Attitudes of College Football Coaches Regarding NCAA Mouthguard Regulations and Player Compliance

Objectives: The purpose of this study was to assess the attitudes of Division 1-A college head football coaches regarding the NCAA mouthguard regulations, current patterns of use by players, and responsibility for enforcement; and to compare the coaches' responses with those of officials studied previously. Methods : A 15-item questionnaire was mailed to all 106 Division 1-A football coaches to assess their attitudes. Percent frequency distributions of coaches' responses to each item were computed and compared to the officials' responses. Results : Responses were received from 98 coaches (92.45%). While 87 percent of coaches reported having a team dentist, the majority reported that the team trainer was responsible for selecting the type of mouthguard used. Most coaches (53%) reported that all players wore mouthguards, but that quarterbacks were least compliant. Most coaches reported that mouthguard rules were beneficial in determining player compliance and resulted in more frequent use. Seventy-four percent would warn the player of a violation themselves, yet only 26 percent felt the coach had the greatest influence on players wearing mouthguards. Seventy-six percent felt the current enforcement of the rules is appropriate. Coaches opinions varied from those of officials. Conclusions : Coaches view themselves, the players, or the trainer as most responsible for players wearing mouthguards, not referees. This finding coincides with the officials' opinion that the coaches should be accountable.     

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.     

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.     

Paired maxillary and smaller mandibular mouthguard for rugby player with malalignment

A rugby player who had frequently experienced soft tissue injuries while playing rugby and wearing a conventional custom‐made mouthguard came to the hospital clinic. The patient had suffered traumatic soft tissue injuries such as lip lacerations and bite trauma. Severe crowding due to ectopic maxillary and mandibular canines was observed. In response to the patient's request for better protection, a set of maxillary and mandibular mouthguards was designed: one covering the entire maxillary dentition and the other the mandibular front teeth only. The mouthguards were to be worn simultaneously. In this paper, we describe how these mouthguards were fabricated and discuss the results. The patient has experienced no injury to the stomatognathic system, including the lips, for five seasons since he began wearing this set of mouthguards. This new pairing of mouthguards appears to offer sufficient protection against injury, despite severe malalignment. We believe that this new type of paired maxillary and mandibular mouthguards has the potential to reduce sports‐related dental injuries.     

Use of mouthguard rates among university athletes during sport activities in Erzurum, Turkey

Abstract –  The purpose of this study was to determine the attitudes of mouthguard users in Erzurum, Turkey. The participants' appreciation in the use of protective devices, such as mouthguards, during sport activities was also evaluated. In this study, a 10-item questionnaire was distributed to 50 coaches and a 10-item questionnaire was distributed to 768 university athletes of three different sport modalities (basketball, soccer and volleyball) in the Atatürk University Sport Competitions. The Sport Competitions are composed of 20 faculty, except the faculty of dentistry. The result of the coaches' questionnaires indicated that none of the athletes used mouthguards while participating in sports. Of the coaches, 64% had seen orofacial trauma in their athletes during sport activities and 76% believed that mouthguards prevented oral injuries. Of the coaches, 76% reported that university athletes should use mouthguards in sport activities. The result of the university athletes' questionnaires revealed that the mouthguard utilization rate was 0%. Of all players, 78.1% were males (age 17–29) and 21.9% were females (age 18–23). Of all players, 7.31% had suffered from one or more type of oral injury while not wearing mouthguards. The results indicate that in Turkey, the use of mouthguards is rare in sports. It should be a combined duty of dentists, sports physicians, and coaches to encourage the use of mouthguards during training and sport activities. Doctors and dentists need to recommend a more intensive education of students in sports medicine and sports dentistry.     

Dental injury and its prevention in Swiss rugby

Abstract – Objectives: Rugby players are at a high risk of sustaining dental injury because of the high number of tackles implicit to the game. This study aimed to determine the frequency of injuries sustained by players in the Swiss rugby league. Methods: During the 2010/11 season, 517 rugby players from 19 clubs were questioned about dental trauma as well as the use of mouthguards and other forms of body protection. The level of awareness about tooth avulsion and replantation was also assessed. Participants included athletes from four different leagues; National (155), Premier (122), Women’s (90) and Juniors (150). Results: Of the 517 players taking part in the survey, 54.4% had sustained at least one serious injury and 39.5% had sustained a facial injury. One hundred and thirty‐nine athletes (37.3%) had observed another player sustain a dental injury during a game, whilst 35 (6.8%) had personally sustained one or more dental injuries. Dental injury rate was considerably higher amongst forwards than backs. Four hundred and fifty‐six players (88.2%) wore a mouthguard of which three‐quarters were tailor‐made. Three hundred and thirteen players (60.5%) were aware that an avulsed tooth can be replanted; however, only 27 (5.2%) had heard of the tooth rescue boxes. These results demonstrate that, whilst general injuries occur with regularity in rugby, dental injuries are not amongst the most common forms. This is almost certainly attributable to the high level of mouthguard usage. Particularly for players in the junior league, in which the use of mouthguards was lowest, the risk of dental injury may be reduced by an increased level of education about tooth protection. Conclusions: To this end, an increased awareness about and usage of tooth rescue boxes would be desirable. It would seem sensible to make the wearing of mouthguards compulsory in contact sports such as rugby.     

Mouthguard utilization rates during sport activities in Ankara, Turkey

Abstract –  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.     

Basketball players' experience of dental injury and awareness about mouthguard in China

Abstract –  The objective of the present study was to describe the occurrence of orofacial, particularly dental injuries in basketball, and to survey the athletes' awareness concerning the use of mouthguards during basketball training and competition. A pilot questionnaire was designed and tested with basketball players. Two hundred and thirty-six male athletes were surveyed. Seventy-seven players were professional players. Exactly 80.6% professionals and 37.7% semi-professional athletes had an experience of oral soft tissue laceration and dental injuries in basketball practice. The difference between the two groups is significant. The incidence of dental and oral injuries was related to the length of training time. About 59% of the athletes ranked the risk of orofacial and dental injury in basketball as medium. Although the awareness of mouthguards among the basketball players was very high (80.1%), only one of them had used the custom-made mouthguard. Most of the athletes gained the knowledge about mouthguards from foreign players (33.5%), media (24.8%) and teammates/classmates (24.3%). The influence of dentists was very weak. Athletes should be informed about the high risk of oral injuries when participating in contact sports. Dentists should play a more significant role in the program of promoting mouthguard use to prevent the occurrence of oral injury in sport participation.     

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.     

Use of mouthguards by basketball players in Victoria, Australia

Abstract – Basketball is a popular sport in Australia. Although orofacial injuries are common, mouthguard (MG) wear in basketball appears to be low. The purposes of this study were: to measure mouthguard wear by basketball players before and after a promotional intervention; to assess players' knowledge of the value of mouthguards for prevention of injury; and to describe their experience of orofacial injury. Two questionnaires (baseline and follow‐up) were administered to a convenience sample of 496 basketball players in Victoria, Australia. Players recruited were youths (12–15‐year olds, n = 208) and adults (18 years and over, n = 288), from all basketball levels (social to elite). Completion of the baseline questionnaire was followed immediately by an intervention comprising written and verbal information, a mouthguard blank and instructions on mouthguard construction. The follow‐up questionnaire was mailed to all respondents 10–12 weeks later; 135 youths (65%) and 157 adults (54%) completed this. Mouthguard wear at baseline was low but was more frequent at games (62%) than at training (25%). Despite 90% of players acknowledging the protective value of a mouthguard, wear by youths did not increase following the intervention, and wear by adults increased by only 14% for training and 10% at games. Previous orofacial injury was recorded at baseline by 23% of players, but few had requested compensation from Basketball Australia (youths, 17%; adults, 30%). Two predictor variables were statistically identified as related to mouthguard wear: previous orofacial injury and age group. Mouthguard wear was significantly more frequent amongst players with previous injury; such players were 2.76 times more likely to be wearers than those without previous injury. Youths were 2.31 times more likely to wear mouthguards than adults. Only 34 players (12% of respondents at follow‐up) had a mouthguard constructed from the blank provided. Although youth and adult groups differed, the overall extent of mouthguard use was disappointingly low. Despite wide recognition of mouthguard value, the intervention had little effect on promoting their use.     

Incidence of cerebral concussions associated with type of mouthguard used in college football

Abstract –  Controversy exists among sports dentists as to whether or not a 'custom made' mouthguard is more effective in reducing the incidence of cerebral concussion than the boil-and-bite 'non-custom made' mouthguard. While members on each side remain steadfast in their opinion, not a single epidemiological study has been conducted to investigate the effect of type of mouthguard worn on the incidence of cerebral concussion. The aim of this study was to determine if there was a difference between the type of mouthguard worn and the incidence of cerebral concussions among National Collegiate Athletic Association (NCAA) Division I-A football players. During the 15-week 2001 college football season, trainers entered, via an interactive web site, weekly data for each game and practice sessions for the preceding week. Eighty-seven (76%) out of a possible 114 Division I teams participated. A total of 506 297 athletic exposures were recorded; 369 brain concussions were reported. The incidence of cerebral concussions per 1000 exposures was 0.73. Utilizing a risk ratio with a 95% confidence interval, no statistical difference occurred in the incidence of cerebral concussions between football players wearing custom made versus non-custom made mouthguards (0.990,1.750). In this study, there was no advantage of wearing a custom made mouthguard over a boil-and-bite mouthguard to reduce the risk of cerebral concussion in football players.     

Attitudinal factors influencing mouthguard utilization

From the introduction of a protective mouthpiece in the sport of boxing, the evidence for the importance of this piece of athletic equipment in injury prevention has grown. Yet, despite this knowledge, only five amateur sports and one professional sport have regulations requiring the use of mouthguards. Even in the sports that require their use, compliance is not universal. Attitudes of coaches, officials, parents, and players about wearing mouthguards all influence their usage. Studies of the attitudes of these groups reveal that coaches are perceived as the individuals with the most impact on whether or not players wear mouthguards. There is reluctance among college football officials to enforce mouthguard violations that they believe are inappropriate. Parents see themselves as having responsibility in determining mouthguard use; however, their views about when and for whom mouthguards are necessary reveal a lack of complete understanding of the benefits. Resistance on the part of players stems from the physical characteristics of the mouthguard, interference with breathing and speech, and the effect on the players' image. Education on the effectiveness of properly fitted mouthguards for injury prevention, information on the risk for injury, availability of more comfortable and appealing mouthguards, and development of an approach for expanding regulations are all tools that can lead to the development of more positive attitudes and increased usage.     

Attitudes concerning mouthguard use in 7- to 8-year-old children

The purpose of this study was to determine the acceptance of 3 types of mouthguards 1) stock, 2) boil and bite, and 3) custom-made by 7-8 year old children playing organized soccer. Three teams volunteered to participate and the type of mouthguard was randomly selected for each team. The children were fitted for the mouthguards and after wearing them, a questionnaire was returned to the investigator. Eighty two percent of the children wearing custom made mouthguards and 87% of the boil and bite ranged from happy to enthusiastic about its use. None of the children provided stock mouthguards reported liking their use. Only 1 child in the custom group failed to wear the appliance during practice and games while the children in the stock group ranged from 20% to all of the time. Ninety five percent of the parents believe that children should wear mouthguards when injuries may occur. However, only 24% of the parents would be willing to pay $25.00 for this protection. It is concluded that mouthguards will be used by children during organized sports activities if they fit.     

Dental injuries in water polo, a survey of players in Switzerland

Water polo is a sporting activity which has a medium risk of causing dental trauma. Owing to the high speed, close body contact, and the combination of throwing and swimming that is inherent to the sport, the general injury potential is high. Using a standardized questionnaire for a total of 415 water polo players from Switzerland, this study examines the frequency of dental and facial injuries in water polo, athletes' habits regarding the wearing of mouthguards, and the general level of knowledge about emergency procedures following dental trauma. The participating players came from 6 divisions: Swiss national leagues A and B, first and second leagues, as well as the women's, and junior's league. The data were evaluated according to division and gender. Of the 415 interviewees, 185 (44.6%) had witnessed a dental injury in water polo. Eighty-seven (21.0%) players reported having suffered a tooth injury when playing water polo. Tooth fracture was the most stated dental injury [86 (16.4%)]. A similar number of tooth injuries were experienced by both male [355 (21.1%)] and female [60 (20.0%)] players. The interviewees over the age of 50 showed a higher incidence of tooth injuries than younger players (>50 years = 41.7%). Slightly more than half of the interviewed players [228 (54.9%)] were aware of the possibility of replanting avulsed teeth. As few as 43 (10.4%) players were familiar with tooth rescue boxes. Only 32 (7.7%) water polo players wore a mouthguard; the most common reason for not wearing a mouthguard was that it was seen to be unnecessary [169 (40.7%)]. This survey highlights the potential for improvement in the level of knowledge about dental injury prevention in water polo. In addition to information and guidelines from the relevant sports' associations, and coaches, dentists could also play a role in the provision of this education.     

A comparison of the attitudes and beliefs of professional rugby players from one club and parents of children playing rugby at an adjacent amateur club to the wearing of mouthguards.

OBJECTIVE: To assess the knowledge that professional rugby players have with regard to the benefits of wearing an oral mouthguard and the importance that they give to wearing the appliance during play, then to compare these views with those of the parents of children who are beginning to play the sport. DESIGN: Questionnaires and covering letters were sent to the parents of children who played rugby at Malton & Norton Rugby Union Football Club (RUFC), which has teams for all age groups from under 7-8 years to adult. Similar questionnaires were sent to the first team squad of Leeds Tykes, a Zurich Premiership rugby union club. The questionnaires asked a series of questions on the use of mouthguards and knowledge of their importance in the prevention of injuries. RESULTS: The overall response rate was 76%. Seventy-four of the 100 questionnaires sent to the parents and 25 of the 30 sent to the professional players were completed and returned. Both the professional rugby players and parents felt that mouthguards were essential when playing rugby. The professionals seemed to have a much greater understanding of the benefits that mouthguards provided. Although parents agreed that children should begin to wear mouthguards as soon as possible, very few actually did. The barriers to providing mouth protection were mainly financial combined with the difficulties of taking the child to the dentist. CONCLUSIONS: If the results from this small study are representative of the current situation, with regard to the wearing of mouthguards by professional players and children, it appears that there is a need for all those involved to ensure that rugby-playing children wear mouthguards. Rugby clubs could consider the appointment of honorary dental advisers and devise systems to ensure that cost is not a factor in preventing children from wearing mouthguards.     

Custom‐made mouthguards protect football players*

Design: A group randomized controlled trial (RCT) was conducted. Intervention Australian‐rules football teams were randomly assigned to the test group (MG, custom‐made mouthguards) or control group (usual mouthguard behaviour). Outcome measure: The number of head or orofacial (H/O) injuries per 1000 person–hours of playing was recorded. Results: Twenty‐three Australian rules football teams were recruited of which 11 were randomized to the control group (n=111) and 12 to the test group (n=190). The majority of players, including those in the control group, wore mouthguards during games; fewer wore them every training session. Overall rate of H/O injuries was 2.7 per 1000 exposure–h, and was higher during games than training. When data were adjusted for division of play and age group there was evidence of a significant (P=0.04) protective effect of MG over control during games and training combined. The adjusted H/O injury incidence rate ratio was 0.56. Conclusions: Custom‐made mouthguards provided a significant protective effect relative to usual mouthguard use during games.     

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.