Put More

1
Put More Bite Into Health Promotion

• Mouthguard Initiative

MOUTHA-2-01
2
Objectives of the Bite Mouthguard Initiative

• Inform practitioners about the incidence of
  oro-facial trauma and the role mouthguards play
  in their prevention
• Have practitioners educate patients and coaches
  about mouthguards
• Convince practitioners to fabricate more
  mouthguards
• Inform practitioners about the types of
  mouthguards and barriers to their use

MOUTHA-2-02
3
Sports dentistry deals with impact-type injuries
MOUTHA-2-03
4
Types of Impact Injuries in Sports

• participant
• apparatus (e.g. bat)
• projectile (e.g., ball or puck)
• (Pinkham Kohn, Dent Clinics N Amer 35609-26,
  1991)

MOUTHA-2-03
5
Ability of Projectiles inSports to Cause Injury

• airborne pucks can travel as fast as 90 mph
• baseballs tennis balls can travel as fast
  as 100 mph
• (Pinkham Kohn, Dent Clinics N Amer
  35609-26, 1991)

MOUTHA-2-05
6
Mouthguards are especially recommended for
collision, contact and fast-moving sports.
MOUTHA-2-06
7
Sports with Mandatory Mouthguard Rules for
Practice and Competition

• Amateur
• boxing
• football
• ice hockey
• mens lacrosse
• womens field hockey
• Professional
• boxing

(Ranalli and Lancaster, J Public Health Dent 53
96-100, 1993)
MOUTHA-2-07
8
Evolution of Mouth Protection in Sports

• Year Event
• 1913 boxing 1st sport to introduce mouth
  protection
• 1960 Natl Fed State H.S. Assns mandates face
  guards for high school football
• 1962 Natl Alliance Football Rules Cmt mandates
  mouthguards for high school football
• 1974 Football Rules Cmt of NCAA mandates
  mouthguards for college football
• 1976 College hockey mandates mouthguard use
• 1983 Natl Academy for Sports Dentistry
  established
• 1990 NCAA mandates mouthguards be a visible
  color
• (Johnsen Winters, Dent Clinics N Amer
  35657-66, 1991
• Lancaster and Ranalli, Pediatric Dent 15398-402,
  1993)

MOUTHA-2-08
9
ADA Endorsement of Mouthguards

• 1960 - first resolution endorsing use of
  mouthguards passed
• 1985 - resolution supporting the use of
  mouthguards for all sports where risk of injury
  is significant passed.
• (Johnsen Winters, Dent Clinics N Amer
  35657-66, 1991)

MOUTHA-2-09
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Academy for Sports Dentistry endorses mouthguard
use for the following sports

• acrobatics
• baseball
• basketball
• boxing
• cycling
• discus
• equestrian sports
• field hockey
• football
• gymnastics
• handball

• ice hockey
• judo
• karate
• lacrosse
• motorcross
• martial arts
• parachuting
• rugby
• racquetball
• skiing
• soccer

• squash
• surfing
• skate boarding
• shot putt
• skydiving
• trampoline
• tennis
• volleyball
• wrestling
• weight lifting
• water polo

(Johnsen Winters, Dent Clinics N Amer
35657-66, 1991)
MOUTHA-2-06
11
Protective Benefits of Mouthguards

• reduce tooth fractures dislocations
• protect against intraoral soft tissue lacerations
  bruises
• protect against jaw fractures by absorbing energy
  from traumatic blows to the chin
• prevent upward backward displacement of
  mandibular condyle
• (Johnsen Winters, Dent Clinics N Amer
  35657-66, 1991)
• may protect against brain concussions by
  cushioning shock from a blow to the jaw
  preventing transmission of the shock through the
  TMJ to the skull
• (Blum Kranz, J Dent Children 4922-24, 1982)

MOUTHA-2-11
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Cost/Benefit of Mouthguards

• Total rehabilitative costs for a single
  knocked-out tooth are more than 20 times that of
  a custom-made mouthguard.
• 200,000 (est.) football injuries per year are
  prevented by mouthguards. (ADA Council on Dental
  Materials, JADA 10984-7, 1984)
• Since the introduction of mandatory mouthguards
  and padded helmets in football, the incidence of
  dental injuries has been reduced from 10 chance
  each year to a 0.35-0.45 chance. (Camp, Dent
  Clinics N Amer 35733-56, 1991)
• Incidence of facial dental injuries per 100
  players declined from 2.2 to 0.3 following
  adoption of face-mask mouthguard regulations.
  (Heintz, JADA 77632-36, 1968)
• Dental treatment for teeth avulsed by youngsters
  trying to slam-dunk basketballs ranged from
  35-2,200, with a mean cost of 929. (Kumamoto
  et al JADA 1281273-74, 1997)

MOUTHA-2-12
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Incidence of Tooth Avulsions or Fractures in the
Military is Unknown
MOUTHA-2-13
14
Proportion of Tooth Avulsions or Fractures Due to
Sports-Related Injuries in the Military is Also
Unknown
MOUTHA-2-14
15
Civilian Incidence/Prevalence Data on
Sports-Related Oral Trauma
MOUTHA-2-15
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Multi-sport

• Over 5 million teeth are knocked out at sporting
  events each year
• (ADA Council on Dental Materials, JADA 10984-7,
  1984)
• Natl Youth Sports Found. for the Prev. of
  Athletic Injuries estimates that athletes have a
  10 chance of sustaining an injury to the face or
  mouth during playing season.
• (Padilla Balikou, J Calif Dent Assoc 2127-37,
  1993)

MOUTHA-2-16
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Multi-sport Continued

• 13 of all dental injuries are sport-related
• (Hayrinen-Immonen et al., Endod Dent Traumatol
  6208, 1990)
• Of all sports-related accidents, 11-18 are
  maxillo-facial injuries
• (San, Proc Finn Dent Soc 84Supplement IV, 1988)

MOUTHA-2-17
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Multi-sport

• 9 of adolescent athletes suffered oral trauma
  75 of these injuries involved individuals not
  wearing mouthguards 40 occurred to baseball and
  basketball players.
• (McNutt et al., Pediatric Dent 11209-13,
  1989)

MOUTHA-2-18
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Civilian Studies

• Year Population of Injuries to Oral Region
• 1951 H.S. football 50
• players in 3 states
• (Cathert, Dent Digest 57346-48, 1951)
• 1954 H.S. football 54
• nationwide
• (1954-55 Handbk, Natl Fed State H.S. Assns)
• 1960 H.S. football players 20
• in Wisconsin
• (Morrey, JADA 64392-3, 1962)

MOUTHA-2-19
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Football

• 3.9 of a high school football players suffered
  from oral trauma while wearing mouth guards.
• (Garon, Merkle, and Wright, JADA 112663-65, 1986)

MOUTHA-2-20
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Basketball

• 7.5 of female college basketball players
  sustain orofacial injuries.
• (Morrow, Bonci, Seals, Barnwell, I Natl
  Athletic Trainers Assoc 26334-5, 1991)
• 10 of male college basketball players sustain
  orofacioal injuries.
• (Morrow et al., J Natl Athletic Trainers Assoc.
  26338-42, 1991)

MOUTHA-2-21
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Baseball

• Of all baseball injuries, 41 occur to the head,
  face, mouth or eyes.
• (U.S. Consumer Product Safety Commission, 1981)

MOUTHA-2-22
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Rugby

• Poll of 1987 U.S. World Cup Team
• 95 believe mouthguards protect
• 50 wear mouthguards
• (Chapman, Am J Sports Med 17690-91, 1989)

MOUTHA-2-23
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Limitations of Sports Trauma and Mouthguard
Studies

• many had very small samples
• most were limited to adolescents in a
  restricted locale for a limited time
• definition of outcomes varied widely

25
Conclusion From Sports Trauma and Mouthguard
Studies

• estimates of protective effect of mouthguards
  vary widely between and within sports
• a substantial number of studies have been done
• most studies conclude mouthguards contribute to
  reducing oro-facial injuries

MOUTHA-2-27
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Mouthguard Use in the Military is Unknown
MOUTHA-2-28
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Military Data on Occupationally-related Oral
Trauma
MOUTHA-2-33
28

• Ankle injuries and HEAD TRAUMA tie as the
  leading cause of MAJOR injuries in IDF
  paratroopers.
• Overall injury rate 0.89 or 9/1000 plane jumps.
• Earlier studies show injury rates of 0.3-1.4
  or 3.1-14/1000 plane jumps. (Bar-Dyan,
  Bar-Dyan, Shemer, Milit Med 1631-2, 1998)

MOUTHA-2-34
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On- and Off-the-job Injury Prevention is
one of the top priorities of LTG Peake, the
Army Surgeon General.
MOUTHA-2-32
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Reducing injuries 10 in the Army would save
an estimated 35m. (COL Bruce Jones, MD,
USACHPPM)
MOUTHA-2-36
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Mouthguards may also be used to prevent
occupationally-related injuries for paratroopers
and for tankers.
MOUTHA-2-31
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Types of Mouthguards

• Stock
• Boil-and-bite
• Custom-made

(Padilla Balikov, CDAJ 2127-37, 1993)
MOUTHA-2-37
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Stock
ready to wear without further preparation
least expensive bulky lack retention must be
held in place by constant occlusal pressure may
interfere with speech or breathing
MOUTHA-2-38
34
Boil Bite
immersed in hot water formed in mouth using
finger, tongue biting pressure available in
limited sizes may lack proper extension into
buccal vestibules or posteriorly
MOUTHA-2-39
35
Custom-made
fabricated by dentists from stone casts of
patients maxillary arch best adaptation,
maximum retention, comfort stability least
interference with breathing or speech
MOUTHA-2-40
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Stock and boil-and-bite mouthguards can be
purchased at sporting goods stores.
MOUTHA-2-41
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Why Athletes Dont Use Mouthguards

• lack of awareness
• may not know mouthguards are recommended for
  the sports they engage in
• use not encouraged by coach
• not mandatory for the sports they engage in
• object to mouthguard use

MOUTHA-2-46
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Behaviors of athletes are most influenced by
their coaches.
MOUTHA-2-47
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Sources of Information About Mouthguards Reported
by Coaches

• Sales representatives 72
• Educational Materials 33
• Dentists 11
• (DeYoung, Godwin, Robinson J Dent Res 72277,
  1993)

MOUTHA-2-48
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Course of Action for Mouthguards

• educate
• motivate
• fabricate

MOUTHA-2-49
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Educating Patients About Mouthguards
MOUTHA-2-50
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Points to Emphasize Orally

• If you play sports or participate in training
  activities such as pugil stick, bayonet, or
  confidence course, you may need a mouthguard.
• Mouthguards will help protect your teeth against
  fractures and loss from sports injuries.

MOUTHA-2-51
43
To reinforce your oral message, give patients
take-home flyers on mouthguards.
MOUTHA-2-52
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Why educate people who cant benefit from a
service?

• raise awareness
• diffuse knowledge
• may influence others as a parent, relative, or
  peer

MOUTHA-2-53
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Mouthguards Should Be Checked Regularly for

• Distortions
• Bite-throughs
• Tears
• If present, replace.

MOUTHA-2-54