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PubMed2004

Nigerian dentists' knowledge and attitudes towards mouthguard protection.

The objective of this study was to assess the knowledge and attitudes of Nigerian dentists towards mouthguard protection. A pre-tested 15-item, one-page questionnaire was distributed to 185 dentists practising in different parts of the country with government hospitals or private establishments, by 'hand-delivery' system. Filled and returned forms were 170 (response rate of 92%). The period of the survey was between April and August 2003. Dental graduates from the different dental schools in the country responded to this survey. About 49% of the respondents indicated having only classroom lectures on mouthguards during their undergraduate trainings, 11% said they had some laboratory sessions in addition while no form of education on mouthguards was received by 40%. About 82% had never recommended mouthguard protection for athletic patients, and the major reason was no formal training in the subject. Only 58.5% were familiar with the different types of mouthguards, 75.9% would not be able to supervise or fabricate mouthguards and 50.6% would prefer custom-made mouthguard for their athletic patients. About 84% felt the current training on mouthguards in Nigerian dental schools is inadequate. Over 98% agreed that mouthguard usage in contact sports should be encouraged with the involvement of the dentists. The knowledge and attitudes of the respondents towards mouthguard protection did not vary significantly across years of postqualification from dental schools as well as the professional status of the dentists (P > 0.05). Although Nigerian dentists support mouthguard protection in contact sports and want to be involved in the provision of mouthguards for athletes, their knowledge of the protective device is inadequate. There is need for attention to be given to this subject in the undergraduate curricula of our dental schools.

Adult↗
PubMed2004

Non-surgical treatment of sports-related temporomandibular joint disorders in basketball players.

In this study, 18 basketball players (11 female, seven male; age range 14-32 years) with temporomandibular joint (TMJ) problems who had a history of sport injuries related to head or jaw region were evaluated and the results of the treatment were presented. A standardized functional examination of the masticatory system was performed including measurement of maximal jaw movements, recording of joint sounds, pain on movement of the jaw as well as tenderness to palpation of the both TMJ or masticatory muscles. Patients were also evaluated periodontally. Diagnosis was made according the criteria, described by Okeson, and appropriate treatment was applied using different kind of splints. At the end of treatment only one patient continued with right TMJ reduction with slight pain. Except for that patient, none of the patients had pain after treatment. The maximum opening of the jaws and the maximal jaw movements were statistically increased after treatment. Patients with TMJ problems also showed periodontal problems, most likely due to inadequate oral hygiene because of the limited jaw movements and pain. Periodontal parameters including probing depth (PD), Plaque index (PI), and Sulcus Bleeding Index (SBI) improved after treatment. Sports-related TMJ injuries may result in complex problems such as pain, TMJ sounds, limitation in maximal jaw movements and maximum opening of the mouth, difficulty in chewing. With the appropriate diagnosis this could be treated non-surgically in 6-8 months. This study also showed that the TMJ disorders may cause periodontal problems, which may affect all teeth and also the general health of the athlete.

Adolescent↗
PubMed2005

Dental trauma and mouthguard usage among ice hockey players in Turkey premier league.

An epidemiological survey was carried out among the ice hockey players of Turkish Premier Ice Hockey League. The purpose of the present study was to evaluate the prevalence of dental trauma in youth and adult ice hockey players, as well as to check if the players were aware of mouthguards and had used any. The players were interviewed to determine the occurrence of dental trauma during ice hockey and mouthguard usage level. Results revealed that awareness of Turkish ice hockey players to dental trauma is neglected while the majority of players also demonstrated limited utilization of mouthguard.

Adolescent↗
PubMed2005

Dental trauma incidence and mouthguard use in elite athletes in Turkey.

Contact sports may lead to dental trauma, which often can be reduced with appropriate preventive measures. While numerous studies exist on this topic for several countries throughout the world, there is a lack of comprehensive descriptive studies in Turkey. The purpose of this study was to investigate the incidence and type of dental injuries associated with three different sports among Turkish elite athletes, who do not contact (volleyball), contact directly (taekwondo) or indirectly (handball) with competition rivals. Additionally, awareness and use of mouthguards were also compared. Thus, during the 2003 and 2004 Turkish National Championships in three sports, 50 taekwondo, 62 handball and 50 volleyball male athletes were interviewed by questionnaire. Results showed that taekwondo and handball athletes experienced significantly more dental trauma than volleyball athletes (P < 0.05). Twelve of the taekwondo (24%), 16 of the handball (26%) and four of the volleyball athletes (8%) experienced at least one type of dental injury. Awareness of mouthguards as a preventive measure against dental trauma was significantly higher among taekwondo and handball athletes (P < 0.05), although a very small percentage in either of these sports actually wore a mouthguard (10 and 0%, respectively). Trauma incidence between direct contact with rival competitors and indirect contact with rival competitors was not significantly different. The incidence of dental trauma in contact sports shows that the awareness and use of mouthguards must be intensified. Mouthguard use should be made compulsory, especially in those sports with high risk for dental trauma.

Adult↗
PubMed2005

Oro-facial injuries in Central American and Caribbean sports games: a 20-year experience.

Dental services in sports competitions in the Games sponsored by the International Olympic Committee are mandatory. In every Central American, Pan American and Olympic Summer Games, as well as Winter Games, the Organizing Committee has to take all the necessary measures to assure dental services to all competitors. In all Olympic villages, as part of the medical services, a dental clinic is set up to treat any dental emergency that may arise during the Games. Almost every participating country in the Games has its own medical team and some may include a dentist. The major responsibilities of the team dentist as a member of the national sports delegation include: (i) education of the sports delegation about different oral and dental diseases and the illustration of possible problems that athletes or other personnel may encounter during the Games, (ii) adequate training and management of orofacial trauma during the competition, (iii) knowledge about the rules and regulations of the specific sport that the dentist is working, (iv) understanding of the anti-doping control regulations and procedures, (v) necessary skills to fabricate a custom-made and properly fitted mouth guard to all participants in contact or collision sports of the delegation. This study illustrates the dental services and occurrence of orofacial injury at the Central American and Caribbean Sports Games of the Puerto Rican Delegation for the past 20 years. A total of 2107 participants made up the six different delegations at these Games. Of these 279 or 13.2% were seen for different dental conditions. The incidence of acute or emergency orofacial conditions was 18 cases or 6% of the total participants. The most frequent injury was lip contusion with four cases and the sport that experienced more injuries was basketball with three cases.

Athletic Injuries↗
PubMed2005

Level of information concerning dental injuries and their prevention in Swiss basketball--a survey among players and coaches.

Basketball carries a medium risk of dental injuries. Swiss data are not available in this respect. Using a standardized questionnaire 302 basketball players from 29 Swiss teams and their 29 coaches were interviewed. The questions focused on the frequency of dental accidents, their prevention and subsequent procedure. The participating 302 players came from three divisions: semi-professional players of National League A and B (102), amateurs of Regional League 2 and 3 (100) and young people of up to the age of 18 (100). The data were evaluated in relation to division, sex and team function. Of the 331 interviewed persons 102 had already seen a dental trauma in basketball and 55 had already had a dental trauma. Only four of the interviewed persons wore mouthguards. The awareness of the procedure following a dental trauma was unsatisfactory. The results of the survey show that significantly more information and education is required in Swiss basketball not only through sports associations but also through coaches and dentists.

Adolescent↗
PubMed2005

Can mouthguards prevent mandibular bone fractures and concussions? A laboratory study with an artificial skull model.

Some sports' accidents are responsible for inflicting traumatic brain injuries and mandibular bone fractures when impacts occur to the chin. It is often thought that mouth guards can prevent many of these injuries. However, such assertions may be insufficient without adequate research. It is therefore necessary to establish a systematic method of investigation to solve this problem. In the present laboratory study, tests were performed using pendulum impact equipment and an artificial skull model connected to strain gages and accelerometers to simulate and measure the surface distortions related to bone deformation or fractures and the acceleration of the head related to concussions. As impacts, direct blows to the mandibular undersurface were applied. As a result, wearing a mouth guard decreased (P < 0.01) the distortion to the mandibular bone and the acceleration of the head significantly compared with not wearing a mouth guard (54.7%: to the mandible -- measured at a total of three different points, 18.5%: to the head measured at a total of three different points). Within the limits of this study, the following conclusions were drawn: The present measuring system in this study was able to evaluate the distortion to the mandibular and the acceleration of the head from the direct blow to the mandibular undersurface. Mouth guards can reduce distortion to the mandibular and the acceleration of the head from the same blow. So mouth guards might have the possibility to prevent mandibular bone fractures and concussions. However, further well-designed and exhaustive studies are vital to show that mouth guards reduce the incidence of concussions and mandibular bone fractures.

Acceleration↗
PubMed2005

Do custom-made mouth guards have negative effects on aerobic performance capacity of athletes?

Mouth guards are considered an essential part of equipment for athletes participating in contact sports. The purpose of this study was to evaluate the effect of custom-made mouth guards on the ventilatory gas exchange effects of taekwondo athletes. The subjects were 22 elite athletes aged between 14 and 17 years. To determine the effect of mouth guard use during exercise, oxygen consumption (VO(2)) was measured with a portable gas analysis system while an exercise tolerance test with a shuttle run test protocol was performed. Values with and without mouth guard were compared. Wilcoxon ranks test was used for the statistical analysis. The results show that wearing mouth guards has no significant effect on maximal oxygen uptake (VO(2max)), minute ventilation (VE), tidal volume (VT) and respiratory exchange ratio (RER) while performing maximal exercise (P > 0.05). In conclusion, taekwondo athletes can use custom-made mouth guards without negative effects on their aerobic performance capacity.

Adolescent↗
PubMed2006

Orofacial/cerebral injuries and the use of mouthguards by professional athletes in Switzerland.

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.

Adult↗
PubMed2006

Comparison of forces transmitted through different EVA mouthguards.

Athletic mouthguards have been recommended for decades with varying levels of athlete acceptance. Issues related to compliance center around the ability to breath and speak while wearing the mouthguards. Fabrication techniques have changed over time to a two-layer ethylene vinyl acetate mouthguard fabricated on a high-pressure machine. The reported ideal thickness of these mouthguards has been somewhat variable depending on the sport and anticipated level of risk. Recent research however, has identified 4 mm as the optimal thickness of EVA. In this study an acrylic dental cast was fabricated and mounted to a drop impact fixture. Mouthguards of varying ply, thickness and palatal coverage were fabricated and tested in the fixture. Strain gauges and load cells were used to evaluate the effect of ply, thickness, and palatal coverage on the ability of these mouthguards to minimize transmitted forces. The purpose of this study was to identify those variables of mouthguard construction that will minimize the overall transmitted force of impact to the anterior dentition.

Analysis of Variance↗
PubMed2006

Does hard insertion and space improve shock absorption ability of mouthguard?

Mouthguards are expected to reduce sports-related orofacial injuries. Numerous studies have been conduced to improve the shock absorption ability of mouthguards using air cells, sorbothane, metal wire, or hard material insertion. Most of these were shown to be effective; however, the result of each study has not been applied to clinical use. The aim of this study was to develop mouthguards that have sufficient prevention ability and ease of clinical application with focus on a hard insertion and space. Ethylene vinyl acetate (EVA) mouthguard blank used was Drufosoft and the acrylic resin was Biolon (Dreve-Dentamid GMBH, Unna, Germany). Three types of mouthguard samples tested were constructed by means of a Dreve Drufomat (Type SO, Dreve-Dentamid) air pressure machine: the first was a conventional laminated type of EVA mouthguard material; the second was a three layer type with acrylic resin inner layer (hard-insertion); the third was the same as the second but with space that does not come into contact with tooth surfaces (hard + space). As a control, without any mouthguard condition (NOMG) was measured. A pendulum type impact testing machine with interchangeable impact object (steel ball and baseball) and dental study model (D17FE-NC.7PS, Nissin, Tokyo, Japan) with the strain gages (KFG-1-120-D171-11N30C2: Kyowa, Tokyo, Japan) applied to teeth and the accelerometer to the dentition (AS-A YG-2768 100G, Kyowa) were used to measure transmitted forces. Statistical analysis (anova, P < 0.01) showed significant differences among four conditions of NOMG and three different mouthguards in both objects and sensor. About acceleration: in a steel ball which was a harder impact object, shock absorption ability of about 40% was shown with conventional EVA and hard-insertion and about 50% with hard + space. In a baseball that was softer compared with steel ball, a decrease rate is smaller, reduction (EVA = approximately 4%, hard-insertion = approximately 12%, hard + space = approximately 25%) was admitted in the similar order. A significant difference was found with all the combinations except for between EVA and hard-insertion with steel ball (Tukey test). About distortion: both buccal and lingual, distortions had become small in order of EVA, hard-insertion, and hard + space, too. The decrease rate is larger than acceleration, EVA = approximately 47%, hard-insertion = 80% or more, and hard +space = approximately 98%, in steel ball. EVA = approximately 30%, hard-insertion = approximately 75%, and hard + space = approximately 98% in baseball. And a significant difference was found with all the combinations (Tukey test). Especially, hard + space has decreased the distortion of teeth up to several percentages. Acceleration of the maxilla and distortions of the tooth became significantly smaller when wearing any type of mouthguard, in both impact objects. But the effect of mouthguard was clearer in the distortion of the tooth and with steel ball. Considering the differences of mouthguards, the hard-insertion and the hard + space had significantly greater buffer capacity than conventional EVA. Furthermore, hard + space shows quite high shock absorption ability in the tooth distortion. Namely, hard + space has decreased the distortion of teeth up to several percentages in both impact objects.

Acceleration↗
PubMed2006

Dental squash injuries - a survey among players and coaches in Switzerland, Germany and France.

Squash belongs to sporting activities with medium risk of causing dental trauma. Because of high velocity, close body contact and the use of rackets the injury potential in squash has increased. The aim of this work was to conduct a comparative study between Switzerland, Germany and France on a number of issues: the frequency of dental and facial injuries in squash, athletes' habits of wearing mouthguards, as well as the general level of information about emergency measures after a dental trauma and the resulting consequences. Using a standardized questionnaire a total of 653 individuals, 600 squash players and their 53 coaches, were interviewed. In each of the three countries 200 players belonging to four different divisions (juniors, amateurs, semi-professionals and professionals) were surveyed. Of these 653 interviewees 133 (20.4%) have already observed a dental injury; 27 (4.5%) have experienced a dental trauma themselves. Less than half of all interviewed players and coaches (47.6%) were aware of the possibility of replanting avulsed teeth. Just 5.1% were familiar with the tooth rescue kit. Only one individual wore a mouthguard. The results show that the area of squash requires more information about prevention through sports associations, coaches and dentists.

Adolescent↗
PubMed2006

Elite tae kwon do athletes' satisfaction with custom-made mouthguards.

Mouthguards are considered by most authors to be an essential part of equipment for athletes participating in contact sports. However, there are few studies evaluating the satisfaction of the elite athlete with mouthguards. The purpose of this study was to evaluate the satisfaction of elite tae kwon do athletes with custom-made mouthguards in a period of 4 months. The subjects were 22 elite athletes (11 boys and 11 girls) aged between 15 and 17 years. Each athlete was provided with an individual mouthguard made of ethyl vinyl acetate (EVA) material. Using Visual Analog Scale (VAS) questionnaire, esthetic appearance, ability to talk and to breathe, kiyapping (yelling in tae kwon do), oral dryness, nausea, stability, ease in fitting into the mouth, inclination to chew and overall satisfaction were evaluated. Respective values of boys and girls were also compared. One-way anova and paired sampled t-tests were performed for statistical analyses using spss 11.0 windows program. There was no significant difference in the level of satisfaction between the first week and fourth month values. Results also showed that the level of satisfaction did not change statistically between male and female athletes.

Adolescent↗
PubMed2006

Oral trauma, mouthguard awareness, and use in two contact sports in Turkey.

The purpose of the present study was to evaluate the occurrence of dental hard and soft tissue injuries during participation in contact sports, and the awareness and use of mouthguards in a young adult sample of semi-professional or amateur boxers and tae kwon do participants in Turkey. The samples consisted of 274 young adults [174 male (63.5%) and 100 female (36.5%)] aged between 17 and 27 years of which 185 (67.5%) were tae kwon do practitioners, and 89 (32.5%) were boxers. The participants answered a standard questionnaire. All answers were evaluated and then statistical analyses were performed. Of the total sample, 61 of the subjects (22.3%) suffered dental trauma. Of these sufferers, 32 (17.3%) were boxers and 29 (32.6%) were tae kwon do practitioners. It was found that 19 (6.9%) athletes lost their teeth post-trauma. Of the 54 subjects (19.7%) suffering soft tissue injuries, 44 were female (81.5%), while only 10 were male (18.5%), of which 40 (74.1%) were tae kwon do practitioners and 14 (25.9%) were boxers. Of the total sample of 274 subjects, 228 (83.2%) were well informed about mouthguard usage. Of the total sample, 153 (55.8%) of the subjects used mouthguards, all of which were boil-and-bite type. The results of our study indicate that dentists and sports authorities in Turkey should promote the use of mouthguards in contact sports such as tae kwon do and boxing, which have a serious risk for dental and oral soft tissue trauma and tooth loss.

Adolescent↗
PubMed2006

Anterior palatal mouthguard margin location and its effect on shock-absorbing capability.

The purpose of this study was to evaluate the influence of a mouthguard's (MGs) anterior palatal margin location on its shock absorbing capability. A simulation study was conducted on a maxillary phantom model with maxillary teeth, bone, and soft tissue. Miniature strain gauges were attached to the labial and palatal surfaces of the right central incisor as well as the bone surface on the palatal side. MGs were made with ethylene vinyl acetate sheets, with thickness of 2.0, 3.0, and 4.0 mm, using a pressure-forming machine. The locations of the anterior palatal MG margins were set at 4.0, 2.0, and 0 mm from the cervical margin in three experimental configurations. The control situation was without a MG. A calibrated 7N of shock was applied to the middle portions of the labial and palatal surfaces of the central incisor. The amount of tooth deflection was evaluated. The results were analyzed with one-way anova accompanied by the Scheffe's test and multiple regression analysis (P<0.05), designating the strain as the dependent value. The results indicated that the thickness rather than the location of the anterior palatal margin of the MG has a significant influence on the reduction of tooth deflection against a horizontal blow.

Adult↗
PubMed2006

Mouthguard utilization rates during sport activities in Ankara, Turkey.

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.

Adolescent↗
PubMed2006

Adhesive strength and its improvement referring to the laminated-type mouthguard.

The manufacture of laminated-type mouthguards requires skill in fusing sheets of mouthguard materials together. Adequate adhesive strength is required to use mouthguards in a stable condition for a long time. Therefore, in this study, the exfoliation test was applied and some treating techniques and conditions that improve the adhesive strength on a laminated surface were examined. Samples were laminated with two pieces of mouthguard material (3 mm thickness) having an adhesive area of 5 x 5 mm2, and whose other end was the holding part. The experimental factors used were as follows: heating time, use of solvent, elimination and direct heating of the laminate surface, colour of materials and water sorption. The result was measured at the time of breakage of the maximum load (N) and the form of destruction was examined. At 165 s of heating time, material failure was shown at under a load exceeding 5.0 N when compared to an untreated condition. Material failure was measured when a solvent was used and during the elimination of the laminated surface at a heating time of 150 s, which is 15 s lesser than in an untreated condition. Material failure was also measured by direct heating on the bonding surface of a second sheet of material at a heating time of 135 s, which is 30 s lesser than in an untreated condition. The differences in colour of the materials influence adhesion. Clear and light coloured materials showed higher adhesion ability. One-way analysis of variance confirmed a statistically significant difference in heating time differences, usage of solvent, elimination, direct heating on bonding surface and colour (P < 0.05). The decrease of adhesive strength by water sorption at 23 degrees and 37 degrees C was not observed significantly. Maximal laminated bond strength can be obtained by minimal heating time and proper treatment with the use of solvent, elimination and direct heating on bonding surface. The differences in the colour of the materials influenced adhesion. Clear and light coloured materials showed higher adhesive ability. Water sorption did not affect the adhesive strength. Therefore, if laminated-type mouthguards were manufactured properly, it can be used for a longer time and in a good condition.

Adhesiveness↗