The use of mouthguards

A mouthguard is a useful appliance to prevent oral injuries, and their emotional and financial consequences. Most sportsmen are aware of the benefits of a mouthguard. Nevertheless, a relatively small percentage of sportsmen in contact sports are using a mouthguard actually. Whether or not a mouthguard is used, is predominantly determined by its comfort. Therefore, a mouthguard must be optimally comfortable. However, to make sportsmen using an even optimal mouthguard, needs motivation. Stimulating of motivation is the task of parents, coaches, (team) physicians, and (team) dentists. Especially coaches seem to have great influence on sportsmen. Children are very much influenced by their parents. It is the task of general dental practitioners not only to inform sportsmen and their parents, but also their coaches and team physicians about the risks of oral injuries and about the benefits of preparing a mouthguard. General dental practitioners must put themselves disposal to prepare mouthguards for their individual patients as well as for all players of a team who wish to have a mouthguard prepared.     

Are all mouthguards the same and safe to use? The influence of occlusal supporting mouthguards in decreasing bone distortion and fractures

Abstract –  The safety benefits of mouthguards have been demonstrated in many studies, with many authors and sports dentists strongly recommending the wearing of mouthguards. However, wearing a mouthguard with incorrect occlusion might cause a variety of problems. It comes as no surprise that a traumatic blow to the chin, while wearing an insufficient mouthguard lacking anterior contact, can result in severe distortions to the mandibular bone, and bone fractures. The aim of this study was to clarify how ineffective insufficient occlusal supporting mouthguards are and how dangerous they can be to use. Consequently, in this study, occlusal supportive areas were varied and accelerations of head and distortions of the mandible were measured using an artificial skull model and a pendulum impact device. As a result, the distortions of the mandible tended to increase as the supported area decreased. On the contrary, accelerations of the head decreased as the occlusion part decreased. Thus, a lot of impact energy was consumed in the distortion of the mandible; accordingly, it seemed that only a little destructive energy was transferred to the head. From this study, it would seem that wearing a mouthguard, which is insufficient in the occlusion, has the potential of causing a bone fracture of the mandible. Consequently, mouthguards should have proper occlusion.     

The prevalence of orofacial injuries and use of mouthguards in Rugby Union

A bstract — Mouthguards are important for those involved in contact sports and their use in such sports is recommended by authorities as they provide considerable protection for the orofacial structures. The use of mouthguards in contact sports in part reflects the success of community awareness programmes designed to encourage such practice. A comprehensive study of 116 Rugby Union footballers was undertaken in 1984 to study the prevalence of orofacial injuries and the use of mouthguards in that sport and the results are presented in this paper. The grades ranged from club level through to international level of competition. Overall the usage of mouthguards was high and ranged from 79–96 per cent in the various teams. This study is the most complete ever recorded in Rugby Union.     

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

Abstract –  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.     

Rugby athletes' awareness and compliance in the use of mouthguards in the North West of Italy

Abstract – Background: The prevention of dental injuries during full‐contact sports such as rugby is extremely important. Wearing a mouthguard can significantly reduce the frequency and severity of orofacial injuries, but it is not always used as athletes find it difficult to tolerate. The purpose of the present study was to determine the awareness and the extent of mouthguard use in a sample of young rugby athletes in the North West of Italy. Material and Methods: The athletes of four amateurs rugby teams based in the Province of Turin, Italy completed a questionnaire about playing history, current use and type of mouthguards, disturbs associated with mouthguard use, and general attitudes towards mouthguards. Results: Only 53.85% of the subjects reported wearing their mouthguard all the time both during training and games. The most commonly reported problem associated with using a mouthguard was the discomfort on speech, followed by difficulty in closing lips, adversely affected breathing, adversely affected swallowing and slipping sensation. A statistically significant association between patients <22 years and non‐use of mouthguards was observed. Conclusion: Limited knowledge about oral injury prevention and limited use of mouthguards were observed. The present study suggests that educational courses for rugby players and coaches to promote the use of mouthguards would be extremely important to reduce common complaints about these devices and increase their usage.     

Traumatic injuries of the teeth in connection with general anaesthesia and the effect of use of mouthguards

The aim of the present study was to describe the frequency of dental injuries over a 10-year period, where a mouthguard was used in approximately 10% of intubation cases or endoscopying. The types of injury are presented and the use of different types of mouthguard is discussed. Among 120,086 procedures involving anaesthesia carried out in the period 1983-1992 at Bispebjerg Hospital, Copenhagen, 75 cases of dental trauma occurred. The incidence of dental traumatic injuries was 0.06%. Although eight patients had used mouthguards they were registered with traumatic injuries to the teeth in connection with general anaesthesia. Of the patients, 58% were women and 42% men, with a mean age of 61 years. Seventy-eight percent of the injuries were located in the maxilla and 91% of these involved the incisor area of the maxilla. Forty-one percent were classified as lateral luxations or mobile teeth, 47% were classified as fractured teeth, 10% tooth avulsions and the remaining 2% were classified as concussions. Because of the low frequency of traumatic dental injuries in connection with general anaesthesia and the non-significant effect of the use of mouthguards, routine use of mouthguards is not recommended. Only when a patient is to have an endoscopy done under general anaesthesia, and the surgeon or anaesthesiologist foresees problems (restricted mouth opening, extensive fixed prosthetics, extensive loss of marginal bone) is use of an individually made mouthguard indicated.     

Traumatic injuries of the teeth in connection with general anaesthesia and the effect of use of mouthguards

Abstract— The aim of the present study was to describe the frequency of dental injuries over a 10-year period, where a mouthguard was used in approximately 10% of intubation cases or endoscopying. The types of injury are presented and the use of different types of mouthguard is discussed. Among 120 086 procedures involving anaesthesia carried out in thc period 1983–1992 at Bispebjerg Hospital, Copenhagen, 75 cases of dental trauma occurred. The incidence of dental traumatic injuries was 0.06'%. Although eight patients had used mouthguards they were registered with traumatic injuries to the teeth in connection with general anaesthesia. Of the patients, 58% were women and 42% men, with a mean age of 61 years. Seventy-eight percent of the injuries were located in the maxilla and 91% of these involved the ineisor area of the maxilla. Forty-one percent were classified as lateral luxations or mobile teeth, 47% were classified as fractured teeth, 10% tooth avulsions and the remaining 2% were classified as concussions. Because of the low frequency of traumatic dental injuries in connection with general anaesthesia and the non-significant effect of the use of mouthguards, routine use of mouthguards is not recommended. Only when a patient is to have an endoscopy done under general anaesthesia, and the surgeon or anaesthesiologist foresees problems (restricted mouth opening, extensive fixed prosthetics, extensive loss of marginal bone) is use of an individually made mouthguard indicated.     

Prevalence of orofacial injuries and use of mouthguards in high school Rugby Union*

In Australia there is a tradition of early involvement of children in contact sports. Mouthguards are known to reduce the risk of dental and associated injuries — however, Australian studies of the use of mouthguards in contact sports and the prevalence of dental and associated injuries have only focused on adult participants. Previous studies of high school Rugby Union players in New Zealand have shown that between 13 and 15 per cent had previously sustained dental injury while between 30 and 37 per cent wore mouthguards regularly. One hundred and thirty Rugby Union football players attending a large high school in Brisbane participated in this survey. All believed in the safety value of mouthguards in football. All of the players in the four open teams and the majority of players in the four under-age teams wore mouthguards, and the incidence of dental injury was very low, approximately 4 per cent. These and other results will be presented and compared with previous similar studies.     

Effectiveness and fabrication of mouthguards

Abstract –  Although mouthguards have been suggested as a means for preventing dental traumatic injuries, there are still some controversies over some aspects such as effectiveness in preventing concussions, material selections, method for fabrication, design, side effects and so on. The purpose of this literature review was to clarify differences in opinions with supporting evidence on these issues and find the best guidelines for promoting usage and providing mouthguards with better protective capability and fewer side effects such as difficulty in breathing and speaking.     

Spin-off applications of mouthguards

The spin-off applications of mouthguards are many and varied. Their uses range from protective to therapeutic and span all areas of medicine and dentistry. The designs range from simple minor modifications of the soft athletic mouthguard to sophisticated adaptations containing gears or electric switches. Their creative applications have provided relief to the cancer patient, increased independence to the handicapped and limited mobility patient, protection to the dentition of the patient undergoing general anesthesia, relief for the TMJ syndrome sufferer, and decreased risk of damage to the teeth and palate of the intubated infant, to name only a few. The adaptations and applications of this simple device are inspired by the needs of the patient and limited only by the imagination of the provider.     

Protective mouthguards and sports injuries

In summary the advantages of providing custom-fitted mouthguards for athletes, especially those involved in contact sports, has been discussed along with the methodology of construction. Because of the apparent lack of negative effects on physical performance and the superior protective characteristics of custom-fitted mouthguards, it seems logical to recommend their use in the competitive sports arena.     

Compliance with fluoride gel use in irradiated patients

Patients who undergo radiation therapy that includes the salivary glands frequently experience severe xerostomia. The standard of care for these patients who have natural teeth has become daily application of fluoride by means of custom-fabricated carriers. The purpose of this study was to determine patient compliance with fluoride gel application using carriers.
Using a structured verbal questionnaire, we interviewed 76 patients who had completed radiation therapy for head and neck cancer. Thirty of these patients were seen regularly in the dental clinic of the Cancer Agency (group 1); the remaining 46 were not seen on a regular basis (group 2).
Overall, 43% of patients reported using fluoride gel regularly (once a day). In group 1, 67% of patients used fluoride regularly, as did 28% of patients in group 2 (p = 0.001). There were no significant differences between the groups in frequency of toothbrushing and use of dental floss. Compliance with the use of fluoride in carriers was not associated with differences in other oral care measures in the two groups, which suggests that fluoride application in carriers achieves limited compliance in relation to daily oral health care measures. Regular follow-up of patients after radiation therapy is needed to assess their need for, and compliance with, daily fluoride application.