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.     

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.     

Compliance of children and youngsters in the use of mouthguards

Abstract –  The purpose of the study was to examine the compliance of children wearing their mouthguards, and to evaluate socio-environmental factors that impact upon the usage of the device. Eighty children attending the student clinic of the Hadassah School of Dental Medicine received mouthguards free of charge. One year later, 69 participants and their parents answered a survey aimed at gaining information regarding compliance and comfort when wearing the mouthguard correlated with gender, ages of parents and child, number of siblings, position of child in the family, socio-economic status, education of parents and past dental injuries of siblings or parents. Twenty-nine percent of the children never wore the mouthguard, 32% wore it sometimes, 15.9% wore it when necessary at the beginning but stopped after one month and 23.2% wore the mouthguard whenever needed. About 68% of the participants still possessed the mouthguard one year after receiving it, 44.9% reported that they did not wear the mouthguard because they forgot and 42% reported that the reason for not wearing the appliance was because it was not comfortable. Seventy-seven percent of the parents were not aware of the existence of this appliance prior to this study. In addition, 47.9% stated that dentists had not offered such treatment to them in the past, 20.8% indicated that their child had never possessed a mouthguard before due to its significant expense and 39.6% stated that they would not invest in this treatment in the future because their child would not wear the appliance. Boys were more comfortable wearing the mouthguard than girls. The younger the child and the later s/he was in the sibling order of the family, the more likely s/he was to lose the mouthguard.     

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.     

Custom-fitted protective mouthguards.

Custom-fitted protective mouthguards for children and adults during sports activities can prevent or minimize traumatic dental injuries. This article reviews a method for fabrication of custom mouthguards and discusses their use.     

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.     

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.     

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.     

Experimental comparative study of various mouthguards

The aim of this study was to evaluate the mechanical and physical properties of several standard size commercially available mouthguards. For the purpose of objective testing, a special study model, which the various gum shield devices could be fitted onto, was developed to record tooth deflection caused by impact forces induced by a pendulum ram impact testing machine. The data measured on teeth provided with various gum shield devices were correlated with those of unprotected teeth; this enabled the individual cushioning effects of the respective devices and their specific force conduction to be evaluated. Using mouthguards considerably diminishes the deflection of the teeth subjected to stress in comparison with the row of unprotected teeth. In addition, force is transmitted to the adjacent teeth all the way to the distal regions of the row of teeth. The individual cushioning effects are directly correlated to the thickness of the material; the force distribution is determined by the rigidity of the gum shield device. The devices examined showed considerable differences with regard to force distribution and dimensioning. The study showed that this was due to the thickness of the materials, the manufacturing process and the composition of the materials of the devices examined. In comparison to laboratory-produced devices of similar material thickness, the devices that were designed to be fitted by the user achieved significantly poorer results as regards both cushioning properties and dissipation of exerted forces.