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Title: 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
10
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
12
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
13
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
16
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
17
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
18
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
19
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
20
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
21
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
22
Baseball
  • Of all baseball injuries, 41 occur to the head,
    face, mouth or eyes.
  • (U.S. Consumer Product Safety Commission, 1981)

MOUTHA-2-22
23
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
24
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
26
Mouthguard Use in the Military is Unknown
MOUTHA-2-28
27
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
29
On- and Off-the-job Injury Prevention is
one of the top priorities of LTG Peake, the
Army Surgeon General.
MOUTHA-2-32
30
Reducing injuries 10 in the Army would save
an estimated 35m. (COL Bruce Jones, MD,
USACHPPM)
MOUTHA-2-36
31
Mouthguards may also be used to prevent
occupationally-related injuries for paratroopers
and for tankers.
MOUTHA-2-31
32
Types of Mouthguards
  • Stock
  • Boil-and-bite
  • Custom-made

(Padilla Balikov, CDAJ 2127-37, 1993)
MOUTHA-2-37
33
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
36
Stock and boil-and-bite mouthguards can be
purchased at sporting goods stores.
MOUTHA-2-41
37
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
38
Behaviors of athletes are most influenced by
their coaches.
MOUTHA-2-47
39
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
40
Course of Action for Mouthguards
  • educate
  • motivate
  • fabricate

MOUTHA-2-49
41
Educating Patients About Mouthguards
MOUTHA-2-50
42
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
44
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
45
Mouthguards Should Be Checked Regularly for
  • Distortions
  • Bite-throughs
  • Tears
  • If present, replace.

MOUTHA-2-54
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