.

METHODS

Consumer trends were obtained by contacting all 352 NCAA Division I programs. Athletic trainers present in the office when called answered the following questions: 1) "When an athlete breaks his or her nose, is a custom or generic face guard used?" and 2) "What brand is the generic face guard that is used?" Data was analyzed to determine trends among athletic programs. Also, a database of OTC devices available was generated using PubMed, Google, and manufacturer Web sites.

RESULTS

Among the 352 NCAA Division I athletic programs, 254 programs participated in the survey (72% response rate). The majority preferred custom-made guards (46%). Disadvantages included high cost and slow manufacture turnaround time. Only 20% of the programs strictly used generic brands. For the face mask database, 10 OTC products were identified and classified into four categories based on design, with pricing ranging between $35.99 and $69.95.

CONCLUSION

Only a handful of face masks exist for U.S. consumers, but none of them have been reviewed or classified by product design, sport application, price, and collegiate consumer use. This project details usage trends among NCAA Division I athletic programs and provides a list of available devices that can be purchased to protect the nose and face during sports.

LEVEL OF EVIDENCE

NA. Laryngoscope, 126:1054-1060, 2016.

Dental problems in athletes

Orofacial injuries and diseases occur in athletes, and they may not always have access to dentists. Therefore team physicians should be aware of the common injuries and initial management. Treatment of dental injuries will depend on whether the teeth are primary or permanent. The most common type of fracture is crown fracture, but there are other dental injuries that can lead to future complications if not treated promptly and monitored closely. Tooth avulsions need to be handled properly, and athletes should see a dentist as soon as possible. Despite the urgency of some injuries, other orofacial injuries or diseases, such as lacerations and caries, should not be overlooked. Proper education and use of mouth guards can assist athletes in reducing their risk of orofacial injuries.

Intra-oral Mouth-Guard In Sport Related Oro-Facial Injuries: Prevention is Better Than Cure!

India is rapidly assuming a more health-conscious posture. Olympic competition and professional sports have turned from mere dreams into goals. Many major professional sports leagues are expanding. Sports dentistry is a composite of skills for treatment, prevention, education and research in which dentistry and sports come together. Custom athletic mouth guards present additional health-care opportunities. They are designed to reduce the impact force of a direct blow to the jaw and create a gap between the condyle and skull thereby reducing the transference of the impact to the brain. The prevalence and severity of injuries to the teeth, jaws and intra-oral and peri-oral soft tissues, concussions and neck injuries are reduced when mouth guards are used. The dentist can play a proactive role in helping to deliver important expanded health care services.

A survey of orofacial injuries among basketball players

OBJECTIVE

To determine the prevalence of orofacial injuries among basketball players in Benin City, Nigeria and to survey the athletes' awareness, attitude and use of mouthguards.

METHODS

A cross-sectional survey of basketball players in the standard basketball arena in Benin City was conducted between November 2009 and January 2010. A self-administered questionnaire elicited information on demography, the prevalence of oral and facial injuries, distribution of site and cause of orofacial injuries, athletes' knowledge, attitudes and usage of mouthguards. Data were subjected to descriptive statistics and Chi square test.

RESULTS

The response rate was 78%. Of the 156 respondents, 79.5% were male and 20.5% female, with a mean age of 23.1 years. The distributions was amateurs (61.5%) professionals (38.5%). The mean number of injuries in previous 12 months was 3.7 ± 1.8. The prevalence of both facial and oral injuries among the respondents was 62.8% with the lip and gingiva most commonly involved respectively. The common causes of the orofacial injury reported were from elbows of opponents, falling and collisions with other players. The prevalence of injury was not significantly associated with demography, category, competition and duration of participation. More than half had heard and seen mouthguards and the coach was the leading source of information. The reasons for non-use of mouthguard were mostly ignorance, non-availability and non-affordability.

CONCLUSION

The high prevalence of orofacial injury among basketball players reported in this study justifies the need for multidisciplinary injury prevention interventional approach with emphasis on the rules of the games.

Implant-supported prosthesis misalignment related to the dental arch: a 14-year clinical follow-up

The purpose of this study was to warn the dental community about a possible problem in function with partial implant-supported prostheses used for long periods. The misalignment between natural teeth and the implant-supported prosthesis on teeth 11 and 12, observed in a 14-year clinical follow-up, illustrates the fact. The metal-ceramic crowns were placed in 1995 after a rigorous occlusal adjustment. Evaluations were made at 4, 6, 9, and 14 years, when it was noticed that the restorations were positioned palatally and extruded in comparison with the natural teeth. After 9 years, a greater discrepancy was noticed, with anterior occlusion and esthetic changes. The possible causes have been discussed: occlusal problems, parafunctional habits, and natural movement. The first 2 options were discarded after clinical analysis and diagnosis. Therefore, the natural movement probably deriving from an interaction of mechanical and genetic factors might have been the cause. The implants do not have periodontal ligaments but rather ankylosis, so they do not suffer those movements. This case emphasizes the need to inform patients that implants can last more than 10 years in function, but this is not the case with restorations, which lose function and esthetics and must be replaced.

First aid for dental trauma caused by sports activities: state of knowledge, treatment and prevention

In view of the widespread lack of knowledge of first aid procedures in cases of dental trauma, this article describes the current state of knowledge and highlights the need for education of those likely to witness or be victims of dental trauma while practising sports. Dental and oral injuries, the commonest type of orofacial injuries, are often sustained by athletes playing contact sports; indeed, they represent the most frequent type of sporting injury. Studies of a large group of children and adults have shown that as many as 31% of all orofacial injuries are caused by sporting activities. Furthermore, current literature on the subject emphasizes that awareness of appropriate triage procedures following dental trauma is unsatisfactory. Delay in treatment is the single most influential factor affecting prognosis. What should we know and, more importantly, what should we do? Immediate replantation of an avulsed tooth is the best treatment option at the site of the accident. If replantation is impossible, milk is the preferred transport medium for the avulsed tooth. There is a general low level of awareness about the need for prompt triage of traumatic dental injuries sustained in sports, despite their relative frequency. When a cohort of Swiss basketball players was interviewed, only half were aware that an avulsed tooth could be replanted. Cheap, commercially available tooth storage devices containing an isotonic transport medium (so-called 'Save-a-Tooth boxes'), can maintain the viability of an avulsed tooth for up to 72 hours, prior to replantation. More readily available storage media such as milk, sterile saline or even saliva may be used, but knowledge of this information is rare among sports participants. For example, just 6.6% of the Swiss basketball players interviewed were aware of the 'Tooth Rescue box' products. Sporting organizations seem to offer very little information about sports-related risks or preventive strategies for orodental trauma. Having an attending dentist at sports events - amateur or professional - is clearly a luxury that is neither practical nor affordable. The solution must lie in extending the knowledge of management of orodental trauma beyond the dental profession. Educational posters, when displayed prominently in sports clubs, gym halls and dressing rooms of swimming pools, are a clear, accessible and low cost method of presenting the appropriate procedures to follow after orodental injury. When the potentially avoidable financial burden and discomfort of protracted restorative or cosmetic dentistry are taken into account, rarely can such significant morbidity be so easily prevented.

Dento?alveolar and maxillofacial injures ? a survey of knowledge of the regimental aid providers in the Israeli army

The present study evaluated the knowledge of physicians and emergency medical technicians (EMT) regarding primary treatment for oral and maxillofacial trauma and assessed the experience they have in treating oral and maxillofacial injuries. The study population consisted of 80 military physicians and EMT during their military service. A questionnaire was distributed relating to demographic data such as age, gender, position, and type of military service, as well as past experience in treating or witnessing oral and maxillofacial trauma, former education regarding diagnosis and treatment of oral and maxillofacial trauma, assessment of knowledge regarding oral and maxillofacial trauma, etc. The questionnaire was answered by 76 participants (95% response rate): 32 physicians and 44 EMT. Only 17 (22.4%) received education regarding oral and maxillofacial trauma (eight physicians, 25% and nine EMT, 20.5%). Nevertheless, 23 (30.3%) reported witnessing such an injury during their military service. Oral and maxillofacial injuries were first seen by the EMT in 43.4% of the cases, a physician in 23.7%, and a dentist in only 9.2%. Overall, 66 (86.8%) of the physicians and EMT stated that it was important to educate the primary health care providers regarding diagnosis and treatment of oral and maxillofacial trauma. Special emphasis should be given to providing primary caregivers with the relevant education to improve their knowledge and ability of dealing with diagnosis and treatment of oral and maxillofacial trauma.

Mouthguards in Sport Activities

Three systematic reviews were conducted on: (i) the history of mouthguard use in sports; (ii) mouthguard material and construction; and (iii) the effectiveness of mouthguards in preventing orofacial injuries and concussions. Retrieval databases and bibliographies were explored to find studies using specific key words for each topic. The first recorded use of mouthguards was by boxers, and in the 1920s professional boxing became the first sport to require mouthguards. Advocacy by the American Dental Association led to the mandating of mouthguards for US high school football in the 1962 season. Currently, the US National Collegiate Athletic Association requires mouthguards for four sports (ice hockey, lacrosse, field hockey and football). However, the American Dental Association recommends the use of mouthguards in 29 sports/exercise activities. Mouthguard properties measured in various studies included shock-absorbing capability, hardness, stiffness (indicative of protective capability), tensile strength, tear strength (indicative of durability) and water absorption. Materials used for mouthguards included: (i) polyvinylacetate-polyethylene or ethylene vinyl acetate (EVA) copolymer; (ii) polyvinylchloride; (iii) latex rubber; (iv) acrylic resin; and (v) polyurethane. Latex rubber was a popular material used in early mouthguards but it has lower shock absorbency, lower hardness and less tear and tensile strength than EVA or polyurethane. Among the more modern materials, none seems to stand out as superior to another since the characteristics of all the modern materials can be manipulated to provide a range of favourable characteristics. Impact studies have shown that compared with no mouthguard, mouthguards composed of many types of materials reduce the number of fractured teeth and head acceleration. In mouthguard design, consideration must be given to the nature of the collision (hard or soft objects) and characteristics of the mouth (e.g. brittle incisors, more rugged occusal surfaces of molars, soft gingiva). Laminates with different shock absorbing and stress distributing (stiffness) capability may be one way to accommodate these factors.Studies comparing mouthguard users with nonusers have examined different sports, employed a variety of study designs and used widely-varying injury case definitions. Prior to the 1980s, most studies exhibited relatively low methodological quality. Despite these issues, meta-analyses indicated that the risk of an orofacial sports injury was 1.6-1.9 times higher when a mouthguard was not worn. However, the evidence that mouthguards protect against concussion was inconsistent, and no conclusion regarding the effectiveness of mouthguards in preventing concussion can be drawn at present. Mouthguards should continue to be used in sport activities where there is significant risk of orofacial injury.

Knowledge of oral health professionals of treatment of avulsed teeth

The management and immediate treatment of an avulsed permanent tooth will determine the long-term survival of the tooth. The aim of this study was to evaluate the knowledge of oral health professionals on the new guidelines for emergency treatment of avulsed teeth. A 12-item questionnaire was distributed among general dentists, specialists, dental hygienists and dental assistants attending Continuing Education courses at the School of Dentistry, University of Southern California, between 2003 and 2004. This study reports only on the general practitioners who comprised 83% of the participants. The results revealed an uneven pattern of knowledge among them regarding the emergency management of an avulsed tooth. Statistically significant associations were related to the participants' previous dental trauma education and their age. In conclusion, there is a need to improve the knowledge of general dentists in the current guidelines for emergency treatment of avulsed teeth.

Using mouthguards to reduce the incidence and severity of sports-related oral injuries

BACKGROUND

This report reviews the available literature on the types and properties of athletic mouthguards, current fabrication methods and the role of mouth protectors in reducing the incidence and severity of sports-related oral injuries.

OVERVIEW

For more than 50 years, the American Dental Association has promoted the protective value of wearing properly fitted mouthguards while participating in athletic or recreational activities that carry a risk of dental injury. Safety is essential to maintaining oral health, and a properly fitted mouthguard can minimize the risks of sustaining oral injuries during participation in sports.

CONCLUSIONS

The dental literature supports the use and protective value of mouthguards in reducing sports-related injuries to the teeth and soft tissues. Dentists are encouraged to educate patients regarding the risks of oral injury in sports, fabricate properly fitted mouthguards, and provide appropriate guidance on mouthguard types and their protective properties, costs and benefits. Further studies addressing the effectiveness of currently available mouthguard types and population-based interventions for reducing oral injuries are recommended.

CLINICAL IMPLICATIONS

Participants in sporting and recreational activities are often susceptible to oral injury. To reduce the incidence and severity of sports-related oral trauma, the use of a properly fitted mouthguard is recommended in any athletic or recreational activity that carries a risk of injury.

Rehabilitation of basketball injuries

Basketball is one of the most popular sports in the United States and throughout the world, and therefore represents one of the most common sources of sports-related injuries. Basketball injuries should be managed by the same general rehabilitation principles as other sports injuries. Additionally, the clinician should be aware not only of general sports injuries but of those injuries most commonly seen in basketball players. By maintaining knowledge of the most common basketball injuries as well as their diagnosis and treatment, the clinician can help to optimize the athlete's return to play and enjoyment of the sport.

A One-year Review of Craniofacial Injuries in Amateur Soccer Players

The purpose of this study was to investigate the rate of craniofacial injuries in amateur soccer and help us better understand the nature of these injuries. Retrospective study was carried out using records from the patients with craniofacial injuries associated with soccer activities. All data were collected on the basis of sex, age, type and anatomic site of the injury. In the one-year period of this study, 11/53 cases with craniofacial injuries associated with soccer activities have been treated in our clinic. The highest incidence was in the 18 to 24 year age group (mean age 20.7) with male propensity. The majority of the patients suffered from dento-alveolar fractures (36%), followed by temporomandibular joint disorders (27%), mandibular fractures (27%), and nasal fractures (9%). The most common cause of the fractures was impact against another player (63.6%), followed by impact against equipment (18.2%) and impact against the ground (18.2%). These results show that there is a high risk of potential oral and craniofacial injury during soccer activities.

Physician and emergency medical technicians' knowledge and experience regarding dental trauma

The purpose of the present study was to evaluate the knowledge of physicians and emergency medical technicians (EMT) regarding primary treatment for dental trauma and to assess the experience they have in treating dental injuries. The study population consisted of 70 military physicians and EMT during their military service. A questionnaire was distributed relating to demographic data, such as age, gender, position, and type of military service, as well as the following issues: past experience in treating or witnessing dental trauma, former education regarding diagnosis and treatment of dental trauma, assessment of knowledge regarding dental trauma, etc. Of all participants, only 4 (5.9%), all physicians, received education regarding dental trauma. Nevertheless, 42 (61.8%) reported they witnessed such an injury during their military service. Dental injuries were first seen by the EMT in 41.2% of the cases, by the physician in 25%, and by a dentist in only 7.3%. Overall, 58 (85.3%) of the physicians and EMT stated that it was important to educate the primary health care providers regarding diagnosis and treatment of dental trauma. Special emphasis should be given to providing primary caregivers with the relevant education to improve their knowledge and ability of dealing with diagnosis and treatment of dental trauma.

Does hard insertion and space improve shock absorption ability of mouthguard?

Mouthguards are expected to reduce sports-related orofacial injuries. Numerous studies have been conduced to improve the shock absorption ability of mouthguards using air cells, sorbothane, metal wire, or hard material insertion. Most of these were shown to be effective; however, the result of each study has not been applied to clinical use. The aim of this study was to develop mouthguards that have sufficient prevention ability and ease of clinical application with focus on a hard insertion and space. Ethylene vinyl acetate (EVA) mouthguard blank used was Drufosoft and the acrylic resin was Biolon (Dreve-Dentamid GMBH, Unna, Germany). Three types of mouthguard samples tested were constructed by means of a Dreve Drufomat (Type SO, Dreve-Dentamid) air pressure machine: the first was a conventional laminated type of EVA mouthguard material; the second was a three layer type with acrylic resin inner layer (hard-insertion); the third was the same as the second but with space that does not come into contact with tooth surfaces (hard + space). As a control, without any mouthguard condition (NOMG) was measured. A pendulum type impact testing machine with interchangeable impact object (steel ball and baseball) and dental study model (D17FE-NC.7PS, Nissin, Tokyo, Japan) with the strain gages (KFG-1-120-D171-11N30C2: Kyowa, Tokyo, Japan) applied to teeth and the accelerometer to the dentition (AS-A YG-2768 100G, Kyowa) were used to measure transmitted forces. Statistical analysis (anova, P < 0.01) showed significant differences among four conditions of NOMG and three different mouthguards in both objects and sensor. About acceleration: in a steel ball which was a harder impact object, shock absorption ability of about 40% was shown with conventional EVA and hard-insertion and about 50% with hard + space. In a baseball that was softer compared with steel ball, a decrease rate is smaller, reduction (EVA = approximately 4%, hard-insertion = approximately 12%, hard + space = approximately 25%) was admitted in the similar order. A significant difference was found with all the combinations except for between EVA and hard-insertion with steel ball (Tukey test). About distortion: both buccal and lingual, distortions had become small in order of EVA, hard-insertion, and hard + space, too. The decrease rate is larger than acceleration, EVA = approximately 47%, hard-insertion = 80% or more, and hard +space = approximately 98%, in steel ball. EVA = approximately 30%, hard-insertion = approximately 75%, and hard + space = approximately 98% in baseball. And a significant difference was found with all the combinations (Tukey test). Especially, hard + space has decreased the distortion of teeth up to several percentages. Acceleration of the maxilla and distortions of the tooth became significantly smaller when wearing any type of mouthguard, in both impact objects. But the effect of mouthguard was clearer in the distortion of the tooth and with steel ball. Considering the differences of mouthguards, the hard-insertion and the hard + space had significantly greater buffer capacity than conventional EVA. Furthermore, hard + space shows quite high shock absorption ability in the tooth distortion. Namely, hard + space has decreased the distortion of teeth up to several percentages in both impact objects.

Orofacial/cerebral injuries and the use of mouthguards by professional athletes in Switzerland

The objective of the present study was to measure the occurrence of orofacial and cerebral injuries in different sports and to survey the awareness of athletes and officials concerning the use of mouthguards during sport activities. Two hundred and sixty-seven professional athletes and 63 officials participating in soccer, handball, basketball and ice hockey were interviewed. The frequency of orofacial and cerebral trauma during sport practice was recorded and the reason for using and not using mouthguards was assessed. A great difference in orofacial and cerebral injuries was found when comparing the different kinds of sports and comparing athletes with or without mouthguards. 45% of the players had suffered injuries when not wearing mouthguards. Most injuries were found in ice hockey, (59%), whereas only 24% of the soccer players suffered injuries when not wearing mouthguards. Sixty-eight percentage of the players wearing mouthguards had never suffered any orofacial and cerebral injuries. Two hundred and twenty-four athletes (84%) did not use a mouthguard despite general acceptance by 150 athletes (56%). Although the awareness of mouthguards among officials was very high (59%), only 25% of them would support the funding of mouthguards and 5% would enforce regulations. Athletes as well as coaches should be informed about the high risk of oral injuries when performing contact sports. Doctors and dentists need to recommend a more intensive education of students in sports medicine and sports dentistry, and to increase their willingness to become a team dentist.

Level of information concerning dental injuries and their prevention in Swiss basketball - a survey among players and coaches

Basketball carries a medium risk of dental injuries. Swiss data are not available in this respect. Using a standardized questionnaire 302 basketball players from 29 Swiss teams and their 29 coaches were interviewed. The questions focused on the frequency of dental accidents, their prevention and subsequent procedure. The participating 302 players came from three divisions: semi-professional players of National League A and B (102), amateurs of Regional League 2 and 3 (100) and young people of up to the age of 18 (100). The data were evaluated in relation to division, sex and team function. Of the 331 interviewed persons 102 had already seen a dental trauma in basketball and 55 had already had a dental trauma. Only four of the interviewed persons wore mouthguards. The awareness of the procedure following a dental trauma was unsatisfactory. The results of the survey show that significantly more information and education is required in Swiss basketball not only through sports associations but also through coaches and dentists.

Parental perceptions regarding mandatory mouthguard use in competitive youth soccer

OBJECTIVE

To understand factors that influence parental perceptions regarding mandatory mouthguard use in competitive youth soccer.

SETTING AND SUBJECTS

A web based survey of parents whose 8-14 year old children participated in outdoor competitive youth soccer during the fall of 2002. Questions focused on: previous injury, education provided, dentist/physician recommendations, and parental perceptions of mouthguard use.

MAIN OUTCOME MEASURE

The outcome variable was parental agreement with the statement "mouthguards should be mandatory for competitive youth soccer". Logistic regression and chi(2) were performed using STATA 8.0.

RESULTS

Altogether 120 parents participated. The children had a mean (SD) age of 11.8 (1.5) years and 48% were female; 14% wore mouthguards and 11% suffered orofacial injuries. Nineteen percent of parents reported receiving educational material from the youth soccer organization. Although 92% of parents believed that mouthguards were effective in reducing orofacial injuries, only one half agreed that mouthguards should be mandatory. Thirty percent of respondents reported that their dentist/physician recommended mouthguards for competitive youth soccer. Logistic regression showed that dentist/physician recommendation and parental female gender were independently associated with parental agreement for mandatory mouthguard use (odds ratio 2.9, 95% confidence interval (CI) 1.2 to 7.3; odds ratio 3.0, 95% CI 1.1 to 6.5).

CONCLUSIONS

Few athletes wear mouthguards during competitive youth soccer. Health care professionals in this study did not capitalize on the apparent influence they have on parental beliefs regarding mouthguard use. Efforts are needed by both health professionals and soccer organizations to educate parents about orofacial injuries and mouthguard use in competitive youth soccer.

Nigerian dentists' knowledge and attitudes towards mouthguard protection

The objective of this study was to assess the knowledge and attitudes of Nigerian dentists towards mouthguard protection. A pre-tested 15-item, one-page questionnaire was distributed to 185 dentists practising in different parts of the country with government hospitals or private establishments, by 'hand-delivery' system. Filled and returned forms were 170 (response rate of 92%). The period of the survey was between April and August 2003. Dental graduates from the different dental schools in the country responded to this survey. About 49% of the respondents indicated having only classroom lectures on mouthguards during their undergraduate trainings, 11% said they had some laboratory sessions in addition while no form of education on mouthguards was received by 40%. About 82% had never recommended mouthguard protection for athletic patients, and the major reason was no formal training in the subject. Only 58.5% were familiar with the different types of mouthguards, 75.9% would not be able to supervise or fabricate mouthguards and 50.6% would prefer custom-made mouthguard for their athletic patients. About 84% felt the current training on mouthguards in Nigerian dental schools is inadequate. Over 98% agreed that mouthguard usage in contact sports should be encouraged with the involvement of the dentists. The knowledge and attitudes of the respondents towards mouthguard protection did not vary significantly across years of postqualification from dental schools as well as the professional status of the dentists (P > 0.05). Although Nigerian dentists support mouthguard protection in contact sports and want to be involved in the provision of mouthguards for athletes, their knowledge of the protective device is inadequate. There is need for attention to be given to this subject in the undergraduate curricula of our dental schools.