Wearing Sports Mouthguards to Prevent Oral and Maxillofacial Trauma.

The theme of the academic annual conferences held by the Chinese Stomatological Association from 2021 to 2023 was "Protecting Natural Teeth to Maintain Oral Health" and coincided with the 24th Winter Olympic Games that took place in Beijing in 2022, and thus prevention of oral and maxillofacial trauma once again attracted the attention of stomatological experts and the public. The incidence of oral and maxillofacial trauma caused by sports is around 25% to 34%1-5, and varies based on the type of sport and other factors, such as age, sex and the skill level of the participants. The risk of oral and maxillofacial trauma is extremely high in high-confrontation and high-speed sports, especially for children and adolescents. Wearing sports mouthguards when participating in sport is an effective way to prevent and reduce the incidence of oral and maxillofacial trauma in such sports, and is the simplest and most practical method of doing so. Sports have developed and gained in popularity significantly in China in recent years, but the awareness and use of sports mouthguards are low. Based on the above background, the Chinese Stomatological Association advocates that athletes and sport participants should wear mouthguards in various confrontational and high-speed sports, and calls on dental practitioners and sports-related organisations to actively support the popularisation and application of sports mouthguards to prevent or alleviate oral and maxillofacial trauma and to raise awareness and increase knowledge of methods to protect natural teeth.

Effect of helmet use on maxillofacial injuries due to bicycle and scooter accidents: a systematic literature review and meta-analysis.

Maxillofacial injury is a common injury resulting from bicycle (including e-bike) and scooter accidents. With 80,000 admissions to emergency departments in 2019, bicycle accidents account for more than half of all traffic-related emergency department visits in the Netherlands. The United States reports approximately 130,000 injuries and 1000 fatalities related to cycling annually. This systematic review and meta-analysis was performed to examine the protective effect of helmets against maxillofacial injuries resulting from bicycle and scooter (including e-bike and e-scooter) accidents. After a systematic literature search, 14 studies were found to be eligible for this systematic review. Of these, 11 were included in the meta-analysis. None of the included studies focused on vehicles with motors (e-bikes and e-scooters); all focused only on non-motorized vehicles. All included studies were non-randomized, which could have led to bias in the pooled results. Data from the included studies were tested for heterogeneity using the binary random-effects model (DerSimonian-Laird method), and the odds ratio for the occurrence of maxillofacial injury in cyclists wearing a helmet versus those not wearing a helmet was calculated by random-effects meta-analysis. Patients who had worn a helmet suffered significantly fewer maxillofacial injuries than patients who had not, in bicycle accidents (odds ratio 0.682). In conclusion, wearing a helmet has a significant protective effect against maxillofacial injury, indicating the need for strict helmet legislation.

The impact of helmet use on oral and maxillofacial injuries associated with electric-powered bikes or powered scooter: a retrospective cross-sectional study.

BACKGROUND: Electric bikes (E-bikes) and powered scooters (P-scooters) have become increasingly popular modes of public transportation, but they have been associated with injuries of all kinds, including dental trauma. Helmet use is promoted as a means of reducing injuries in accidents involving motorized and unmotorized vehicles. The aim of the study was to evaluate the impact of helmet use on the number and severity of oral and maxillofacial injuries caused by E-bikes and P-scooters. METHODS: A retrospective cross-sectional study design was used. The cohort included all patients referred to the emergency department of a tertiary medical center in 2014-2020 with oral and maxillofacial injuries involving E-bikes or P-scooters. Data were collected from the medical files on demographics, types of injuries, circumstances of occurrence, work-up, treatment, and outcome. Use of a helmet was recorded in each case. RESULTS: Of the total 1417 patients referred to the emergency department for E-bike and P-scooter-related trauma, 62 had oral and maxillofacial injuries, including 57 riders and 5 pedestrians. All had hard- or soft-tissue injuries; 20 (32.2%) had head injuries and 22 (35.5%) had dentoalveolar injuries. Eleven riders had worn a helmet at the time of injury (17.7%). Helmet use was associated with time of injury (weekday/weekend, daytime/night-time), type of motorized vehicle (E-bike or P-scooter), head injury, and number of bone fractures. Head injuries occurred more often on the weekend (57.9%) than during the week (20.9%) and were more likely to occur in riders who were not protected by a helmet (37.3% vs 18.2%). Patients who used helmets also had a lower rate of fractured bones (18.2%) and dentoalveolar injuries (23.7%) than patients who did not (68.8 and 37.3%, respectively). Interestingly, helmet use had no protective effect on soft-tissue injuries. CONCLUSIONS: Helmet use by E-bike and P-scooter riders decreased the probability of head injury and of hard tissue and dentoalveolar injuries. These results may provide guidance for effective legislation and regulation of helmet use and improved treatment protocols for general and dental physicians.

Prevalence and distribution of maxillofacial trauma in tertiary care centers before/ after motorcycle helmet use law in Sullia, India-A retrospective study.

BACKGROUND/AIMS: In India, motorcycles are commonly involved in accidents and traffic rules negligence, most of which include some type of maxillofacial trauma. In September 2019, the rules for motorcycle and helmet use were modified to compulsory use in the state of Karnataka. The aim of this study was to assess the impact of mandatory helmet use on maxillofacial fractures and injuries in Sullia Taluk, Karnataka. MATERIALS AND METHODS: The study was based on the information obtained from clinical records in the K.V.G Dental College and the K.V.G Medical College from February 2019 to February 2020. The inclusion criteria were subjects who met with two-wheeler accidents with complete case records and radiological investigations. RESULTS: A total of 78 individuals reported with maxillofacial trauma from February 2019 to February 2020. The mean age was 31 ± 14 years. There were 74 (94%) males and 4 (6%) females. Forty-nine cases reported before the mandatory helmet use rule and 29 cases reported after the helmet use rule. There was a 36.3% decrease in the incidence of maxillofacial trauma, 23.5% decrease in fractures, and an 89% reduction in the number of victims who underwent open reduction and internal fixation during the post-law period. CONCLUSION: There was a significant reduction in the incidence and severity of maxillofacial trauma after the implementation of the helmet rule.

Helmets Decrease Risk of Bicyclist-Related Maxillofacial Injuries But Not Severity.

PURPOSE: Given the increasing use of bicycles for local transportation and recreation, the purpose of the present study was to measure the effects of bicycle helmets on the frequency and severity of maxillofacial injuries. The specific aims were to measure and compare the frequencies and severity of maxillofacial injuries between injured bicyclists who had or had not worn helmets. MATERIALS AND METHODS: We implemented a retrospective cohort study and enrolled a sample of bicyclists who had been injured from January 4, 2012 to March 31, 2018 and had presented to Harborview Medical Center for evaluation and treatment. The primary predictor variable was helmet use (yes vs no). The primary outcome variables were 1) the presence of a maxillofacial injury (yes vs no); and 2) injury severity, measured using the Face Abbreviated Injury Scale (FAIS). The other study variables were grouped into demographic or injury-related variables. The appropriate univariate, bivariate, and multivariate logistic regressions statistics were computed, and statistical significance was set at P < .05. RESULTS: The sample included 1379 subjects, with a mean age of 39.6 ± 18.9 years (range, 1 to 91 years), and 78.4% were male. The frequency of facial injuries between the helmeted and nonhelmeted bicyclists was 17.3% and 30.6%, respectively (relative risk, 0.6; 95% confidence interval, 0.5 to 0.7; P < .0001). The protective effect held after adjusting for age, gender, and alcohol exposure. The FAIS score between the helmeted and nonhelmeted riders was 1.8 ± 0.5 and 1.9 ± 0.6, respectively (P = .8). CONCLUSIONS: The helmeted bicyclists were 40% less likely to have a facial injury from bicycle accidents. For those cyclists with a facial injury, however, the injury severity was not different between the helmeted and nonhelmeted wearers. This might have been because, that unlike American football helmets, standard bicycle helmets do not include a face mask to protect the face.

Custom-made facemask as a coadjuvant in the postoperative treatment of sport-related facial trauma: Case report.

Maxillofacial injuries are a regular consequence of sport activities that can force athletes to take a long time off from training and competitions. One way to decrease the time that the athlete needs to get back to his or her training exercises after surgery is to use a custom facemask as a coadjuvant in the postoperative recovery phase. This case report describes the case of a 16-year-old male athlete who suffered facial trauma (orbitozygomatic fractures) during a soccer game. After surgery, a facemask was used during the postoperative phase. He returned to his regular physical activities only 3 weeks after surgery. This simple and very efficient procedure is a good option for athletes who suffer facial injuries.

Occupational group, educational level, marital status and deleterious habits among individuals with maxillofacial fractures: retrospective study

Background: To investigate the occupational profile, educational level, marital status and deleterious habits to the health of patients with maxillofacial fractures of a population of northeastern Brazil. Material and Methods: A retrospective study of patients records admitted to the Division of Oral and Maxillofacial Surgery at the Walter Cantídio University Hospital (Fortaleza, Brazil) who sustained maxillofacial fractures was conducted in the period between 2006 and 2015. Results: A total of 338 patients rendered 355 fractures. Males were the most affected (p <0.001), with prevalence in the third decade of life (p <0.001). There was a predominance of motorcycle accidents (p <0.001), home workers (p <0.001), low educational status (p = 0.032), and no cigarette use (p <0.001) or alcohol (p = 0.023). Fractures of the zygomatic-orbital complex were the most prevalent in the sample (p <0.001). Conclusions: The sociodemographic profile exerted a significant influence on the epidemiological profile of maxillofacial fractures in a Brazilian population during the study period (AU)

No disponible

Should alcohol screening be a routine practice in alcohol-related facial trauma care? A narrative review.

The link between alcohol intoxication and Emergency Department (ED) attendance for management of alcohol-related injuries has been well documented. The acute settings such as ED and surgical wards may not be the most appropriate environment for treatment of chronic conditions, but traumatic episode presentation to ED may offer the most opportunistic time to focus on screening against harmful alcohol use in order to provide timely feedback and support. Although ED provides an opportunity to identify patients with alcohol problems, the initial challenge is finding suitable ways to identify and screen affected patients. This paper is a narrative review on methods of alcohol screening and its effectiveness and efficacy in trauma care setting. It is second part in a series on implementation of screening and brief intervention in managing trauma patients.

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.

Prevention of Sport-related Facial Injuries.

There is evidence that eye protection, mouth guards, helmets, and face guards are effective in reducing the risk of facial injury; however, such safety practices are not adopted universally by all athletes playing high-risk sports. Underlying beliefs about risk perception, comfort, ineffectiveness, utility, and a lack of awareness or enforcement have been identified as reasons people may not adopt preventive measures. There are several high-risk sports that have not mandated or do not enforce use of protective equipment. Valid evidence can assist with addressing the resistance caused by prevailing beliefs and could be essential in influencing rule changes.

Adolescentes vítimas de traumatismo maxilofacial decorrente de violência interpessoal: uma análise socioespacial / Adolescents victims of maxillofacial trauma resulting from interpersonal violence: a socio-spatial analysis

Violência entre adolescentes no Brasil aumenta assustadoramente e mostra números de uma epidemia. Os traumatismos maxilofaciais intimidam e costumam desfigurar a face de suas vítimas, o que na adolescência pode gerar traumas psicológicos podendo vir acarretar outros problemas futuros. O mapeamento socioespacial das residências de vítimas de atos violentos favorece o planejamento e organização de ações de governos que possam ser efetivas para fornecer segurança a população. O presente estudo objetivou entender o fenômeno da violência entre os adolescentes de 10 a 19 anos vítimas de traumatismo maxilofacial através de uma análise socioespacial. Foi desenvolvido um estudo transversal realizado através de análise de dados secundários coletados nos Serviços de Cirurgia e Traumatologia Maxilofacial de três hospitais públicos especializados no atendimento a traumas de média e alta complexidade e referência no atendimento às vítimas de traumatismos maxilofaciais em Belo Horizonte, Minas Gerais, Brasil. Foram identificados 589 registros de adolescentes vítimas de traumatismo maxilofacial decorrentes de violência interpessoal, com predominância do sexo masculino e os domicílios das vítimas apresentaram um padrão espacial agregado, ou seja, em áreas específicas da cidade, de alta vulnerabilidade sócio-econômica, apontando associação entre pobreza e violência

National Athletic Trainers' Association Position Statement: Preventing and Managing Sport-Related Dental and Oral Injuries.

OBJECTIVE: To provide athletic trainers, health care professionals, and all those responsible for the care of athletes with clinical recommendations for preventing and managing sport-related dental and oral injuries. BACKGROUND: Participation in competitive sports continues to grow at both the interscholastic and intercollegiate levels. Therefore, exposure to, and the incidence of athletic-related injury, including orofacial injury, will also likely increase. At the time of this writing, the leading governing agencies for interscholastic (National Federation of State High School Associations) and intercollegiate (National Collegiate Athletic Association) sports require only protective orofacial equipment (eg, mouthguards) for 5 and 4, respectively, of their sanctioned sports. Although orofacial injuries represent a small percentage of all sport-related injuries, the financial burden associated with these injuries (eg, tooth avulsion) can exceed $15 000 over an adult life. Therefore, effective management of sport-related dental injuries is critical to the long-term financial, physical, and emotional health of people who have experienced dental trauma. RECOMMENDATIONS: Based upon the current evidence regarding sport-related orofacial injury, we provide recommendations related to planning considerations, education, and mouthguard efficacy, material, fabrication, and care considerations. Additionally, suggested best practices for managing sport-related dental injury are also given for athletic trainers and other health care professionals.

Sinusitis maxilar secundaria al tratamiento con implantes cigomáticos / Maxillary sinusitis due to treatment with zygomatic implants

El uso de implantes cigomáticos en la rehabilitación de pacientes con atrofia maxilar severa es una alternativa más de tratamiento a tener en cuenta. A pesar de ser una técnica predecible, consolidada y ampliamente documentada por numerosos estudios y profesionales, no está exenta de complicaciones. El objetivo de esta revisión es evaluar la prevalencia y causas de sinusitis maxilar secundaria al tratamiento con implantes cigomáticos. Se ha observado que la sinusitis es la complicación postquirúrgica más frecuente asociada a esta técnica. Sin embargo, se da en un pequeño porcentaje de pacientes, lo que corrobora el éxito del tratamiento con implantes cigomáticos. La aparición de sinusitis se relaciona con la técnica original intrasinusal. Para evitarla, han aparecido técnicas como la colocación extrasinusal de los implantes o la utilización de técnicas quirúrgicas combinadas como la elevación de seno simultánea a la colocación del implante o la utilización de la bola adiposa de Bichat (AU)

The use of zygomatic implants in the prosthetic rehabilitation of the patient with severe maxillary bone atrophy is a therapeutic alternative to consider. In spite of being a technique which is considered predictable, consolidated and widely documented by numerous studies and professionals, it is not exempt from complications. The main objective of this review is to evaluate the prevalence and causes of maxillary sinusitis associated with the use of zygomatic implants. It has been reported that maxillary sinusitis is the most frequent surgical complication linked to this technique. However, it appears in a few number of patients, fact that supports the high success rates of the use of zygomatic implants. Sinusitis has been related to the original intrasinusal technique. To avoid this complication, some techniques such as the extramaxillary approach, the combination with sinus graft or the use of buccal fat pad have been developed (AU)

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.

Assessment of custom and standard, self-adapted mouthguards in terms of comfort and users subjective impressions of their protective function.

BACKGROUND: Various sports disciplines involve some risk of injury. Orofacial injuries constitute 4-18% of all sports-related injuries. Mouthguards are an effective method of preventing injuries and their consequences during various sports activities, especially cycling, football, basketball, handball, skiing, and hockey. Mouthguards can cause discomfort when placed in the oral cavity, in particular due to the fact that a minimal thickness of 4 mm in the labial region is necessary to reduce the impact force of an injury. AIM: The objective was to provide user's general clinical assessment of custom mouthguards made from various polymer materials and with various technologies (thermoforming pressing, traditional flasking, injection molding) and of standard 'boil and bite' mouthguards available on the market in terms of general comfort and their subjective impressions of the protective function. MATERIALS AND METHODS: In total, 168 mouthguards (five types of custom mouthguards and three types of standard 'boil and bite' mouthguards) were assessed by 21 athletes practicing various disciplines, who were asked to complete a questionnaire regarding general comfort and subjective impressions of protective function based on a 5-point scale. RESULTS: Custom mouthguards made with the injection technique from ethyl vinyl acetate received the best scores due to the high level of comfort and the sense of protection they provided. CONCLUSIONS: Custom mouthguards, especially those fabricated with the injection molding technique of Corflex Orthodontic, were shown to be superior to standard mouthguards in terms of their comfort and users' subjective impressions of their protective function.

Variations in mouthguard thickness according to fabrication method.

AIM: The purpose of this study was to examine differences in mouthguard thickness according to the method used to form the mouthguard sheet in a combination vacuum-pressure former. MATERIALS AND METHODS: The material used in this study was a mouthguard sheet of 3.8-mm ethylene vinyl acetate. Three forming methods were used: vacuum-forming, vacuum-pressure-forming, and pressure-forming. The sheets were formed when heating causing them to displace 15 mm from baseline. We measured mouthguard thickness at the labial surface of the central incisor, the buccal surface of the first molar, and the occlusal surface of the first molar. Differences in thickness in different regions of mouthguards formed under different conditions were analyzed by two-way analysis of variance and the Bonferroni method. RESULTS: We found that mouthguard thickness differed in different regions of the central incisors and the first molars (P < 0.01). The incisal (cusp) region was thinner than the cervical region. There were significant differences in the thicknesses of vacuum-formed mouthguards and vacuum-pressure-formed mouthguards (P < 0.05), with the vacuum-forming method resulting in thinner guards than the vacuum-pressure-forming method. Mouthguard thickness at the first molar did not differ according to the forming method. CONCLUSIONS: Our results suggest that mouthguard thickness at the anterior teeth varies with different forming methods. This information is important when selecting a mouthguard-forming method.

Difference in vacuum-formed mouthguard thickness according to heating condition.

AIM: The purpose of this study was to examine the differences of the vacuum-formed mouthguard thickness by the heating condition within the proper heating temperature. MATERIALS AND METHODS: The material used in this study was a mouthguard sheet of 3.8-mm ethylene vinyl acetate. The sheets were formed by vacuum forming using a vacuum-pressure former. Three heating conditions were prepared: The sheet was heated until the center was displaced by 10, 15, and 20 mm from baseline. We measured mouthguard thickness at the labial surface of the central incisor, buccal surface of the first molar, and occlusal surface of the first molar. Differences in thickness in different regions of mouthguards formed under different heating conditions were analyzed by two-way analysis of variance and Bonferroni method. RESULTS: We found that mouthguard thickness differed in different regions of the central incisors and the first molars (P < 0.01). The incisal (cusp) region was thinner than the cervical region. There was statistically significant difference among the heating conditions at the buccal surface of the first molar (P < 0.01), and the thickness became larger as the sheet was heated. Mouthguard thickness at the labial surface of the central incisor and occlusal surface of the first molar did not differ among the three heating conditions. CONCLUSIONS: Our results suggest that the best heating condition within the proper temperature was the condition that the sheet was heated until its center displaced by 20 mm. This finding is necessary knowledge when forming a mouthguard sheet.

Thickness and fit of mouthguard according to changing the holding conditions and the heating conditions of the mouthguard sheet.

The aim of this study was to examine the difference of the thickness and fit of the mouthguard sheet according to the holding conditions and the heating conditions. The material used in this study was Sports Mouthguard (3.8 mm thickness). Two holding conditions of the sheet were undertaken: One was the condition that the sheet was held all around the periphery, and the other was that the sheet was held at only four points. The sheets were formed using a vacuum former when the sheets were heated until they hung 2.0, 3.0, and 4.0 cm from the baseline. We measured the thickness of the mouthguard and calculated the ratio of changes. The fit of the mouthguard was also investigated. The differences of the ratio of changes in the thickness and the fit according to the holding conditions, heating conditions, and measurement areas were analyzed by three-way anova. The results showed that the thickness differed significantly among the holding conditions, heating conditions, and measurement areas (P < 0.01). The condition that the sheet was held at only four points could maintain the thickness especially on the heating condition set at a hanging distance of 4.0 cm. The fit of the sheet differed among the heating conditions and measurement areas (P < 0.01), but not by the holding conditions. The thickness of the sheet could be maintained by holding the sheet only at four points without being inferior to the sheet held all around the periphery in the fit, and this result could be useful on fabricating proper mouthguard.

Vehicle occupant restraint systems impact on eye injuries: a review.

Vehicle occupant trauma to the eyes and associated facial structures has evolved rapidly in conjunction with safety-oriented vehicle design, including restraint systems. Trends vary worldwide with culture, personal factors, vehicle safety equipment, and the traffic environment-including physical, legislative, and enforcement. Wearing safety belts is essential to occupant protection. Airbags were designed as a supplement to protect the head from hard surfaces in frontal crashes, not as a primary countermeasure. Even where vehicle fleets are new with high airbag prevalence, but safety culture and knowledge of restraints is less than robust, injury attributable to not wearing seatbelts is frequent, especially in countries where high-powered vehicles are prevalent. Upper bodies of rapidly forward-moving unrestrained occupants collide with rearward-accelerating airbags. Airbag deployment produces injuries such as corneal abrasions, alkali burns, and the effects of globe compression.