The best mouthguard is one that a player will wear, writes Dr Edward O’Reilly and Dr Abigail Moore

Preventing dental trauma

The best mouthguard is one that a player will wear, writes Dr Edward O’Reilly and Dr Abigail Moore. Worldwide, 20 to 30 per cent of 12-year- olds have suffered dental injuries. The peak incidence of dental injuries is age 9-10 years (with a third higher incidence in males), which coincides with an increase in sporting activity. Unsurprisingly, one of the most common causes of dental trauma is participation in sports, especially contact sports (basketball, American football, boxing, rugby, football, ice hockey, hurling, Gaelic football, handball) (Andreasen 2007, Castaldi 1974).

Higher rates of dental injuries are seen in contact sports due to increased collisions at high speeds (Yamada 1998, Castaldi 1974). Competitive matches hold higher risk of injury than training (Sane 1988). The risk of dental injuries compared with general injuries is low but related costs are high, so prevention is key (Newsome 2000).

Most (80 per cent) injuries involve the maxillary incisors (potentially immature), which tend to be the most clinically aesthetically challenging and costly to restore (Andreasen 2007, Newsome 2000). Ideally, any activity where the potential for dental trauma can exist should utilise mouthguards to protect the competitors.

Role of mouthguards in prevention of oro-facial injuries Mouthguards (sportguards, gumshields) were first introduced by boxers in the 1920s (Cathcart 1958). A mouthguard is defined as: a resilient device or appliance placed inside the mouth to reduce oral injuries, particularly to teeth and surrounding structures. They considerably diminish the deflection of teeth subjected to stress in comparison with unprotected teeth. (Hoffmann 99).

Mouthguards act through distribution of the energy form impact, decreasing the likelihood and severity of dental injury and concussion (Chapman 1985, Johnston 1996). The exact mechanism depends on the direction of impact (see Table 1 – p23).

Official recommendations: Only five amateur sports and one professional sport have regulations in the USA (Gardiner 2000). The GAA have, in their most recent congress, made it mandatory for juvenile players up to the age of 18 to wear mouthguards from the start of 2013. This rule will come into effect for senior players from the start of 2014. This is something that is welcomed by all in the dental profession. The current Irish recommendations for the most commonly played contact sports are seen in Table 2. Our role to promote mouthguard use.

Mouthguards are preventative dentistry’s contribution to sports. Dentists have an obligation to promote the use of well-fitted and properly designed mouthguards to prevent dental trauma.

Dental professionals are responsible for addressing these issues by providing more comfortable, high quality, appealing and affordable mouthguards that do not impact negatively on sporting performance. We should aim to identify high-risk patients and educate them on advantages of prevention and the options available. The most common barriers to mouthguard wear are discomfort and difficulty in breathing and speaking (Gardiner 2000, Boffano 2012). Institutions may be afraid of implementing compulsory measures in case of diminishing participation. Even in sports where mouth protection is compulsory, such as American football, compliance can be poor with only 33 per cent of athletes reporting using custom-made mouthguards in one survey (Ranalli 95). In 1991, approximately one in five players were not wearing a mouthguard fitted by a dentist, even though almost 50 per cent had experienced an orofacial injury playing rugby (Chapman 1993). In a survey of their rugby clubs in October 2011 the IRFU.

Patients at increased risk of dental trauma Playing contact sports Increased overjet Anterior restorations High smile line Orthodontics – increased tooth mobility, fabrication difficulty, additional injury from appliance Mixed dentition – immature teeth.