Effect of helmet use on maxillofacial injuries due to bicycle and scooter accidents: a systematic literature review and meta-analysis

Maxillofacial injury is a common injury resulting from bicycle (including e-bike) and scooter accidents. With 80,000 admissions to emergency departments in 2019, bicycle accidents account for more than half of all traffic-related emergency department visits in the Netherlands. The United States reports approximately 130,000 injuries and 1000 fatalities related to cycling annually. This systematic review and meta-analysis was performed to examine the protective effect of helmets against maxillofacial injuries resulting from bicycle and scooter (including e-bike and e-scooter) accidents. After a systematic literature search, 14 studies were found to be eligible for this systematic review. Of these, 11 were included in the meta-analysis. None of the included studies focused on vehicles with motors (e-bikes and e-scooters); all focused only on non-motorized vehicles. All included studies were non-randomized, which could have led to bias in the pooled results. Data from the included studies were tested for heterogeneity using the binary random-effects model (DerSimonian-Laird method), and the odds ratio for the occurrence of maxillofacial injury in cyclists wearing a helmet versus those not wearing a helmet was calculated by random-effects meta-analysis. Patients who had worn a helmet suffered significantly fewer maxillofacial injuries than patients who had not, in bicycle accidents (odds ratio 0.682). In conclusion, wearing a helmet has a significant protective effect against maxillofacial injury, indicating the need for strict helmet legislation.

Maxillofacial and dental injuries sustained in hurling

The incidence of facial injuries in hurling has decreased since the introduction of helmets with facial protection. The aim of this study was to identify the incidence of facial and dental injuries sustained in hurling training or matches and compliance with wearing helmets, with or without modified or unmodified faceguards. This prospective study included all patients who attended the Mid Western Regional Hospital Limerick, with injuries sustained while playing hurling during 2007 and 2008 seasons. The study population included 70 patients. Forty two (60%) injuries occurred during practice and 28(40%) during matches. Fifty two players (75%) sustained facial injuries whilst no helmet was worn. Eighteen injuries (25%) were sustained by players wearing helmets. Th study demonstrates that 60% of injuries occur during training when players do not wear helmets. We support the recent introduction by the GAA making it compulsory to wear helmets with faceguard protection from January 1st 2010.

A retrospective study on the epidemiology and treatment of maxillofacial fractures

BACKGROUND

Maxillofacial injuries constitute a substantial proportion of cases of trauma. This descriptive analytical study assesses the cause, type, incidence, and demographic and treatment data of maxillofacial fractures.

METHODS

A retrospective study on maxillofacial traumas was carried out in the Department of Plastic and Reconstructive Surgery at Sişli Etfal Hospital (Istanbul, Turkey) between January 1, 2000 and December 31, 2005. The study included 216 patients with a mean age of 29.8 years. Sex and age distribution of patients, etiology of trauma, localization of the fractures, treatment modalities, time to treatment after the trauma, and postoperative complications were recorded.

RESULTS

The male predilection was 75.5%. Road traffic accident was the most common causative factor (67.1%), followed by interpersonal violence (19.4%), falls (12.5%), and work- and sport-related accidents (0.9%). A total of 50% of the patients suffered isolated mandibular fractures, 23.6% had isolated midface fractures, and 26.3% had combined midface and mandibular fractures. Regarding distribution of mandibular fractures, the majority (26.8%) occurred in the parasymphysis, 14.8% in the angulus, and 11.1% each in the symphysis and corpus. Complications occurred in 6% of patients, and the most common was malocclusion followed by infection and nonunion.

CONCLUSION

The causes and pattern of maxillofacial fractures reflect trauma patterns within the community and, as such, can provide a guide for the design of programs geared toward prevention and treatment.

[Face trauma in young people: medical and social aspects of the problem]

Problem of maxillofacial traumatism in juvenile age group has not only medical but also social aspect. The social aspect of the problem is in traumatism steady growth in this most vulnerable in the social attitude population group that lead not only to considerable disability but to significant society expenditures on patients rehabilitation. Medical aspect of the problem is in the special character of young organism biological reaction upon trauma that should be taken into consideration when organizing medical care to the victims.

Prevention of traumatic dental lesions: cognitive research on the role of mouthguards during sport activities in paediatric age

AIM

This study reports a personal contribution and the analysis of the most recent literature on prevention of dentoalveolar traumas, and the lack of knowledge and use of protective oral devices in children (7-12 years old) practicing sports. Different oral protection devices will be illustrated, and among them the types more suitable for the investigated age group.

MATERIALS AND METHODS

Recently we conducted a survey on a sample of 300 children between 8 and 11 years of age practicing basketball, to assess the frequency of oral traumas, correlated predisposing factors, level of knowledge of mouthguards and possible frequency of use of such devices.

RESULTS

From the survey it emerged that only 30 subjects knew about mouthguards (15 of them received the information from their dentist) and none of them received information from the coach or within the sport club. Furthermore, only 3 subjects (1% of the sample) wore a mouthguard during practice. Our study and other literature contributions highlight the total lack of information of the practitioners, especially the young ones, and the unconcern for these problems by the organisations (clubs) where sports are practiced. A cycle of 2 brief conferences about orofacial trauma prevention and use of mouthguard was administered. Regarding the type of mouthguard more suitable to adolescent athletes, the semi-individual types of new generation seem to be the best choice, since they can be refitted multiple times in order to adapt to the dental and skeletal growth. Conclusion We can conclude reasserting the absolute need of providing information about the risks of orofacial trauma related with basketball and other contact sport activities, and to promote the use of mouthguards as a primary protective measure among athletes, which will considerably reduce the social costs associated with such trauma occurrences.

Properly fitted custom-made mouthguards

With an increase in sporting activities comes an increase in orofacial injuries. A properly fitted mouthguard has been shown to provide protection against orofacial injuries and trauma to the teeth and supporting tissues such as the lips, cheeks, and tongue. However, because it is not mandatory that all athletes (amateur and professional) wear a mouthguard, many do not for reasons such as fit, comfort, social stigma, and speaking constraints. Athletes prefer mouthguards to be comfortable, soft, and resilient, which is characteristic of a custom-fitted mouthguard. This article will review reasons athletes prefer not to wear mouthguards and advantages of a custom-made mouthguard, as well as describe a process to fabricate a custom-made mouthguard.

[Custom-made mouthguards and prevention of orofacial injuries in sports]

The importance of sports dentistry has become even greater due to the role that sports have in modern society. As the risk of sports-related injuries appears already in the period of children's play and is constantly present in various risk-related sporting activities, the role of dental profession has become extremely important. Custom-made mouthguards are the most highly recommended mouthguards used for successful prevention of orofacial and dental injuries. It is important to inform athletes of the best characteristics of a custom-made mouthguard such as retention, comfort, fit, ease of speech, resistance to tearing, ease of breathing as well as good protection of the teeth, gingiva and lips. The shape and surface of the mouthguard which encloses the teeth, the gingival and the hard palate can vary depending on the anatomical features of the athlete's jaw, his/her dental arch, the type of sports activity, as well as the materials used in the manufacture of the mouthguard. Mouthguards should not extend distally further than the first molars because some athletes complain of the vomiting reflex. In addition, mouthguards may interfere with breathing. They should reach the mucogingival border labially and extend a few millimeters palatally in order to provide the best protection for the labial gingival and good retention. The labial flange should extend up to 2 mm of the vestibular reflection. The palatal flange should extend about 10 mm above the gingival margin thus enclosing the greatest part of the anterior palate surface with a slight narrowing distally not further than the first molars. Materials used in the manufacture of mouthguards should satisfy a number of physical, mechanical and biological requirements. Essential properties of materials used in the manufacture of mouthguards include water absorption, density, thickness as well as temperature transmission, energy absorption and drawing strength (tensile strength) of custom-made mouthguards. Such materials should have an optimal consistency in order to cushion the traumatic impact. Currently, ethylene-vinyl acetate (EVA) is the most commonly used mouthguard material. An optimal thickness of the mouthguard is achieved by the application of vacuum forming pressure-lamination technique in two layers of a thermoplastic sheet of EVA copolymer and if needed, by placing two layers of protective air-cells against the critical area. Some investigations in the Croatian samples showed that the most common injuries in water polo occur in the orofacial region (96.4% of cases), of which 80% are injuries of lips, tongue and cheek. In the period from 1997 to 2005 the number of orofacial injuries increased by 62%. Dental trauma occurs in 7.6% of cases. In basketball players soft tissue injury in the orofacial complex was established in 69.4% and dental trauma in 11.3% of the respondents. In the selected sample of handball players, soft tissue injuries were established in 78.8%, dental trauma and loss of teeth in 13.6% and temporomandibular joint injuries in 6.8% of the cases. In tae-kwon-do players 88% of orofacial injuries were lacerations, but only 12% reported dental and temporomandibular joint trauma. Only a half of the examined professional basketball players wore mouthguards, and none of the examined tae-kwon-do players. Clinical value of intraoral custom-made mouthguards was proven. Dentists play the key role in the prevention and treatment of sports-related dental and orofacial injuries, collection and dissemination of relevant information, as well as promotion of research on the preventive procedures related to injuries of such a specific aetiology.

A Retrospective Analysis of Oral and Maxillofacial Injuries in Motor Vehicle Accidents

PURPOSE

To clarify the relations of the severity of oral and maxillofacial injuries from traffic accidents (TAs) to seating position and the use of restraint systems.

PATIENTS AND METHODS

Hospital records were reviewed for all patients who had sustained oral or maxillofacial injuries in TAs and then were admitted to the Department of Oral and Maxillofacial Surgery, Dokkyo University School of Medicine (Tochigi, Japan), from 1994 through 2003.

RESULTS

A total of 201 patients, with a mean injury severity score (ISS) of 7.9 +/- 7.6, were included in this study. Although patients with any oral or maxillofacial injury with an Abbreviated Injury Scale (AIS) score of 2 or more had extremely low ISSs, hospitalization was relatively long. The ISS and AIS score of the head or neck were significantly higher in unrestrained drivers (12.4 +/- 11.2, 1.2 +/- 1.4, respectively) than in restrained drivers (6.5 +/- 4.6, 0.4 +/- 1.0, respectively). However, AIS scores of the face were similar in unrestrained drivers (1.9 +/- 0.7) and restrained drivers (1.7 +/- 0.5). Furthermore, the incidence of maxillofacial fractures did not differ between the 2 groups.

CONCLUSION

Because wearing seat belts cannot prevent all oral and maxillofacial injuries in motor vehicle occupants, both physicians and engineers must pay greater attention to the mechanisms of oral and maxillofacial injuries in TAs.

Children, sports injuries & mouthguards

As the young athletes in our practices become involved in organized sports or recreational activities, it is important for dentists to take a proactive role and encourage parents of these kids to wear proper protective equipment to prevent oral injuries. Dentists must educate themselves and their young patients about the prevention of such injuries. Prevention is an obligation of dentistry as well as a critical patient responsibility. Safe sports participation should be the goal of any sports program and the dental profession should enthusiastically work to achieve this goal in every community.

Influence of Maxillary Mouthguards on Physiological Parameters

INTRODUCTION

The purpose of this study was to test the influence of two types of maxillary mouthguards (a self-adapted and a custom-made model: SA and CM, respectively) on various physiological parameters generally associated with performance in team sports.

METHODS

Nineteen trained male subjects participating in team sports were tested. Visual reaction time, explosive power, ventilation at rest, and ventilation and oxygen consumption during submaximal and maximal exercise were measured in three randomized conditions: normal, with SA mouthguards, or with CM mouthguards.

RESULTS

Wearing SA or CM mouthguards did not significantly alter any of the measured parameters compared with the normal condition.

CONCLUSIONS

Wearing a maxillary mouthguard does not affect the main physiological parameters generally associated with team sport performance. These results provide additional support to the policy of encouraging athletes to wear individually fitted maxillary mouthguards.

Mouthguard utilization rates during sport activities in Ankara, Turkey

The objective of this study was to determine the attitudes towards mouthguard use in Ankara, Turkey. In the first part of this study, an eight-item questionnaire was distributed to 22 coaches from 15 secondary schools randomly selected from five municipalities of Ankara, Turkey. The questionnaire sought information on how much coaches know regarding mouthguards and how often children and adolescents of the ages 11-18 use mouthguards. The second part of the study was based on the data obtained from direct interviews answered by 121 university athletes of three different sport modalities (football, ice hockey and martial arts). The purpose of this part of the study was to determine the rate of mouthguard use and the frequency and type of oral trauma in these athletes. The result of the coaches' questionnaires revealed that; none of the 11-18 years old children and adolescents used mouthguards while participating in sports. Of the coaches, 77.2% had seen orofacial trauma in this age group during sport activities and 95.5% of the coaches believed that mouthguards prevented oral injuries. Of the coaches, 72.7% reported that children and adolescents should use mouthguards in sport activities. The second part of the study showed that although all of the athletes owned mouth-formed type of mouthguards, the utilization rate was 74.4%. Of all players, 13.2% had suffered from one or more form of oral injury while not wearing mouthguards. The results show that in Turkey, the use of mouthguards has not become widespread in sports. It can be concluded that regular mouthguard use in sports should be encouraged in Turkey.

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.

[Epidemiology of maxillofacial injuries in athletes]

The general enthusiasm connected with sports activities causes that we often forget about threat connected with careless sports activities. The aim of this paper was the evaluation of causes and frequencies of maxillofacial injuries in hospitalized athletes in the Department of Maxillofacial Surgery in Katowice. Period between 1992-2002 was analyzed. Material consisted of 59 patients in whom injury required hospitalization. In studied material the frequency and causes of maxillofacial injuries in athletes in eleven-year period was examined. Male and female patients were divided in two groups: I--team sports and II--individual sports. In analyzed material injuries of upper part of facial skull were not affirmed. Injuries of upper facial massif overweighed its bottom massif injuries.

Craniomaxillofacial injury in sport: a review of prevention research

Current decision making in prevention of sport related craniomaxillofacial injury is based on available data derived from surveillance and attitude based studies. The literature on this type of injury prevention lacks the high quality scientific design and evidence on which mandatory interventions can be based. Currently available prevention methodology can provide a better understanding of injury mechanisms and produce valid interventions.

Attitudes of Central Collegiate Hockey Association Ice Hockey Players Toward Athletic Mouthguard Usage

OBJECTIVE

The purpose of this study was to examine Central Collegiate Hockey Association ice hockey players' attitudes regarding the use of athletic mouthguards and to determine the effects of mouthguard type, player position, education, and usage time with respect to attitudes.

METHODS

A questionnaire measuring players' attitudes toward mouthguards was sent to certified athletic trainers (ATC) responsible for providing healthcare coverage at 10 institutions of the Central Collegiate Hockey Association (CCHA). The ATC's distributed the surveys to all the players on their respective collegiate teams. Out of a total of 265 players listed on the roosters of the CCHA, one hundred and sixty five (62%) players returned the surveys, with 158 surveys used in the analyses (60%).

RESULTS

Approximately 13.3% of players (n=21) reported wearing mouthguards 50% of the time or greater during games and 3.8% (n=6) reported wearing mouthguards 50% of the time or greater during practices. Twenty-six percent (n=41) of the players never received educational information regarding using mouthguards. Thirty-nine percent (n=59) of the players reported altering mouthguards to obtain a better fit while 91% of the players were not influenced by the cost of the mouthguard. A 2 x 2 x 2 ANOVA revealed a significant interaction among player position and mouthguard type with respect to player attitudes (F(1,131) = 4.96, P < 0.05), with defensive players having more negative attitudes toward mouthguard usage compared to offensive players.

CONCLUSION

No one specific factor affecting attitudes was identified, however, players reported limited educational opportunities to learn about the effectiveness of mouthguards. Therefore, coaches, dentists, and healthcare providers should engage in more preventive educational programs to increase player attitudes and compliance.

[Profile of maxillofacial trauma in bicycle accidents]

OBJECTIVE

To determine the maxillofacial trauma profile, concomitant results and treatment of those persons injured in bicycle accidents. Several variables were identified such as age, sex, mechanism, place, month, injury patterns and symptomatology, time for receiving medical care, and treatments.

MATERIAL AND METHODS

This was an exploratory, descriptive, analytic, and retrospective study. All patients with maxillofacial trauma injury as a result of bicycle accidents were admitted to the emergency service in 2002 in the traumatology hospital Victorio de la Fuente Narváez, Mexican Institute of Social Security that covers the entire Federal District zone and some suburbs, without any distinction made as to injury specialty.

RESULTS

Patients (127) with maxillofacial trauma from bicycle accidents were identified. Children aged 6 to 10 years were the most affected. There was more injury in soft tissue in the midfacial area, such as contusions, injuries dermabrasion and some fractures resulting in nose trauma. Most of the accidents happened in the streets by falling from the bicycles. Forty six persons had more than two maxillofacial injuries. Head trauma with cervically projected sprain was demonstrated as associated trauma. More than 50% of the patients received immediate treatment under local anesthesia by maxillofacial surgery or orthopedics and traumatology during the afternoon and night.

CONCLUSIONS

Prevention programs for parents and children in homes, schools and medical care facilities should be established to encourage traffic education and the use of protective headgear.

[Sports and orofacial injuries]

Many people enjoy sports, it is healthy and relaxing. There is, however, an inherent risk of sustaining injuries and fractures of the maxillofacial skeleton. Adequate diagnostics and treatment are mandatory to minimize the possible long-term consequences of injuries. Dentists may become primary involved in the diagnosis of such traumas, particularly when injuries are limited to the orofacial region. In addition, they can play an important role in caring for sportsmen with orofacial injuries, for instance by endodontic, restorative, and prosthodontic treatments. This paper discusses the assessment and treatment of fractures of the mandible, the zygoma, the mid-face, the orbital bones, the nose, and the frontal sinus. The assessment must followed by treatment as soon as possible. Treatment options of orofacial fractures are conservative treatment by exercising and/or oral splints and surgical reposition, either or not using osteosynthetic materials.

Maxillofacial and ocular injuries in motor vehicle crashes

BACKGROUND

Injuries from motor vehicle crashes constitute a leading cause of death in the young and a high degree of morbidity and mortality in all age groups. Facial trauma has been consistently shown to be the single most common injury to the occupants of vehicles involved in crashes. This has been confirmed by more recent studies which have demonstrated a continuing high incidence of facial fractures amongst belted drivers. Airbags have been advocated as a supplemental restraint system. However, their deployment can cause injury particularly if the driver is of short stature, unrestrained or out of position within the vehicle.

METHODS

The Crash Injury Research Engineering Network (CIREN) project aims to correlate the injuries received by occupants in vehicle crashes with the biomechanics of vehicle deformation. All cases of facial injury which presented to the University of Michigan Medical Center, USA in 1999 were retrospectively evaluated with reference to the methods of occupant restraint and to the correlation between the injuries sustained and vehicle deformation.

RESULTS AND CONCLUSIONS

The case analysis confirmed the value of airbags to the safety of vehicle occupants but reinforced the conclusion that they must still be considered supplemental restraint systems. New generation airbags will minimise the risk of injury even to small stature or out of position occupants as they will prevent deployment in situations where they may have an adverse effect.

Facial trauma: a recurrent disease? The potential role of disease prevention

PURPOSE

The objectives of this investigation were to determine a profile of facial trauma patients presenting to the emergency department of University Hospital, University of Medicine and Dentistry of New Jersey, Newark, NJ, and to assess patient interest in violence or stress reduction programs.

MATERIALS AND METHODS

A prospective study of the patients was conducted with the aid of a data collection form generated specifically for the purpose of this study. Data regarding patient age, race, gender, various aspects of social history, mechanism, and nature of injury were collected over a period of 1 year. In addition, all patients were asked to respond to 4 health promotion questions. All patients for whom the oral maxillofacial surgery service was consulted were included in the study. Descriptive statistical analysis of the data was used.

RESULTS

A total of 92 patients were enrolled, of whom 80% were males. The mean age of patients enrolled was 30.5 years with the peak incidence of injury occurring in the 20- to 30-year-old age group (n = 30). The most frequent etiology was assault (75%), followed by motor vehicle accidents (18.5%). The most frequently occurring injury was mandible fracture (46.7%), followed by lacerations (42.4%). Within the study sample, 42.4% had previous injuries. Patients with facial injuries were 1.5 times more likely to have experienced previous interpersonal violence. This patient group also expressed an overwhelming willingness to change their behavior patterns (91.3%).

CONCLUSIONS

The findings of this investigation indicated that most facial trauma patients are between the ages of 20 and 30 years and male. Assault is the most common etiologic agent resulting in facial trauma. Mandible fractures and lacerations are the most likely injuries in the facial trauma patient. Patients experiencing recurrent trauma due to assault are more responsive to violence reduction programs than those experiencing only 1 assault.

Patterns of maxillofacial injuries related to interaction with horses

PURPOSE

Studies of trauma patients have described patterns of injuries sustained from unfortunate encounters with large animals. However, the patterns of maxillofacial injuries have yet to be reported. The goal of this investigation was to describe and report on maxillofacial injuries that are associated with interaction with horses.

PATIENTS AND METHODS

Charts were selected from the trauma registry by E-code at a level 1 trauma center in Portland, OR. A retrospective review was performed on charts collected from the previous 5 years (1998-2002). Data were collected according to patient, pattern of injuries, and mechanism of injury.

RESULTS

The 62 patients who were identified consisted of 15 males (24%) and 47 females (76%) and ranged in age from 1 to 83 years (average age, 32 years; most frequent age, 12 years). Most of the accidents occurred in the spring months and involved a horse known to the patient. The most common mechanism was falling from the horse. However, being kicked was correlated with a more serious injury (P =.048). The most frequent injury was abrasion/contusion (24 [39%]), second were lacerations (20 [32%]), and third were fractures (18 [29%]). Fifty (81%) were not wearing helmets. Forty-six (74%) of the patients had other associated injuries.

CONCLUSIONS

In patients with facial injuries related to horses, younger females were the most frequently involved. Facial injuries were often associated with other types of injuries. Nearly a third of the facial injuries sustained were fractures. The percentage of riders without a helmet was high. However, in our patient population, wearing a helmet does not seem to add any protection to the face, and almost all of the accidents involved a horse known to the patient. More education aimed at horse owners regarding the use of helmets, proper handling and riding skills, and supervising young riders is encouraged to prevent further injuries.

Bicycle helmets — does the dental profession have a role in promoting their use?

OBJECTIVES

To review the available literature regarding the: epidemiology of bicycle related head injuries; consequences of head injuries; rates of cycle helmet use; impact of educational campaigns and legislation on usage rates; effectiveness of cycle helmets in protecting against head and facial injuries; arguments against the compulsory use of bicycle helmets.

DATA SOURCES

A computerised Medline search was conducted using the keywords: head injury, facial injury, bicycle helmets, accidents.

DATA SELECTION

All available information was considered.

DATA SYNTHESIS

Data was collated manually.

CONCLUSIONS

The wearing of bicycle helmets contributes significantly to the prevention of head injuries (HI) and traumatic brain injury (TBI), particularly in children and adolescents. There is evidence to support the role of cycle helmets in the prevention of injuries to the middle third of the face and some dental injuries. There is a case for the implementation of legislation accompanied by educational campaigns to increase significantly the use of cycle helmets. The dental profession could: play an active role in promoting cycle helmet use; support calls for the compulsory wearing of cycling helmets, particularly for children; press for modification of helmet design and standards to increase protection of the face.

Effect of restraint systems on maxillofacial injury in frontal motor vehicle collisions

PURPOSE

Motor vehicle collisions (MVCs) are the leading cause of maxillofacial fractures. Additionally, maxillofacial injuries are the most common injury related to air bag deployment. We sought to characterize the occupant restraint system (seat belt and air bag) and collision characteristics associated with MVC-related maxillofacial injuries.

MATERIALS AND METHODS

The 1991-2000 National (United States) Automotive Sampling System Crashworthiness Data System (CDS) data files were used. The CDS is a national probability sample of passenger vehicles involved in police-reported tow-away MVCs. Analysis was limited to front seat occupants involved in frontal collisions of delta-V (estimated change in velocity) of greater than 15 km/hr. The risk of facial injury was calculated according to occupants' restraint use (unrestrained, seat belt only, air bag only, and seat belt and air bag combined) and compared using risk ratios (RRs) and associated 95% confidence intervals (CIs).

RESULTS

Occupants restrained with a seat belt only (RR, 0.48; 95% CI, 0.40 to 0.57) or a seat belt and an air bag (RR, 0.83; 95% CI, 0.73 to 0.94) had a significantly reduced risk of any facial injury compared with completely unrestrained occupants. There was no association for those restrained with an air bag only (RR, 1.19; 95% CI, 0.82 to 1.73). A similar pattern of results was observed for moderate to severe facial injuries and for facial fractures.

CONCLUSION

Seat belt use significantly reduces the risk of facial injury in frontal MVCs. Air bag use was not associated with the risk of facial injury.

[Materials for mouth protectors]

Taking into account the number of teeth which are yearly irreversible traumatised during sport activities, the general use of mouthguards would contribute positively to the prevention of dental injuries. Custom-made mouthguards are more comfortable to wear and offer better retention and protection than stock and mouth-formed mouthguards. Different kinds of materials are available on the market for the construction of mouthguards. A polyethylene-polyvinylacetate copolymer (EVA) is the most suitable material. EVA allows the inclusion of hard or soft layers within the mouthguard. The thickness of a mouthguard is important for the reduction of applied forces to teeth: energy absorption capacity increases with material thickness. Increased thickness however, is associated with a reduction of comfort. Therefore, it is important that dentists take the patients' wishes and demands on both comfort and protection into consideration. A description of the clinical and technical method for the construction of a custom made mouthguard is given.

Oro-facial injury and mouthguard usage by athletes in Nigeria

OBJECTIVE

To determine the extent of awareness concerning mouthguard use for sports as well as the amount and type of oro-facial trauma associated with sporting activities among Nigerian athletes.

DESIGN

A questionnaire survey.

MATERIALS AND METHODS

A questionnaire was completed by 273 athletes (91% completion rate) who participated in the National Sports festival in May 2002 in Benin City, Nigeria. The sample was representative of all the 36 states in Nigeria including the Federal capital territory, Abuja. Descriptive statistics were employed and the data were further analysed using the chi-square test.

RESULTS

Awareness concerning mouthguards was claimed by 226 (82.8%) of the athletes but significantly fewer athletes who claimed awareness of the devices were using them. Only 93 (41.2%) of this mouthguard-aware group knew of the three types of mouthguard available. Of all the respondents, 131 (48.0%) believed that wearing mouthguards would reduce the prevalence and/or severity of oro-facial injuries during sports. In all, 158 (57.9%) of them had one form of oro-facial injury or the other with contact sports accounting for most of them (78.5%) while 21.5% resulted from non-contact events. The prevalence of oro-facial injuries was significantly lower while wearing mouth protectors.

CONCLUSIONS

Although the majority of the athletes claimed awareness of mouthguards, less than one-third used them. Over half of the athletes were not sure that mouthguards could reduce the prevalence and/or severity of oro-facial injuries. There is need to educate the athletes more concerning mouthguards.

Alcohol-related violence and the role of oral and maxillofacial surgeons in multi-agency prevention

The maxillofacial region is by far the most frequently selected target in assaults on adults. There is a causal link between alcohol intoxication and injury. Therefore, oral and maxillofacial surgery is, in effect, the lead speciality for those injured in violence and has a responsibility to orchestrate holistic care that takes into account mental health needs. Recent years have also seen a determined effort by oral and maxillofacial surgeons to get involved in wider issues of prevention, exemplified by the national UK BAOMS Facial Injuries Awareness Week. Multi-agency prevention, not just with mental health professionals in the case of individual patients, but also with emergency medicine, public health, local government, the police and the voluntary sector is key to success. Given the potential complexity of collaborations like this, it is important to understand what works in multi-agency prevention. This paper reviews successful interventions: their rationale and how oral and maxillofacial surgeons can contribute to local injury prevention.

Sports dentistry and dental traumatology

Sports dentistry had its origins in the 1980s. More recently, the Academy for Sports Dentistry joined forces with the International Association of Dental Traumatology in cosponsoring the World Congress on Sports Dentistry and Dental Traumatology. It is the intent of the present paper to introduce readers to the arena of sports dentistry, suggest future areas for collaborative research, and stimulate authors to submit high quality, scientifically based manuscripts on sports dentistry to Dental Traumatology.

Assessment of accuracy of navigated implant placement in the maxilla

PURPOSE

The use of computed tomography (CT) based intraoperative navigation has greatly improved surgery in many specialties. In this study, the precision of the SMN system (Zeiss, Oberkochen, Germany) for navigated drilling and following implant placement in the maxilla was evaluated. This study should demonstrate the suitability of navigation systems for computer-assisted implantation in the maxilla to avoid perforation of the maxillary sinus.

MATERIALS AND METHODS

Sixty target drillings were carried out on 10 standardized polyurethane milling models after CT scanning. The models were produced with cranial open maxillary sinuses. The CT scans were performed with a slice distance of 1 mm. Then the CT data were transferred to the workstation of the SMN system and registration of the reference markers (fiducials) for superposition of the native and CT model was done. Referencing of the model was performed with the aid of a drilling tool. This drilling tool was used for later navigation-assisted drilling into the maxilla. The target of drilling was the maxillary sinus floor. The aim was to come as near as possible without perforation. The distance from the bottom of the drilling holes to the maxillary sinus floor was measured after sectioning of the model. In another 10 models, implants were placed after performing 60 navigated drilling holes.

RESULTS

In the first part of the study, an average drilling depth of 6.97 mm and a mean distance to the sinus floor of 0.11 mm (standard deviation = 0.2) was found. In 13 specimens, the inferior border of the sinus was perforated. In the second part of the study, a perforation of the sinus floor by the implants was seen in 47 cases. The mean distance to the maxillary sinus was 0.25 mm (standard deviation = 0.2).

DISCUSSION AND CONCLUSIONS

High precision of CT-based navigation for controlled preimplant drilling was seen, but a high incidence of penetrations into the maxillary sinus was caused by the subsequent implant placement.

Centers for Disease Control and Prevention. Promoting oral health: interventions for preventing dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries. A report on recommendations of the task force on community preventive services

The Task Force on Community Preventive Services (the Task Force) has conducted systematic reviews of the evidence of effectiveness of selected population-based interventions to prevent and control dental caries (tooth decay), oral (mouth) and pharyngeal (throat) cancers, and sports-related craniofacial injuries. The Task Force strongly recommends community water fluoridation and school-based or school-linked pit and fissure sealant delivery programs for prevention and control of dental caries. Using the rules of evidence it has established, the Task Force found insufficient evidence of effectiveness or ineffectiveness of the remaining interventions reviewed. Therefore, the Task Force makes no recommendation for or against use of statewide or communitywide sealant promotion programs, population-based interventions for early detection of precancers and cancers, or population-based interventions to encourage use of helmets, facemasks, and mouthguards to reduce oral-facial trauma in contact sports. The Task Force's finding of insufficient evidence indicates the need for more research on intervention effectiveness. Until the results of such research become available, readers are encouraged to judge the usefulness of these interventions by other criteria. This report presents additional information regarding the recommendations, briefly describes how the reviews were conducted, and provides information designed to help apply the strongly recommended interventions locally.

The impact of airbags and seat belts on the incidence and severity of maxillofacial injuries in automobile accidents in New York State

OBJECTIVE

To evaluate the effect driver-side and passenger-side airbags have had on the incidence and severity of maxillofacial trauma in victims of automobile accidents.

DESIGN

Retrospective analysis of all automobile (passenger cars and light trucks) accidents reported in 1994.

SETTING

New York State.

PATIENTS

Of the 595910 individuals involved in motor vehicle accidents in New York in 1994, 377054 individuals were initially selected from accidents involving cars and light trucks. Of this subset, 164238 drivers and 62755 right front passengers were selected for analysis.

MAIN OUTCOME MEASURES

Each case is described in a single record with approximately 100 variables describing the accident, eg, vehicle, safety equipment installed and utilized or deployed, occupant position, patient demographics, International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses, and procedural treatments rendered. A maxillofacial trauma severity scale was devised, based on the ICD-9-CM diagnoses.

RESULTS

Individuals using airbags and seat belts sustained facial injuries at a rate of 1 in 449, compared with a rate of 1 in 40 for individuals who did not use seat belts or airbags (P<.001). Those using airbags alone sustained facial injuries at the intermediate rate of 1 in 148, and victims using seat belts without airbags demonstrated an injury rate of 1 in 217 (P<.001).

CONCLUSION

Use of driver-side airbags, when combined with use of seat belts, has resulted in a decrease in the incidence and severity of maxillofacial trauma.

Recovering maxillofacial trauma patients: the hidden problems

This longitudinal study highlights the psychological and functional problems that can result from maxillofacial trauma. This is the first study to report outcome at one year. A total of 147 patients admitted for surgery following facial trauma were recruited over a seven-month period. Three questionnaires were used to record patient-derived levels of dysfunction: the Hospital Anxiety Depression scale, a modified University of Washington Quality of Life questionnaire and five non-validated facial trauma items. At one year 46 patients (31%) responded. Although there were significant improvements in scores from pre-operatively to one year, with all patients being discharged from outpatient follow-up, there was a substantial level of subjective symptomatology. Most notable was the level of anxiety and depression, which were present in 30% of the sample at both time points. Health-care professionals tend to underestimate the long-term effects of maxillofacial trauma. To improve patient care, greater appreciation of these problems is required at the time of initial management.

[Incidence of dental, mouth, and jaw injuries and the efficacy of mouthguards in top ranking athletes]

The aim of the study was to determine the prevalence of orofacial injuries among German top athletes and their attitudes to mouthguards. A questionnaire was mailed to athletes of 10 German contact sports associations. 64.3 percent (303) of the athletes returned questionnaires. 62 percent (188) of the respondents reported that at some time they wore a mouthguard for sports participation. 47.3% (male: 57.8%, female: 38.3%) of these were currently using one. 50% of the mouthguards were custom made by dentists, and 50% were shop bought (boil-and-bite). 32 percent of the participants had, at some time during their sports career, suffered an orofacial injury. The incidence of fractured anterior upper teeth and completely knocked out teeth for athletes without mouthguards was 7 and 14, respectively. Whereas for athletes wearing mouthguards one fractured tooth was reported. Athletes with mouthguards complained of problems with speaking (19.9%) rather than of breathing (3.4%) and fitting difficulties (4.8%). Boil-and-bite mouthguards caused more fitting problems than custom-made ones. As prevalence of oral injuries in body-contact sports is high, athletes should be advised that custom-made mouthguards offer the greatest comfort, fit, durability, and protection against dental injuries.

Patterns of maxillofacial injuries as a function of automobile restraint use

OBJECTIVE

To determine the pattern and severity of maxillofacial injuries sustained in a motor vehicle accident (MVA) resulting from automobile restraint use.

DESIGN

Retrospective database review of patients injured in a MVA who were admitted to the level I trauma center at the University of Louisville Hospital in Louisville, Kentucky.

METHODS

Demographic data, drug and alcohol impairment screening, and comorbidity data were obtained from database searches of trauma records. Forty-four patients had an airbag deployed, 34 patients wore seat belts, and 94 patients were unrestrained. All maxillofacial Abbreviated Injury Scale (AIS) ratings were compared among the three groups.

RESULTS

Twenty-two of the 44 patients (50%) in the airbag group sustained only facial injuries. Fifteen of them had lacerations; four others had only facial abrasions. Three of the airbag patients had moderate facial injuries (AIS = 2); none required operative management. The airbag group had a mean AIS rating of 1.13, the seat belt group a mean AIS of 1.29, and the unrestrained group a mean AIS of 1.46. Patients using either seat belts (mean age, 40.5 y) or airbags (mean age, 44.9 y) were older than the unrestrained group (mean age, 39.6 y). Drug and/or alcohol impairment was significantly greater in the unrestrained group (mean, 38%) compared with the seat belt group (mean, 26%) and the airbag group (mean 11%.).

CONCLUSIONS

Use of airbags is associated with less severe maxillofacial injuries compared with either a seat belt alone or no restraint. There is an inherent risk of minor maxillofacial injuries with airbag usage, but the severity of injury is distinctly reduced.

[Mouth guard protection for prevention of athletic injuries to teeth, mouth and jaw]

Sport is well known as a common cause of dental and oral injuries. Sports-related injuries account for 13% to 39% of all trauma cases in this area. The knowledge about prevention of dental and oral injuries among hobby and professional athletes can be regarded as not satisfactory yet. Mouth guards are considered as one of the most effective means for injury prevention. However, no statements or recommendations regarding use of mouth guards in sports have been published in German language literature yet. The following review article describes several types of available mouth guards and discuss their advantages and disadvantages. Guidelines concerning indications and use of mouth guards are presented.

The circumstances and scope for prevention of maxillofacial injuries in cyclists

A prospective study of cyclists with maxillofacial injuries attending Accident and Emergency departments in South Wales was carried out over a 12 month period. 65% of the 104 accident victims were aged under 14 years, and 81% were male. Only 14% were wearing helmets. Injuries were mapped to 9 facial zones. Nearly half the victims sustained injury to the central facial zone. There was an association between head injury (HI) and the location of impact on the face (p < 0.0001 Chi-square = 41 df = 8), the nature of the accident (p < 0.012 Chi-square = 10.9 df = 3), and type of injury in the impact zone (p < 0.007 Chi-square = 13.4 df = 4). More patients with facial injuries but without facial bone fractures sustained HIs than those with fractures. The facial skeleton may protect the brain by absorbing impact. The high incidence of midface injuries could be reduced by incorporating a facebar in helmet design.

Knowledge and attitudes of Arizona high-school coaches regarding oral-facial injuries and mouthguard use among athletes

The authors assessed high-school athletic coaches' perceptions about oral-facial injuries and mouthguard use in sports that do not mandate mouthguard use. About 72 percent of the coaches said that their athletes sustained oral-facial injuries, 28 percent that some athletes used mouthguards regularly, 48 percent that athletes had sustained injuries and did not use mouthguards regularly, and 31 percent said they would not encourage mouthguard use. Advocacy for mouthguard use should focus on coaches, coaches' associations and rule-making organizations.

[Oro-dental injuries during intubation anesthesia]

Injuries to the oro-dental tissue are still one of the most frequent mishaps during endotracheal intubation and general anaesthesia. However, damage to the soft and hard tissues in most cases involves oral structures already showing advanced pathogenic alterations. Injuries to the teeth are therefore rather more often due to the disease of the teeth than to mistakes during anaesthesia. The risk of injuries to the teeth can be ascertained by means of a presurgical inspection of the oral cavity and evaluation of the individual anatomical conditions in the head and neck region, which may well interfere with the endotracheal intubation. In contrast to anaesthetic pitfalls causing severe disturbance of general health, dental trauma can be treated with quite satisfying functional and aesthetic results. However, in order to maintain conditions for the complete restitution of injured teeth immediate dental therapy is recommended. In preterm infants which need mechanical ventilation during the postnatal period direct laryngoscopy as well as mechanical alterations caused by an oral tube can cause injuries to the tooth germs of the first and second dentition and deformation of the maxillary skeleton. In consequence the patient will need intensive therapy of the resulting disturbances for several years. This review gives information about the causes and types of injuries to the oral and maxillofacial region during general anaesthesia. In addition, the anatomical conditions and pathological changes associated with an increased risk for oro-dental injuries and the facilities for prevention are discussed. Finally, the main aspects of emergency treatment of injuries to the dental hard tissues are presented.

"The spotlight initiative": evidence from oral and maxillofacial surgery

In 1996 Strathclyde Police launched a campaign in order to reduce crime, especially violent crime in the region. Surgical data have been previously suggested as a more accurate reflection of violent activity than police statistics. Whilst police figures record success in reducing serious violent crime during this initiative, there was a slight increase in facial fractures resulting from assault in public places in the same period although this increase was not significant at the p < 0.05 level.

Forensic dentistry. Recognizing the signs and symptoms of domestic violence: a guide for dentists

Non-accidental trauma (NAT) is a leading cause of death and injury in America. Women and elderly persons are much more likely to be injured by a family member or by someone known to them than by any other individual. This aggressive, violent behavior directed against an individual within the home or family has been defined as "domestic violence." Intrafamily violence effects one in two American families and occurs in all segments of society. Studies have shown that unless intervention occurs, the violence tends to escalate often resulting in serious injury or death. Because greater than half of all domestic violence injuries occur in the head and neck area, the dentist is often the first to treat the domestic violence victim. Each member of the dental team must be a participant in the early recognition of domestic violence and other forms of non-accidental trauma. Intervention can only begin after the victim is recognized. While acknowledging the important role of the forensic odontologist in the diagnosis and documentation of intentionally inflicted injuries, the general dentist and the dental team play an equally important role in stopping domestic violence.

Oral injury and mouthguard usage by athletes in Japan

The use of mouthguards in contact sports effectively prevents oral injury and preserves oral structures. We investigated oral injuries and awareness concerning mouthguards among Japanese high school soccer and rugby players. Athletes were asked a series of questions concerning their history of oral injury while participating in sports, and their pattern of mouthguard use was determined. The data were evaluated statistically using chi-square analysis. The incidence of oral injuries was 32.3% for soccer athletes and 56.5% for rugby athletes, with 0.8% and 24.1% of the respective groups having mouthguards. There were significant differences between the soccer and rugby groups (P < 0.001). Although 81.8% of soccer athletes thought mouthguards were unnecessary, only 26.2% of rugby athletes shared this opinion and there was a significant difference between the soccer and rugby groups. Many soccer athletes had insufficient knowledge about mouthguards and were not concerned about preventing oral injury, although it was in fact a common problem in their sport. Athletes as well as coaches must be made aware of the high risk of oral injury when playing soccer, rugby, and other contact sports.

Evaluation of athletic mouthguard through vibration test on maxillary teeth of human dry skull

The athletic mouthguard has been used for the prevention of orofacial injuries in contact sports. In this research, the effectiveness of a mouthguard was evaluated for its protection of the maxillary teeth of a human dry skull through experimental modal analysis. The upper central incisor was excited by an electrodynamic shaker. The frequency response functions of the upper teeth were then recorded on an FFT analyzer in order to identify modal shapes of the maxillary arch with and without a mouthguard. In addition, transient response simulations were carried out and decay rates of transient response waves were compared. As a result, when the mouthguard was in place, the resonance peaks of the frequency response functions were dampened, and the nodes of the modal shapes for the anterior teeth were indefinite in the frequency domain over 1 kHz. In the transient response simulation, the decay rates of transient response waves when the mouthguard was used were significantly higher than those when the mouthguard was not used (p<0.01). The results suggest that the mouthguard relieves the stress concentrated on the anterior teeth in a frontal collision by absorbing and dispersing some of the shock energy, thus quickly stopping the vibration of the maxillary teeth. These findings support the clinical fact that mouthguards prevent orofacial injuries in sporting activities.

An overview of dental care for the young patient: 1. Introduction, priorities and disease prevention

The provision of high-quality dental care for children presents a challenge for the general dental practitioner. The aim must be to ensure that young patients reach adulthood with optimal dental health. This series of three articles takes an overview of good practice in the provision of dental care for children, with emphasis on disease prevention, early diagnosis of dental disease and deformity and appropriate treatment measures. This first paper discusses preventive measures and highlights the need to apply them, particularly for patients at high risk of dental disease or with special needs in relation to dentistry.