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.     

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.     

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.     

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.     

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.     

Oro-facial injuries and mouthguard use in elite female field hockey players

Abstract –  The objectives of this study were to assess the prevalence of oro-facial injuries, frequency of mouthguard use and players' attitudes towards the use of mouthguards among elite English female field hockey players. All 140 players of the English Hockey Association female Premiere League were asked to complete a questionnaire. Main outcome measures were prevalence of oro-facial injuries, frequency of wearing of mouthguards and attitudes to mouthguard wearing. One hundred and ten completed questionnaires were returned (79% response rate). Facial injuries were common. Nineteen percent had sustained dental injury. Five percent of the respondents had at least one tooth avulsed. Eighty-eight percent of the players said that they owned a mouthguard. Mouthguards were worn regularly during matches by 69% but were used less frequently during training. Six percent thought that mouthguards were ineffective. Eighteen percent of the subjects refused to play if they did not have their mouthguard. Sixty-nine percent of the subjects felt that the mouthguards should be worn compulsorily at all times during the game. The following were finally concluded from the study: oro-facial injuries were commonly reported; 88% of the players possessed a mouthguard; and mouthguards were worn regularly during matches by 69% but were used less frequently during training.     

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.     

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.     

Eye injuries and orofacial traumas in floorball – a survey in Switzerland and Sweden

Abstract – The objective of this study was to investigate the occurrence of eye injuries and orofacial traumas in floorball. In addition, the athletes’ habits of wearing protective goggles and mouthguards was surveyed, and an assessment was made of the general level of knowledge amongst athletes and coaches about preventive and first aid measures after a dental trauma and the resulting consequences. The study was conducted by the same interviewer in Switzerland and Sweden during the 2009/2010 season using a standardized questionnaire. A total of 608 individuals (565 athletes and 43 coaches) belonging to the amateur and semi‐professional leagues in the two countries were individually interviewed. Although 72.7% of all athletes had observed and 27.7% of field players had sustained an injury to the eye or its vicinity, only 25 athletes (4.9%) wore protective eyewear. Similarly, despite 31.7% of all players having observed a dental or jaw injury and 11.3% of interviewed field players having suffered one, only one athlete wore a mouthguard on a regular basis. Participants from Switzerland were significantly better informed than participants from Sweden with regard to first aid measures. The results of this study show that floorball has an equally high risk for dental trauma as handball. Further investigations of dental injuries in floorball would be valuable in order to provide players, coaches, parents and sporting federations with the necessary information to make decisions regarding the use of mouthguards. It is strongly recommended that protective eyewear should be made mandatory.     

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.     

Oral injury and mouthguard usage by athletes in Japan

Abstract— The use of mouthguards in contact sports effectively prevents oral injury and preserves oral structures. We investigated oral injuries and awareness concerning mouthguards ainong 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 sigmficant 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 sigmficant difference between the soccer and rugby groups. Many soccer ath-letes 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.     

Mouthguards and their use in sports: Report of the 1st International Sports Dentistry Workshop, 2016

There appears to be much confusion or misinformation worldwide regarding mouthguards and their use in sports. In an effort to clarify where the international dental community stands on mouthguards and mouthguard research, the workshop looked at some important questions. The goal was to one day formulate consensus statements related to these questions, which will be based on current scientific evidence‐based research, to motivate the international community of the importance of dentally fitted laminated mouthguards and the wearing of them by athletes of all sports. There are only five sports in the United States that require the use of mouthguards. If, through workshops such as this, the importance of wearing dentally fitted laminated mouthguards can be demonstrated, then more sports may require their athletes to wear them.     

Orofacial trauma and rugby in France: epidemiological survey

Abstract  – A stratified epidemiological survey was carried out among the best French rugby players to assess the prevalence of trauma to the lower or middle part of the face (TLMPF) and the frequency at which the mouthguards (MGs) were worn. The 1140 randomized players (elite 1, elite 2 and national 1 clubs) filled in the same form anonymously. The variables were first subjected to univariate analysis (Chi-square, anova ). Secondly, they were included in a multivariate model (logistic regression). Some 29.57% of players had already been affected by a TLMPF. The risk increased for the oldest forward players. It also increased with the number of yearly competitions and number of hours of weekly training. Some 64.3% of players used a MG. The frequency at which it was worn increased with the number of yearly competitions, for those who had experinced a previous trauma and for the pack players who had been playing for a long time.     

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.     

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.     

The prevention of orofacial sports injuries in the adolescent

Custom-made mouthguards are effective in reducing orofacial injuries to junior players. A significant reduction or total elimination of these injuries can be expected when mouthguards are used. An acceptable custom-made mouthguard can be constructed for every adolescent; therefore, they can and should be used in contact sport at junior level. This will help young people to become accustomed to these protective devices at an early age. It is important that first mouthguards are comfortable and that adaptations are done whenever needed to ensure that the recipients will want to continue to use these devices. Sports bodies and coaches should do more to enforce the use of mouthguards at all levels. The high incidence of injuries to the oral region makes their use essential. The time has now come for the use of mouthguards to be made compulsory by contact sports authorities, first, for all senior teams, and subsequently for high school and even primary school pupils. Most parents and many dentists are still unaware of injury hazards and (more importantly) the protection available. A team dentist, where there is a possibility of dental injury, is the ideal situation. One dentist can easily be the team dentist for a number of teams, acting as professional adviser, fitting and adjusting mouthguards and ensuring that trauma (or dental disease) is treated by the player's own dentist.     

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.     

Do American football players in Turkey protect themselves from dental or orofacial trauma?

Abstract – Background/Aims: Dental and orofacial trauma in contact sports differs from other sources, as it is possible to prevent it and reduce the dental and orofacial trauma by using protection devices. The aim of this study was to evaluate the occurrence of dental or orofacial trauma in American football players of Turkey National League as well as to investigate if the players were aware of mouthguards (MGs) and had used any. Material and methods: An epidemiological survey was carried out through interviews with 78 American football players in four clubs competing in Turkey National League. Thirteen players had already been affected by orofacial trauma. Results and Conclusions: Results revealed that 67 of 78 Turkish–American football players were aware of MG, while 46 of 78 players also demonstrated its use. It should be concluded that from the moment a youngster starts practising football, he should be encouraged to wear an MG to get used to the sensation and, would automatically consider it as a part of the game. A great responsibility lies on dentists, to inform their patients about the importance of wearing MG and the consequences, if it is not worn.