ORIGINAL PAPERs
Michał Biały
1, A–D, F, Michał stankiewicz
2, B–D, F, Anna stempniewicz
3, B–D, F,
Marlena Cymer-Biała
4, B–D, F, Liwia Minch
3, C, E, FDentists’ Attitudes Towards Mouthguards
Used by Young Athletically-Active Patients
Postawy stomatologów odnośnie do szyn ochronnych
stosowanych przez młodych pacjentów aktywnie uprawiających sport
1 Department of Dental Prosthetics, Wroclaw Medical University, Wroclaw, Poland
2 Department of Dental surgery, 4th Military Teaching Hospital in Wroclaw with the Polyclinic, Wroclaw, Poland 3 Department of Maxillofacial Orthopaedics and Orthodontics, Wroclaw Medical University, Wroclaw, Poland 4 Private Practice in stronie slaskie, stronie slaskie, Poland
A – research concept and design; B – collection and/or assembly of data; C – data analysis and interpretation; D – writing the article; E – critical revision of the article; F – final approval of article
Abstract
Background. The dentist is one of the physicians watching over a child’s proper growth and development. Having
a wide knowledge of craniofacial injury prevention, he can effectively protect patients from trauma side effects. One of the most recommended methods is the use of a mouthguard.
Objectives. Dentists’ attitudes towards the mouthguards used by young athletically-active patients.
Material and Methods. The study involved 52 dentists. The aspects considered in the survey included, inter alia,
the frequency of occurrence of patients with oral injuries in his practice and the kind of injury prevention that was applied. The results were subjected to statistical analysis.
Results. 92% of surveyed dentists have encountered the problem of oral injuries among children and adolescents.
23% of the respondents have dealt with them more often than once a month. 65% of surveyed physicians recom-mended the use of mouthguards. The most recomrecom-mended devices were custom-made mouthguards (76% of the recommended ones), rarely of the “boil and bite” type (18%). stock mouthguards were the least frequently recom-mended (6%). 81% of respondents considered mouthguards used by young athletically-active patients necessary to keep the patients’ safety. 19% had no opinion on the question.
Conclusions. Most of the dentists encouraged young athletically-active patients to wear mouthguards and they
con-sidered the use of mouthguards obligatory. Custom-made mouthguards are most often recommended. Physicians, regardless of their specialties, should implement appropriate prevention against craniofacial damage (Dent. Med.
Probl. 2014, 51, 3, 382–386).
Key words: children, attitude of health personnel, mouth protectors, tooth injuries.
Streszczenie
Wprowadzenie. Nad prawidłowym rozwojem dziecka czuwa m.in. lekarz stomatolog. Mając szeroką wiedzę
z zakresu profilaktyki urazów twarzoczaszki, może skutecznie chronić pacjentów przed ich skutkami. Jednym ze sposobów jest zalecenie stosowania szyn ochronnych.
Cel pracy. Ocena postawy stomatologów odnośnie do szyn ochronnych stosowanych przez młodych pacjentów
aktywnie uprawiających sport.
Materiał i metody. Badaniem ankietowym objęto 52 dentystów. W ankiecie uwzględniono m.in., jak często
denty-sta spotykał się w swojej praktyce z urazami zębów u dzieci oraz jaki rodzaj profilaktyki urazów stosował. Wyniki poddano analizie statystycznej.
Wyniki. 92% ankietowanych lekarzy stomatologów spotkało się z urazami jamy ustnej u dzieci i młodzieży. 23%
badanych miało z nimi do czynienia częściej niż raz w miesiącu. 65% ankietowanych lekarzy rekomenduje stoso-wanie szyn ochronnych. Najczęściej zalecanymi szynami są szyny indywidualnie (76% rekomendowanych szyn),
Dent. Med. Probl. 2014, 51, 3, 382–386
The popularization of contact sports among children and youth exposes them to injuries of different parts of the body, including the viscero-cranium. Damage of the viscerocranium may in-volve soft tissues, bones and teeth. Lacerations and contusions of skin, mucous membrane and muscles are the most common soft tissue lesions. The most frequently occurring bone injuries are fractures. Fractures or partial dislocation of per-manent teeth are the most commonly observed dental traumas [1, 2]. Although any bone can be broken as a result of facial skull injury, it usual-ly happens in the mandible [1, 3]. Protruded max-illary incisors are mainly traumatized teeth. The problem affects one-third of patients with distoc-clusion [4]. Depending on different studies, this malocclusion is present in 28.2% to 70.2% of Pol-ish growing children [5].
“Greenstick fractures”, where a thick, well-vas-cularized periosteum stabilizes bone fractions, are mostly observed in childhood. For this reason, the majority of damage is asymptomatic, heals quickly and without complications [6, 7]. However, some symptomatic cases are ignored, and untreated complications cause irreversible changes [8]. An extreme example is the mandibular condyle frac-ture with displacement of bone fragments. An im-proper treatment or its total absence may contrib-ute to impaired growth of the mandibular ramus, restricted mobility or ankylosis in the temporo-mandibular joint on the side of the fracture. This leads to facial asymmetry, malocclusion, and dys-function of the stomatognathic system. Unilat-eral fractures result in transverse malocclusions (laterogenia), bilateral – in skeletal open bites and skeletal distocclusions [6, 9, 10].
In 77% of cases, tooth injuries are associated with the enamel or dentin loss, so reconstruction is usually required [1]. Endodontic complications and periodontal lesions impede further treatment and increase the risk of failure [2].
Dentists watch over the proper development of a child’s stomatognathic system. Regardless of the specialty, they should be aware of the risks caused by the high physical activity of growing patients. Introduction of appropriate prevention may coun-teract the injury side effects. One of the most rec-ommended methods is the use of a mouthguard.
This appliance covers teeth and alveolar bone, thus reducing the number and severity of oral cav-ity damage [11].
The aim of the study was evaluation of the dentists’ attitudes towards the mouthguards used by young athletically-active patients.
Material and Methods
The study included 52 dentists practicing in public and private surgeries in Wrocław. The phy-sicians had different specialties. An original ques-tionnaire was created for the study. It included questions pertaining to the number of admitted patients under the age of 18, the number of oral cavity injury incidences and types of mouthguards recommended by the doctors. The respondents were also asked to express their opinion on oblig-atory mouthguard use by athletically-active chil-dren and youths.
The results were statistically analyzed using the Kruskal-Wallis test and Mann-Whitney U test. A p-value of < 0.05 was considered significant.
Results
48 (92%) of the surveyed dentists have experi-ence with oral cavity injuries in growing patients. 12 (23%) respondents had to deal with them more often than once a month. All those physicians recommended mouthguards to their athletical-ly-active patients. Among the physicians who en-countered injuries less than once a month (36 re-spondents – 69%), 22 advised the use of protec-tive appliances. Dentists who did not treat oral injuries in young patients (4 respondents – 8%) did not recommend mouthguards (Fig. 1). A to-tal of 34 surveyed physicians (65%) advised athlet-ically-active patients to wear protective dental de-vices. The statistical analysis has confirmed that there are significant correlations between the fre-quency of injuries encountered by the physician and their tendency to recommend mouthguards (p = 0.0009).
The most recommended appliances were cus-tom-made mouthguards (76%), performed
indi-rzadziej formowane w jamie ustnej (18%). Najindi-rzadziej są polecane szyny standardowe (6%). 81% ankietowanych uważa, że szyny ochronne noszone przez dzieci i młodzież aktywnie uprawiającą sport są konieczne do zachowania bezpieczeństwa pacjentów. 19% nie ma na ten temat zdania.
Wnioski. Większość stomatologów zachęca młodych pacjentów uprawiających sporty walki do noszenia szyn
ochronnych i uważa, że ich stosowanie powinno być obowiązkowe. Najczęściej jest polecany ochraniacz wykony-wany indywidualnie. Niezależnie od posiadanej specjalizacji lekarze powinni wdrażać odpowiednie metody zapo-biegawcze uszkodzeń twarzoczaszki (Dent. Med. Probl. 2014, 51, 3, 382–386).
vidually for patients by dentists cooperating with dental technicians. They were recommended by all respondents who encountered oral injuries more often than once a month and by 15 respondents who treated them less than once a month. “Boil and bite”-type mouthguards were recommended rare-ly (18% – 5 respondents). stock mouthguards were recommended the least frequently (6% – 2 resp- ondents). Both appliances were recommended by physicians who had to deal with oral injuries less than once a month. The results are shown in Fig. 2. The statistical analysis did not confirm a correlation between the frequency of injuries
en-countered by the physician and the type of recom-mended mouthguard (p > 0.05).
Dentists expressed their opinion on obligatory mouthguard use by athletically-active children and adolescents. The survey revealed that 81% of re-spondents considered it necessary. This represent-ed all physicians treating oral injuries more fre-quently than once a month, and 30 who dealt with them less than once a month. 19% of respondents had no view on the question (6 dentists who treat-ed injuries less than once a month and all dentists who did not encounter oral injuries). The results are presented in Fig. 3. The correlation between
Fig. 1. Mouthguard
recom-mendation depending on the frequency of encountered traumas
Ryc. 1. Polecanie szyn
w zależności od częstości spotykanych urazów
Fig. 2. Types of recommended
mouthguards depending on the frequency of encountered trau-mas
Ryc. 2. Rodzaje polecanych szyn
w zależności od częstości spoty-kanych urazów
Fig. 3. Dentists’ opinion on obligatory
mouthguard use depending on frequency of encountered traumas
Ryc. 3. Opinia lekarzy o konieczności
stosowania szyn w zależności od częstości spotykanych urazów
the frequency of injuries encountered by the re-spondents and their opinion on obligatory mouth-guard use is statistically significant (p = 0.0001).
Discussion
Prevention of tooth and alveolar process inju-ries is one of the dentists’ tasks. In this study, 92% of the physicians treated those types of injuries in their young patients. 23% of the respondents dealt with traumas more often than once a month. Being aware of the consequences, dentists should properly protect the developing stomatognathic system from harm. One of the methods is mouthguard use.
65% of the surveyed dentists recommended wearing mouthguards to young athletically-active patients. Onyeaso et al. [12] reported in their study that only 18% of Nigerian dentists recommend-ed this kind of protective appliances. According to Maestrello et al. [13], 71% of American den-tists from Virginia advised children and youths to use mouthguards during sport activities. This re-sult was comparable to ours. In the available liter-ature, there are no more studies evaluating den-tists’ awareness of oral trauma prevention.
Our study showed that all the dentists who dealt with oral injuries at least once a month recommend-ed mouthguards. Of the physicians who rarely treat-ed traumas in the oral cavity, only 61% recommend-ed appropriate prophylaxis. Moreover, dentists who did not encounter oral injuries in athletically-active patients did not recommend using mouthguards at all. Hence, patients are supplied with protective dental devices too late, often after trauma. A similar problem was noticed by Bolhuis et al. [14], who stud-ied a group of over 3500 Dutch hockey players. 96% of respondents who suffered an injury during the game became mouthguard users after the accident.
A mouthguard should meet a number of re-quirements to protect the user against the conse-quences of sustained trauma. First, it must be reg-ularly worn by the patient. A stable position in the mouth, durability, ease of speech and breathing, and lack of smell and taste increase the comfort, and thus the frequency of appliance use [15]. Three types of intraoral protective appliances are avail-able: a stock mouthguard, a “boil and bite” mouth-guard and a custom made mouthmouth-guard [16]. The first one is rarely recommended by sport den-tists due to its large size and insufficient retention. The “boil and bite” mouthguard – customized by the user after plasticizing it in hot water – usual-ly needs clenching for stabilization, which reduces wearing comfort. The custom-made mouthguards
are created by a dentist cooperating with a den-tal technician on the basis of the patient’s impres-sions. They are comfortable, durable, have good retention and do not restrict speech or breath-ing [17]. Users quickly adapt to these devices and they are willing to wear them, which guarantees effectiveness of protection [14].
The surveyed dentists mainly recommended custom-made mouthguards (70% of recommended devices), as with American practitioners from Vir-ginia (64% of the recommended ones). “Boil and bite” mouthguards were advised less often (24%), and stock mouthguards were the least frequently recommended ones (6%). In the studies of Mae-strello et al. [13], those two types of protective ap-pliances had the same level of recommendation (18% and 18%). These results have no reflection in reports evaluating the frequency of mouthguard use. According to Fakhruddin et al. [11], 30.4% of children aged 12–14 used custom-made mouth-guards, 48.2% wore “boil and bite” mouthmouth-guards, and 21.4% used stock mouthguards. slightly dif-ferent results were obtained by Mc Nutt et al. [18] evaluating high school students’ preferences. 10% of those surveyed wore custom-made mouthguards, 30% “boil and bite” mouthguards and 60% stock mouthguards. In both reports, prefabricated devic-es were more popular, although they are considered less effective than the custom-made ones [13].
The consequences of oral cavity damage and methods of its prevention are commonly known. For this reason, the vast majority of respondents (81%) agreed with the statement that the use of mouthguards by athletically-active children and adolescents should be mandatory. This opinion was shared by the majority of dentists surveyed by Mae-strello et al. [13] (66%) and Onyeasa et al. [12] (98%). 19% of our respondents had no opinion on the ques-tion. The study proved a high level of awareness re-garding the benefits of mouthguard use.
Our research shows a high level of awareness regarding the benefits of mouthguard use. Howev-er, not every practitioner recommends protective dental devices to children and adolescents who are exposed to oral cavity injuries. Physicians, regard-less of their specialty, should implement appropri-ate prevention against craniofacial damage.
Dentists ought to be encouraged to intensify their efforts in mouthguard popularization among young, athletically-active patients. This can re-duce the number of injuries and minimize their side effects.
Due to the small number of similar reports, further studies evaluating dentists’ awareness re-garding injury prevention should be continued.
References
[1] Manowska B., Arkuszewski P., Tyndorf M.: Review of post-traumatic injuries in patients who received ambu-latory emergency treatment. Czas. stomatol. 2009, 62, 134–140 [in Polish].
[2] Broniarek M., Bołtacz-Rzepkowska E.: Post-traumatic injuries of incisors with incomplete root formation – case report. Czas. stomatol. 2010, 63, 484–489 [in Polish].
[3] Agarwal s.M., Kambalimath D.H., singh M., Jain N., Michael P.: Maxillofacial injuries in children: a 10 year retrospective study. J. Maxillofac. Oral surg. 2013, 12, 140–144.
[4] Proffit W.: The orthodontic problem. Malocclusion and dentofacial deformity in contemporary society. [In:] Contemporary orthodontics. Eds.: Proffit W., Fields H., sarver D. Elsevier Urban & Partner, Wrocław 2009, 2nd
Ed., vol. 1, 3–17 [in Polish].
[5] Kawala B., szumielewicz M., Kozanecka A.: Are orthodontists still needed? Epidemiology of malocclusion among Polish children and teenagers in last 15 years. Dent. Med. Probl. 2009, 46, 273–278 [in Polish].
[6] Jurkiewicz-Ciurej B.: Mandibular condyle fractures in children and adolescents. Porad. stomatol. 2010, 10, 5, 158–163 [in Polish].
[7] Harkness E.M., Thorburn D.N.: Hemifacial microsomia label questioned. Angle Orthod. 1989, 60, 5–11. [8] Osmola K.: Viscerocranial fractures in a family physician practice. Forum Med. Rodz. 2007, 2, 159–164 [in Polish]. [9] Kalia V., singh A.P.: Greenstick fracture of the mandible: A case report. J. Indian soc. Pedod. Prev. Dent. 2008,
26, 32–35.
[10] Rampaso C.L., Mattioli T.M.F., Andrade sobrinho J., Rapoport A.: Evaluation of prevalence in the treatment of mandible condyle fractures. Rev. Col. Bras. Cir. 2012, 39, 373–376.
[11] Fakhruddin K.s., Lawrence H.P., Kenny D.J., Locker D.: Use of mouthguards among 12- to 14-year-old On-tario schoolchildren. J. Can. Dent. Assoc. 2007, 73, 505–510.
[12] Onyeaso C., Arowojolu M.O., Okoje V.N.: Nigerian dentists’ knowledge and attitudes towards mouthguard protection. Dent. Traumatol. 2004, 20, 187–191.
[13] Maestrello C.L., Mourino A.P., Farrington F.H.: Dentists’ attitudes towards mouthguard protection. Pediatr. Dent. 1999, 21, 340–346.
[14] Bolhuis J.H., Leurs J.M.M., Flögel G.E.: Dental and facial injuries in international field hockey. Br. J. sports Med. 1987, 21, 174–178.
[15] Powers J.M., Godwin W.C., Heintz W.D.: Mouth protectors and sports team dentists. Bureau of health education and audiovisual services, council on dental materials, instruments, and equipment. J. Am. Assoc. 1984, 109, 84–89. [16] Gawlak D., Łojszczyk R.: Materials and techniques used in manufacturing mouthguards. stomatol. Współcz.
2010, 17, 1, 8–14 [in Polish].
[17] Nowak T., Białkowska-Głowacka J., Grzesiak-Janas G., siciarz A.: Prevention of dental injury in athletes. Twój Prz. stomatol. 2008, 6, 74–80 [in Polish].
[18] McNutt T., shannon s.W. Jr, Wright J.T., Feinstein R.A.: Oral trauma in adolescent athletes: a study of mouth protectors. Pediatr. Dent. 1989, 11, 209–213.
Address for correspondence:
Michał Biały Nadbrzezna 26/2 57-550 stronie slaskie Poland
E-mail: michal.bialy@umed.wroc.pl Conflict of interest: None declared Received: 25.03.2014
Revised: 2.04.2014 Accepted: 17.05.2014
Praca wpłynęła do Redakcji: 25.03.2014 r. Po recenzji: 2.04.2014 r.
