RESUMO
This is second of a two-part series on the history and effectiveness of mouthguards (MGs) for protection from orofacial injuries. MGs are hypothesized to reduce orofacial injuries by separating the upper and lower dentation, preventing tooth fractures, redistributing and absorbing the force of direct blows to the mouth, and separating teeth from soft tissue which helps prevent lacerations and bruises. The single study on MG use in military training found that when boil-and-bite MGs were required for four training activities, orofacial injury rates were reduced 56% compared with when MGs were required for just one training activity. A recent systematic review on the effectiveness of MGs for prevention of orofacial injuries included 23 studies involving MG users and nonusers and a wide variety of sports. For cohort studies that directly collected injury data, the risk of an orofacial injury was 2.33 times higher among MG nonusers (95% confidence interval, 1.59-3.44). More well-designed studies are needed on the effectiveness of MGs during military training. Despite some methodological limitations, the current data suggest that MGs can substantially reduce the risk of orofacial injuries in sport activities. MGs should be used in activities where there is a significant risk of orofacial injuries.
Assuntos
Militares , Protetores Bucais , Traumatismos em Atletas/prevenção & controle , Traumatismos Faciais/prevenção & controle , Humanos , Lacerações , Boca/lesõesRESUMO
This is the first of a two-part series on the history and effectiveness of mouthguards (MGs) for orofacial injury protection. Military studies have shown that approximately 60% of orofacial injuries are associated with military training activities and 20% to 30% with sports. MGs are hypothesized to reduce orofacial injuries by separating the upper and lower dentation, preventing tooth fractures, redistributing and absorbing the force of direct blows to the mouth, and separating teeth from soft tissue, preventing lacerations and bruises. In 1975, CPT Leonard Barber was the first to advocate MGs for military sports activities. In 1998, Army health promotion campaigns promoted MG education and fabrication. A US Army basic training study in 2000-2003 showed that more MG use could reduce orofacial injuries and the Army Training and Doctrine Command subsequently required that basic trainees be issued and use MGs. Army Regulation 600-63 currently directs commanders to enforce MG use during training and sports activities that could involve orofacial injuries. In the civilian sector, MGs were first used by boxers and then were required for football. MGs are currently required nationally for high school and college football, field hockey, ice hockey, and lacrosse, and are recommended for 29 sport and exercise activities.
Assuntos
Traumatismos em Atletas/prevenção & controle , Traumatismos Faciais/prevenção & controle , Militares , Protetores Bucais/história , Boca/lesões , História do Século XX , Humanos , Esportes , Ferimentos e Lesões/prevenção & controleRESUMO
BACKGROUND: Sport activities can account for up to one-third of all orofacial injuries. Mouthguards (MGs) have been proposed as a way to reduce these injuries. OBJECTIVES: To present a systematic review and meta-analysis of the effectiveness of MGs for the prevention of sports-related orofacial injuries and concussions. METHODS: Using specific search terms, PubMed, Ovid Embase, and the Cumulative Index to Nursing and Allied Health Literature were searched to find studies that (1) contained original quantitative data on MGs and orofacial injuries and/or concussions, (2) included groups involved in sports or exercise activities, (3) included MG users and non-MG users, and (4) provided either risk ratios (RRs) and 95% confidence intervals (95% CIs) comparing injuries among MG users and non-MG users, or data that could be used to calculate RRs and 95% CIs. RESULTS: Twenty-six studies met the review criteria. Investigations employed a variety of study designs, utilized different types of MGs, used widely varying injury case definitions, and had multiple methodological weaknesses. Despite these limitations, meta-analyses indicated that the use of MGs reduced the overall risk of orofacial injuries in 12 cohort trials (summary RR [nonusers/users] = 2.33, 95% CI 1.59-3.44), and 11 trials involving self-report questionnaires (summary RR [nonusers/users] = 2.32, 95% CI 1.04-5.13). The influence of MGs on concussion incidence in five cohort studies was modest (summary RR [nonusers/users] = 1.25, 95% CI 0.90-1.74). CONCLUSION: These data indicate that MGs should be used in sports activities where there is significant orofacial injury risk.
Assuntos
Traumatismos em Atletas/prevenção & controle , Concussão Encefálica/prevenção & controle , Traumatismos Faciais/prevenção & controle , Protetores Bucais , Boca/lesões , Humanos , IncidênciaRESUMO
OBJECTIVE: Develop a hydrophobic, degradation-resistant dental restorative based on an Oxirane-Acrylate IPN System (OASys) with low shrinkage-stress to substantially extend clinical lifetime. METHODS: Unfilled OASys blends were prepared using dipenta-erythritol-hexaacrylate (DPHA) and p-cycloaliphatic-diepoxide (EP5000). Varying proportions of camphorquinone/iodonium photoinitiator, with a co-reactant oligomeric-diol, served as the experimental curing system. The effects of oxirane-acrylate ratio on the degree-of-cure (Durometer-D hardness), hydrophobicity (contact angle), mechanical properties (3-point bending), near-infrared FTIR degree-of-conversion (DoC), polymerization shrinkage, and shrinkage stress were determined. 70:30 BisGMA:TEGDMA resin served as control. RESULTS: Oxirane tended to decrease hardness and increase hydrophobicity. 0:100, 25:75, 50:50 EP5000:DPHA are harder after 24h than control. 75:25 and 100:0 EP5000:DPHA increased in hardness over 24h, but were softer than control. All groups increased in contact angle over 24h. After 24h, 50:50, 75:25 and 0:100 EP5000:DPHA were more hydrophobic (â¼75-84°) than the control (â¼65°). Acrylate DoC was â¼60% across all experimental groups. Initial oxirane conversion varied from â¼42% in 100:0 EP5000:DPHA to â¼82% 75:25 EP5000:DPHA. However, oxirane DoC increased for 100:0 EP5000:DPHA to â¼73° over 24h, demonstrating dark cure. Moduli and ultimate transverse strengths of OASys groups were higher than for 0:100 EP5000:DPHA, with 50:50 EP5000:DPHA having higher modulus than other experimental groups. However, the control had higher modulus and UTS than all experimental groups. Volumetric shrinkage averaged 7% for experimental groups, but stress decreased dramatically with increasing oxirane content. SIGNIFICANCE: Hydrophobic, low shrinkage-stress OASys resins are promising for development of composites that improve longevity and reduce the cost of dental care.