More than 5 million teeth are avulsed each year; many during sports activities, resulting in nearly $500 million spent on replacing these teeth each year.1 In an issue of the Journal of the American Dental Association (JADA), it was reported that 13-39% of all dental injuries are sports-related, with 2-18% of the injuries related to the maxillofacial. Males are traumatized twice as often as females, with the maxillary central incisor being the most commonly injured tooth. Studies of orofacial injuries published over the last thirty years reflects various injury rates dependent on the sample size, the age of participants, and the specific sports.30-31 Even in football, a sport requiring protective gear, only about two-thirds of athletes are in compliance. In soccer, where rules are not uniform on wearing mouthguards, only 7% of the participants wear them.1 In baseball and softball, again only 7% wear mouthguards. Recent studies show basketball had the highest injury rate with both male and female students due to hand or elbow contact or by collision with other players. The close contact of basketball players, as well as the speed of the game increases the potential for possible orofacial trauma.37 Currently, the National Federation of State High School Associations mandates mouthguards for only four sports: football, ice hockey, lacrosse, and field hockey. Wrestlers are mandated if they have fixed orthodontics appliances (braces).32,55 However, many high school and college administrators continue to support mandatory protective equipment relating to many more high school contact sports.29 It is evident from past research studies there is a need for more research on the topic of sports dentistry. There is also a need to educate communities of interest including more regulations for mouthguard use in sports.
In 1962, high school and collegiate football players were required to wear faceguards and mouth protectors during practice sessions and in competition. Several studies confirm that since this requirement, the percentage of orofacial injuries in football has dropped from approximately 50% to one-half of 1%, depending on the study cited.
The American Academy of Pediatric Dentistry recommends a mouthguard for all children and youth participating in any organized sports activities. The American Dental Association (ADA)51 recommends wearing a mouthguard for all of the following sports:
|equestrian events||martial arts||surfing|
|field events||rugby||water polo|
|field hockey||shotputting||weight lifting|
A study conducted on high school varsity basketball teams in Florida assessed the benefit of mouthguard use in sports other than football. It was found that 31% of surveyed Florida varsity basketball players sustained orofacial injuries during the season. Fifty-three percent reported more than one injury during the season. Of the 1,020 players, fewer than half wore mouthguards and only 2 of these sustained oral injuries not requiring professional attention during the season.5 It was concluded by the authors that there is a high risk of orofacial injury competing in basketball without a mouthguard, which would increase a player’s chance of orofacial injury almost sevenfold.6 Soporowski and others found that of all the injuries presented to dental offices, 62% occurred while the patient was participating in an unorganized sport. Children between the ages of seven and ten have the highest number of injuries (59.6%). Baseball had the most injury sites, 72 of 159 injuries, biking followed with 59, and hockey and basketball were third and fourth respectively.7 Another study was conducted with 3,411 athletes. The highest incidence of orofacial injury for the male athletes was noted in wrestling and basketball. For females, it was basketball and field hockey. None of the athletes who sustained an injury was wearing a mouthguard.4
A study conducted on high school athletes, in which researchers interviewed 2,470 junior and senior high school football players, showed 9% of all athletes sustained some form of orofacial injury with 3% reporting loss of consciousness. Fifty-six percent of all concussions and 75% of all orofacial injuries occurred while the athlete refrained from mouthguard protection.4 In Alabama, a study on 754 football players revealed that 52% of all orofacial injuries occurred in sports other than organized football. Basketball and baseball continue to have the highest incidence of sports-related dental injuries with children 7-17 years old. Baseball has the highest incidence of trauma with 7-12 year old children and basketball injuries occur more frequently with children 13-17 years old.4,47 With non-organized sports, bicycles are the most common consumer sports product that contributes to dental injuries of children.47 Other recreational sports include skateboarding and roller or inline skating.29,47-50 Morrow and Kuebker conducted surveys in selected Texas high schools to determine the incidence of orofacial injuries on approximately 122,000 male and female athletes. They measured the types of mouthguards worn and dental injury experienced in football, and later indicated that soccer and basketball had higher dental injury rates than football. The number and nature of dental injuries experienced by male athletes showed that lip and tongue lacerations were the most frequently reported injuries. In addition, fourteen jaw fractures were reported with as many fractures in baseball and soccer as there were in football.8
All athletes constitute a population that is extremely susceptible to dental trauma. Dental injuries are the most common type of orofacial injury. An athlete has a 10% chance of receiving an orofacial injury every season of play. In addition, athletes have a 33-56% chance of receiving an orofacial injury during their playing career.