The International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD) guidelines for prevention of traumatic dental injuries: Part 3: Mouthguards for the prevention of dental and oral trauma.

The Guidelines for Prevention of Traumatic Dental Injuries were reviewed and approved by the Board of Directors of the International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD).

Faculty of sports science students, physical education teachers, and athletes' level of knowledge and attitude about mouthguards.

OBJECTIVES: Traumatic dental injury occurs during sports competitions, training, and practice and can be prevented by the use of mouthguards. For this reason, this study aimed to evaluate the knowledge and attitudes of sports science faculty students, physical education teachers, and athletes about mouthguards. METHODS: Five hundred thirty-two participants were reached via social media. In the questionnaire consisting of 20 questions, questions about the sociodemographic characteristics of the participants were asked in part 1, and questions about their level of knowledge and attitudes about the mouthguards were asked in part 2. Descriptive statistical analysis and a chi-square test were used to evaluate the data. RESULTS: The number of people who think that mouthguards protect the athlete from traumatic dental injury is 381 (71.6%). The number of people who think that mouthguards affect the performance of the athlete is positively 228 (42.9%). To protect against traumatic dental injury, 51.48% of the participants preferred the custom-made; 39.3% of them preferred the boil-bite; 33.22% of them preferred the standard/stock type mouth guard; and 22.96% of them preferred the helmet, and 18.26% of them preferred the face mask. CONCLUSIONS: The knowledge and attitude of sports science faculty students, physical education teachers, and athletes are low about mouthguards. Since these people who are engaged in sports have a high exposure to traumatic dental injuries, education should be given to increase their awareness about mouthguards.

Global research trends of studies related to mouthguards and dental injuries in sports activities: a bibliometric analysis.

Mouthguards (MGs) are essential devices for the protection of sports-related orofacial injuries. Mapping of the literature on this subject may help to guide future studies; therefore, this review aimed to characterize the research trends of studies related to MGs and dental injuries in sports activities through bibliometric analysis of in vivo studies concerning the frequency of MG use; knowledge, awareness, perception, and/or attitude about MGs; and adaptation (fit) of MGs in the mouth and/or prevention of traumatic dental injuries (TDIs). A literature search was performed in 6 databases for studies published up to April 2022. Text mining and analysis software was used to extract and evaluate data related to the study author, country, keywords, journal of publication, and year. Additionally, data related to the type of study, outcome, study population, age group, evaluation method, type of MG, sport classification, and sport category were extracted and analyzed. Of 6140 records identified, 222 were included in the analysis. Most of the articles came from the United States (n = 39; 17.5%) and dentistry journals (n = 145; 65.3%). The journal Dental Traumatology (n = 60; 27.0%) presented the highest number of publications. Most studies were observational (n = 195; 87.8%) and evaluated the frequency of MG use (n = 163; 44.4%). Studies were carried out in athletes (n = 181; 82.6%) and adults (n = 169; 49.1%) using questionnaires or interviews for assessment (n = 206; 84.1%). Only 89 (40.1%) studies evaluated the type of MG, mostly involving contact sports. Custom-made MGs were most commonly studied. More studies involving coaches, dentists, and child and teenaged athletes are warranted to help prevent sportsrelated TDIs in young teeth, mainly through interventional studies on the perceptions of and knowledge about MGs among these populations.

Oral management with mouthguards during the mixed dentition period: A case report.

Custom-made mouthguards are widely used by athletes during training and sporting events for the prevention of oral injuries. However, even though the prevalence of dental injuries in children in the primary or mixed dentition stages is high, few reports have focused on mouthguard use for such cases due to the difficulties associated with adapting them as teeth are lost and replaced. This report presents a case of a Japanese boy in the mixed dentition stage with a custom-made mouthguard. For fabrication, self-curing acrylic resin was used to fill portions of a working model to keep space for the later eruption of permanent teeth. However, adjustment was necessary when gingival swelling occurred in association with maxillary canine eruption, after which refabrication was necessary. Regular management of a custom-made mouthguard by the attending dentist is important for children in the mixed dentition period, especially during maxillary canine eruption, which causes drastic dentition changes. In the present case, custom-made mouthguards were fully effective based on the prediction of changes in the dentition and with regular dental management.

Orofacial trauma and mouthguard use in Brazilian rugby union players.

BACKGROUND/AIM: Rugby union represents a high-risk sport for orofacial trauma due to its impact collisions and repetitive tackles. The aim of this study was to investigate the prevalence of orofacial trauma according to mouthguard use among a sample of Brazilian rugby union players. METHODS: An online questionnaire was sent to the 16 best rugby union clubs in Brazil. The questionnaire contained questions about the training history of each athlete, prevalence of orofacial trauma, and details about mouthguard use. Only participants who reported using a mouthguard were selected for this analysis. RESULTS: A total of 244 individuals were included. The prevalence of orofacial trauma was 34.4%, and 61.9% of them did not wear a mouthguard at the time of the incident. The only type of mouthguard reported was the pre-fabricated ("boil and bite" and "ready-to-wear") type. A stronger association was observed between the reason for using a mouthguard and the outcome, whereas a lower proportion of trauma was observed among individuals who claimed mandatory mouthguard use at the gym/sport (20.0%). Time since the respondent started playing rugby union and who instructed them to use a mouthguard were not associated with orofacial trauma. CONCLUSION: Prevalence of orofacial trauma was high among this sample of rugby union players from Brazil, even with the use of pre-fabricated mouthguards. This study encourages further investigation on the use of custom-made mouthguards in rugby union and the role of coach/physical educators to reduce the prevalence of orofacial trauma.

What strategies can be used to effectively reduce the risk of concussion in sport? A systematic review.

AIM OR OBJECTIVE: To examine the effectiveness of concussion prevention strategies in reducing concussion risk in sport. DESIGN: Systematic review according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. DATA SOURCES: Eleven electronic databases searched and hand-search of references from selected studies. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: The following were the study inclusion criteria: (1) contained original human research data; (2) investigated an outcome of concussion or head impact; (3) evaluated a concussion prevention intervention; (4) included sport participants; (5) analytical study designand (6) peer-reviewed. The following were the exclusion criteria: (1) review articles, case series or case studies and (2) not in English. RESULTS: The studies selected (n=48) provided evidence related to protective gear (helmets, headgear, mouthguards) (n=25), policy and rule changes (n=13) and other interventions (training, education, facilities) (n=10). Meta-analyses demonstrate a combined effect of a 70% reduction (incidence rate ratio (IRR)=0.3 (95% CI: 0.22 to 0.41)) in concussion risk in youth ice hockey leagues where policy disallows body checking, and the point estimate (IRR=0.8 (95% CI: 0.6 to 1.1)) suggests a protective effect of mouthguards in contact and collision sport (basketball, ice hockey, rugby). SUMMARY/CONCLUSIONS: Highlights include a protective effect of helmets in skiing/snowboarding and the effectiveness of policy eliminating body checking in youth ice hockey. Future research should examine mouthguards in contact sport, football helmet padding, helmet fit in collision sport, policy limiting contact practice in youth football, rule enforcement to reduce head contact in ice hockey and soccer, ice surface size and board/glass flexibility in ice hockey and training strategies targeting intrinsic risk factors (eg, visual training). SYSTEMATIC REVIEW REGISTRATION: PROSPERO 2016:CRD42016039162.

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.

Dental trauma prevention with mouthguard in a nose fracturing blow to the face: Case report.

Orofacial injuries are common in sports activities and may vary in complexity and the tissues involved. Most sports-related trauma occurs when a player hits another player, an object or the ground. This report presents a case of an injury caused by a punchlike blow to the face during a handball college team practice session. The patient suffered a traumatic blow to the left side of the nose and mouth and promptly attended a dentist. After a clinical examination and a CBCT scan, the following injuries were diagnosed: upper lip laceration, upper left lateral incisor subluxation and anterior nasal spine fracture. More severe teeth injuries were likely prevented because the patient was wearing a mouthguard.

The Dentist and the Athletic Trainer: A Winning Team for Oral Health Care.

Oral health is a key concern for student athletes. The dentist is the primary oral health care provider. Athletic trainers (ATs) are health professionals who have a primary care role for the student athlete. They are often the first to respond when dental trauma occurs in athletics. This paper informs dentists and ATs about each other and includes best practice in the care of athletes, which can be improved through interprofessional collaboration between dentists and ATs.

[Oral healthcare for the persons with special needs.]

The field of special care dentistry is rapidly gaining recognition as a service that should be provided to the persons with physical, mental or intellectual disabilities by general practitioner, pediatric or geriatric dentists as well as dental hygienists. Because the oral healthcare and dental treatments are given in the narrow space of oral cavity and also accompanying technical difficulties with high risk of injury, the special needs patients are treated under being controlled their behavior or body motion by applying psychological, physical or pharmacological techniques. Those persons also manifest specific oral signs and symptoms such as dental caries, periodontal diseases as well as high incidence of dental hypoplasia, oro-facial trauma or drug-induced gingival overgrowth. The children with developmental disorders especially such as autism spectrum disorder(ASD), attention-deficit/hyperactivity disorder(AD/HD), or specific learning disorder(LD), and those with medical care needs at all times are also increasing relatively in Japan with declining birthrate. Those children have specific dental problems and require the special oral healthcare. This article presents the current status of oral healthcare for the persons with special needs.

Comparative evaluation of custom and standard boil and bite (self-adapted) mouthguards and their effect on the functioning of the oral cavity.

BACKGROUND: Mouthguards provide an effective preventive method against the effects of injuries sustained during sports activities, in particular cycling, football, basketball, skiing or hockey. However, when placed in the oral cavity, they can induce disorders in basic physiological functions. AIM: The objective of this clinical study was to compare the effects of various custom mouthguards with generally available standard boil and bite mouthguards on the functions of the oral cavity. MATERIAL AND METHODS: A total of a 168 mouthguards (five custom and three standard boil and bite mouthguards) were assessed in a questionnaire-based survey. Their negative effects on the integrity of mucosa, speech, breathing, salivary flow and taste as well as in terms of inducing gag reflex, tooth clenching and temporomandibular joint complaints were compared. RESULTS: Porida mouthguard was reported to have the most adverse effects on oral functions. In the majority of the respondents, the remaining mouthguards did not have any adverse effects on the stomatognathic system functions. CONCLUSIONS: Mouthguards do not significantly disturb basic functions of the stomatognathic system. Standard Porida mouthguards were shown to have the most unfavourable effect on oral functions.

A novel mouthpiece prevents bite injuries caused by intraoperative transcranial electric motor-evoked potential monitoring.

PURPOSE: Intraoperative transcranial motor-evoked potential monitoring causes contraction of the masseter muscles, which may cause injuries to the oral cavity and damage to the orotracheal tube. We developed a mouthpiece made from vinyl-silicone impression material to prevent these injuries. The purpose of this study was to examine its efficacy and safety. METHODS: Twenty-two patients undergoing spinal surgery under transcranial motor-evoked potential monitoring were fitted with bespoke vinyl-silicone mouthpieces by dentists before surgery. On induction of general anesthesia and orotracheal intubation, the mouthpiece was attached to the upper and lower dental arches. A lateral cervical X-ray was taken at the end of surgery to examine the condition of the orotracheal tube. The incidence of endotracheal tube deformation was compared with an historic control group of 20 patients in whom a conventional gauze bite block had been previously used before induction of the mouthpiece. The oral cavity was examined by a dentist the day before surgery and 3 days postoperatively, and intraoral injuries were recorded. RESULTS: No endotracheal tube deformation was found in 22 patients fitted with the new mouthpiece. The incidence of tube deformation (none of 22 patients, 0 %) was significantly lower than in those who had been fitted with the gauze bite block (9 of 20 patients, 45.0 %; p < 0.001). Application of the mouthpiece resulted in no tongue or tooth injuries. CONCLUSION: A novel mouthpiece reduced the incidence of damage to the endotracheal tube caused by intraoperative transcranial motor-evoked potential monitoring.

Prevention of trauma to soft tissues from opposing dental implants in completely edentulous patients.

OBJECTIVE: To suggest a technique to prevent trauma of the edentulous ridge from opposing dental implants when prosthesis kept out during night. BACKGROUND: In modern dentistry, implant-supported overdentures are commonly fabricated to minimise the problems associated particularly with mandibular conventional removable denture such as the lack of retention or stability, decreased chewing efficiency, difficulties in speech and soft tissue abrasion. The patients wearing two implant-retained overdentures that are mainly soft tissues supported-implant-retained overdentures are advised to keep prosthesis out of the oral cavity during night to allow the tissues to rest and remain healthy. Few of such patients might complaint about trauma of the opposing soft tissues by the dental implants when prosthesis is kept out. MATERIALS AND METHODS: A thermoplastic resin mouthguard was fabricated by adapting the modelling wax over the abutments on the master cast from thermoplastic resin sheets. The wax was removed and guard was filled with chemically cure permanent silicone soft liner and immediately placed in the patient mouth. CONCLUSION: The trauma caused by dental implants to the opposing edentulous ridge was effectively managed by soft thermoplastic resin mouthguard filled with permanent silicone soft liner.

Dental problems in athletes.

Orofacial injuries and diseases occur in athletes, and they may not always have access to dentists. Therefore team physicians should be aware of the common injuries and initial management. Treatment of dental injuries will depend on whether the teeth are primary or permanent. The most common type of fracture is crown fracture, but there are other dental injuries that can lead to future complications if not treated promptly and monitored closely. Tooth avulsions need to be handled properly, and athletes should see a dentist as soon as possible. Despite the urgency of some injuries, other orofacial injuries or diseases, such as lacerations and caries, should not be overlooked. Proper education and use of mouth guards can assist athletes in reducing their risk of orofacial injuries.

Mandatory mouthguard rules for high school athletes in the United States.

High school athletes seem particularly predisposed to dental injury, but athletic mouthguards have an excellent track record of success in reducing the severity and incidence of dental injuries in sports. Therefore, it has been suggested that mouthguards be made mandatory for high school athletes who participate in sports with risk of injury. The National Federation of State High School Associations currently recommends that mouthguards be mandated for high school football, lacrosse, ice hockey, and field hockey players as well as for wrestlers who are wearing orthodontic appliances. Different states have tried to mandate additional sports with varying degrees of success. This article summarizes the process that leads to rule changes for high school athletes at the national level and discusses the history of 4 states--Minnesota, Maine, New Hampshire, and Massachusetts--that have tried to mandate mouthguards for different sports. Common complaints that lead to the cessation of mouthguard rules, such as speech considerations, breathing ability, and cleanliness, are discussed.

Management of lacerated and swollen tongue after convulsive seizure with a mouth protector: interprofessional collaboration including dentists in intensive care.

We encountered a 74-year-old male patient with tongue laceration after convulsive seizures under intensive care. The tongue showed severe swelling, and the right ventral surface had been lacerated by his isolated and pointed right lower canine. Our university hospital has established a perioperative management center, and is promoting interprofessional collaboration, including dentists, in perioperative management. Dentists collaborating in the perioperative management center took dental impressions, with the support of anesthesiologists who opened the patient's jaw under propofol sedation, to produce a mouth protector. By raising the patient's bite, the completed mouth protector prevented the isolated tooth from contacting the tongue and protected the lacerated wound. Use of the mouth protector prevented the lacerated tongue from coming into contact with the pointed tooth, and the tongue healed gradually. These findings underscore that interprofessional collaboration including dentists can improve the quality of medical care.

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.

Does clenching reduce indirect head acceleration during rugby contact?

BACKGROUND: Concussions are common among athletes, with the potential to cause memory-related, physical, cognitive, emotional, and behavioral damage. A concussion is an acceleration/deceleration injury resulting from direct and indirect biomechanical forces transmitted to the cerebral tissues. From a sports dentistry viewpoint, increased mastication muscle activity or clenching due to the presence of a mouthguard may enhance cervical muscle activity, thereby reducing damage following impact. This relationship has not been previously investigated in the context of rugby. The purpose of this study was to investigate the effect of voluntary clenching on indirect head acceleration during attack- and defense-related drills. MATERIALS AND METHODS: A total of 12 high school rugby players participated in the study. Linear acceleration of the head was measured using an accelerometer that took measurements in three axes. Masseter and sternocleidomastoid muscle activities were measured using wireless electromyography. These data were synchronized using digital video imaging software for analysis. The study protocol was approved by the Tokyo Dental College Ethics Committee. RESULTS AND CONCLUSIONS: Within the limitations of this study, the following results were obtained: the activities performed during rugby practice involved relatively small indirect head acceleration and masseter and sternocleidomastoid muscle activities. After the young male rugby players were instructed to clench their masseter muscles, a marked decrease in head acceleration was observed.

Attitudes towards the use of mouth and face guards in Swedish ice hockey: part 2. Results.

BACKGROUND/AIM: The yearly cost of sports injuries, which affects Swedish society, is estimated to 3 billion SEK (460 million USD). Injuries in ice hockey represent at least 270 million SEK (42 million USD). Despite the high number of injuries, mouth and face guards are rarely used in Swedish ice hockey. The major aim of this study was to examine the attitudes of mouth and face guards in two ice hockey clubs in Sweden (one elite and one division 3 club). A second purpose was to determine why some players use mouth and face guards, while others do not. A third goal was to present a material that ice hockey clubs could use for further discussions. MATERIALS AND METHOD: A phenomenographic analysis of focus groups interviews. RESULTS: The phenomenographic analysis of the data resulted in 12 categories. Within each category, issues, activities and engagement of the participants were described. Further, similarities and differences in the discussions between the elite club and the division 3 club were described. The following categories were found to engage the participants the most: 'Ice hockey is a high-velocity collision sport in which injuries are expected', 'Attitudes towards personal protection guards' and 'Suggested measures'. CONCLUSIONS: The participants were aware of the risk of playing ice hockey, but they know little about the consequences of a dental injury. Although ice hockey players wish to protect themselves, they refuse to accept just any mouth or face guard. Through the discussions about reducing dental and jaw injuries by routine use of protection devices, many reform proposals were presented that could be useful in future discussions.

Which sports have a higher risk of maxillofacial injuries?

OBJECTIVES: Sports etiology is one of the most common causes of maxillofacial injuries. This work aimed to provide an up-to-date review of sports-related maxillofacial injuries. METHODS: An updated review was conducted on Pubmed and Google Scholar. No publication year and language restrictions were applied. Two different search strategies were performed, the first addressed which sports, generally associated with maxillofacial injuries, and the second search was conducted to determine the frequency of maxillofacial injuries associated with each sport individually. RESULTS: The first search returned 26 articles distributed across different sports, from different countries, and with varied age distribution. The second search displayed 85 articles on individual sports group. Papers were rated and categorized according by the sport associated to the reported injury. A useful sports risk scale for maxillofacial injuries has been developed. Peculiar themes from all participating sports were evaluated. The use of protective equipment and other preventive measures were highlighted. CONCLUSIONS: Some sports with ball and cycling can be considered riskier sports for maxillofacial injuries. Athlete education and the mandatory use of mouthguards, helmets, and eye protection, among other things, are crucial to prevent these injuries. Tailor-made mouthguards and protective masks, which are becoming cheaper, are in vogue. The Sports-related Maxillofacial Injuries Risk scale can be useful for athletes, athletic coaches, and maxillofacial surgeons.