Mouthguards: Do they reduce dental trauma in contact sports?

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The use of mouthguards to prevent injuries to the mouth during sporting activity has been recommended by the American Dental Association since the 1950s. Adoption of mouthguard use has been higher is some areas that others and reasons for non-use include, breathing and speech difficulty, dry mouth, nausea and cost.  Stock , self-adapted and dentist fabricated mouthguards are available and design and material used are considered to have an impact on their efficacy.

The aim of this review was to assess whether the use of mouthguards reduces the prevalence of injuries among contact sports athletes.

Methods

Searches were conducted in the Medline, Scopus, Web of Science, Lilacs, Cochrane Library, and SIGLE without restriction of language or publication date. Observational studies providing information on the prevalence of dento-alveolar injuries in athletes who used and who did not use mouthguards were considered. Two reviewers independently selected studies extracted data and assessed methodological quality. Disagreements were resolved by a third reviewer.

The odds of dental trauma in the groups wearing and not wearing mouth guards and odd ratios (OR) and 95% confidence intervals (CI) were calculated. Two random effects meta-analysis were calculated one for studies classified as “free of problems” or “with minor problems, the second included only studies free of problems.  The quality of the overall evidence was assessed using the GRADE approach.

Results

  • 14 cross-sectional studies were included.
  • 11 studies contributed to the two meta-analysis
  • A total of 4375 (2359 mouthguard, 2016 no mouthguard) participants from 8 studies were included in the minor problems meta-analysis.   7.75% (183) mouthguard users suffered dental trauma compared with 48.31% (974) of non-users, OR = 0.18 (95%CI; 0.07 to 0.45).
  • 3 studies involving a total of 3397 (2136 mouthguard, 1261 no mouthguard) participants contributed to the ‘no problems studies’ meta-analysis.  7.5% (160) mouthguard users suffered dental trauma compared with 59.48% (750) of non-users, OR = 0.07 (95%CI; 0.05 to 0.08).

Conclusions

The authors concluded: –

There is association between the prevalence of dental trauma and mouthguard use. Despite some studies with a high risk of bias being included in this systematic review, the results endorse that mouthguards should continue to be recommended and used in sport activities with a high risk of dental trauma. This result should guide sports committees, public authorities, and sports practitioners regarding the importance and necessity of using mouthguards.

Comments

All the studies included in this review are observational with many collecting data using questionnaires. While a quality assessment of the included studies was used and the authors have conducted two analysis based on the assessed quality of the studies the potential for bias in the available evidence should be considered when assessing the findings.  The findings do suggest a beneficial effect from mouthguard use.  While a number of different types of mouthguards and a range of materials are available there was not sufficient information to assess whether this had any influence on the prevalence of trauma.  There was also limited information in relation to their use in different sporting disciplines. Additional studies to clarify the impact of their use and the most effective materials and designs would be helpful.

Links

Primary Paper

Fernandes LM, Neto JCL, Lima TFR, Magno MB, Santiago BM, Cavalcanti YW, de Almeida LFD. The use of mouthguards and prevalence of dento-alveolar trauma among athletes: A systematic review and meta-analysis. Dent Traumatol. 2018 Sep 17.doi: 10.1111/edt.12441. [Epub ahead of print] PubMed PMID: 30222244.

Original review protocol on PROSPERO

Other references

 Dental Elf – 22nd Jun 2018

 

Mouthguards: Do they affect athletic performance?

 

 

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Derek Richards

Derek Richards is the Director of the Centre for Evidence-based Dentistry, Editor of the Evidence-based Dentistry Journal, Consultant in Dental Public Health with Forth Valley Health Board and Honorary Senior Lecturer at Dundee & Glasgow Dental Schools. He helped to establish both the Centre for Evidence-based Dentistry and the Evidence-based Dentistry Journal. He has been involved with teaching EBD and a wide range of evidence-based initiatives both nationally and internationally since 1994.

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