Effectiveness of Mouthguards for the Prevention of Orofacial Injuries and Concussions in Sports: Systematic Review and Meta-Analysis

Knapik, Joseph J.; Hoedebecke, Blake L; Rogers, Georgia G.; Sharp, Marilyn A.

doi:10.1007/s40279-019-01121-w

Cited by 52 publications

(101 citation statements)

References 66 publications

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“…No dental injuries were reported in either cohort during the study period. These results are consistent with the findings of a recent systematic review indicating that mouthguards significantly reduce the risk of orofacial injuries 44. Dental injuries have previously been identified as prevalent in European ice hockey players of all ages—a population where mouthguard use is low 44…”

Section: Discussionsupporting

confidence: 90%

“…Mouthguards may attenuate force transmission following a blow to the jaw and reduce mandibular deformation 41–43. Arguing against these mechanisms, Viano et al found no difference in head injury criterion score using an instrumented artificial mandible skull model with and without a mouthguard in place 44. More biomechanical modelling research is necessary to better inform the mechanism of mouthguard protection of concussion.…”

Section: Discussionmentioning

confidence: 99%

“…In any case, if present, over-reporting of mouthguard use among concussion cases and non-differential misclassification of mouthguard use among cases and controls would have underestimated the protective effect we found. While some argue protective equipment use may alter risk tolerance among wearers, this would likely have had a similar effect on the concussion case group, and the non-concussed, but still injured control group 44. Finally, proper mouthguard fit and mouthguard quality were not assessed at time of injury or at baseline.…”

Section: Discussionmentioning

confidence: 99%

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Mouthguard use in youth ice hockey and the risk of concussion: nested case–control study of 315 cases

et al. 2020

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BackgroundConcussion is the most common injury in youth ice hockey. Whether mouthguard use lowers the odds of concussion remains an unanswered question.ObjectiveTo determine the association between concussion and mouthguard use in youth ice hockey.MethodsNested case–control design. Cases and controls were identified from two prospective cohort studies using valid injury surveillance methods. Cases were players concussed during a game or practice; controls were players who sustained a non-concussion injury during a game or practice. The primary exposure was mouthguard use at time of injury; mouthguard type (dental custom fit or off the shelf) was a secondary exposure. Physician-diagnosed or therapist-suspected concussion was the primary outcome. Dental injury was a secondary outcome. Multilevel logistic regression with random effect at a team level was used to obtain ORs for the mouthguard effect, adjusted for level of play, age group, position, concussion history, mechanism of injury, cohort, session type and body checking policy.ResultsAmong cases, 236/315 (75%) were wearing a mouthguard at time of injury, while 224/270 (83%) controls were wearing a mouthguard at time of injury. Any mouthguard use was associated with an adjusted OR for concussion of 0.36 (95% CI 0.17 to 0.73). Off-the-shelf mouthguards were associated with a 69% lower odds of concussion (adjusted OR: 0.31; 95% CI 0.14 to 0.65). Dental custom-fit mouthguards were associated with a non-significant 49% lower odds of concussion (adjusted OR: 0.51; 95% CI 0.22 to 1.10). No dental injuries were identified in either cohort.ConclusionMouthguard use was associated with lower odds of concussion. Players should be required to wear mouthguards in youth ice hockey.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Mouthguard use in youth ice hockey and the risk of concussion: nested case–control study of 315 cases

et al. 2020

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“…Reasons for exclusion are described in Table . Finally, 19 studies 10‐12,16‐31 were included in this overview (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

Associations and risk factors for dental trauma: A systematic review of systematic reviews

Magno

Nadelman

Leite

et al. 2020

Comm Dent Oral Epid

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Objective We sought to revise, qualify and summarize the body of evidence based on current information on the known associations and risk factors for traumatic dental injury (TDI) occurrence with an overview of systematic reviews. Methods Electronic searches were performed with no language nor date restrictions.According to the PECO strategy, systematic reviews that investigated participants (P) with (E) and without (O) the presentation of factors relating to TDI and these factors’ association with TDI episodes (O) as primary or secondary outcomes were included. Quality assessment and bias control were carried out according to the AMSTAR 2 checklist. In cases of systematic review results of discordance, the Jadad decision algorithm was applied. Results After titles, abstracts and full texts were read, 19 systematic reviews were included in this overview. Four were classified with critically low, eleven with low and four with moderate methodological quality, respectively. In all studies, 249 cross‐sectional, 34 epidemiological surveys, 22 cohort, 9 case‐control, 4 longitudinal, 3 ecological and 30 unspecified studies were included. Male gender, child age, greater overjet, inadequate lip coverage, anterior open bite, caries in the permanent dentition, overweight, a previous history of TDI, tongue piercing, the use of alcoholic beverages and participation in sports were all associated with a greater chance of suffering TDI. Conclusions Sociodemographic, clinical and environmental factors are associated with a greater chance of TDI occurrence. However, most of the systematic reviews included were of a low quality and may not provide an accurate and comprehensive summary of the available research that addresses the question of interest. Well‐designed primary studies on different aspects of TDI are encouraged to provide higher quality scientific evidence.

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“…That correlation is reported in other systematic reviews that have shown the association between dental trauma and the use of this protective device. 46,50 Although the studies included in this review reported the prevalence of injuries generally, it was not possible to analyze the prevalence of injuries by gender. However, a recent review showed that males are more likely to experience sports-related traumatic injuries than females 5 but women suffered injuries that resulted in surgery more often.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of dentofacial injuries in contact sports players: A systematic review and meta‐analysis

Werlich

Honnef

Bett

et al. 2020

Dental Traumatology

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Backgrounds/Aims Contact sports present intense physical contact, and usually, players have a high risk for dentofacial injuries. It is unclear how often these injuries occur and which contact sports present the highest rates. The aim of this study was to assess the prevalence of dentofacial injuries among contact sports participants. Methods A literature search was performed in seven electronic databases (Embase, LILACS, LIVIVO, PubMed, Scopus, SportDiscus, and Web of Science). The gray literature (Google Scholar, OpenGrey, and ProQuest), as well as the reference lists of included studies, was assessed. Experts were consulted to indicate additional studies. The eligible studies were observational studies that contained details of the contact sports participants who were aged over 18 years old, either professional or not, who sustained at least one dentofacial injury in the past, the number of sustained injuries, and studies which provided quantitative data on the characteristics of the dentofacial injuries, such as type and site. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. Results Among 1152 identified studies, 17 articles remained for final analysis. One study was classified as high risk of bias, 14 studies as moderate, and two as low risk. The overall prevalence of dentofacial injuries was 27.57% (95% CI: 17.87‐38.47). The prevalence in each sport was rugby 37.36% (95% CI: 17.45‐59.82), basketball 27.26% (95% CI: 9.45‐50.08), handball 24.59% (95% CI: 14.88‐35.83), and field hockey 19.07% (95% CI: 6.82‐35.62). The most common injury was dental injury 19.61% (95% CI: 8.13‐34.56). Conclusion The overall prevalence of dentofacial injuries among collective contact sports participants was approximately 30%. The most common injury presented was dental injury.

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Effectiveness of Mouthguards for the Prevention of Orofacial Injuries and Concussions in Sports: Systematic Review and Meta-Analysis

Cited by 52 publications

References 66 publications

Mouthguard use in youth ice hockey and the risk of concussion: nested case–control study of 315 cases

Mouthguard use in youth ice hockey and the risk of concussion: nested case–control study of 315 cases

Associations and risk factors for dental trauma: A systematic review of systematic reviews

Prevalence of dentofacial injuries in contact sports players: A systematic review and meta‐analysis

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