Mandating mouthguards

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mandatory mouthguard policies
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Publicity around administrative changes being introduced in children’s sport has led the ADA to renew its call for mandatory mouthguard policies to help protect participants against dental injuries. By Tracey Porter

The wellbeing of children is set to be made a priority in NSW with the state’s rugby league authority announcing a number of radical rule changes.

Among the changes, which will come into effect on a rolling basis from 2023 onwards, is a ban on all tackling for those playing in the under-six competition and an increase in the non-competitive age from nine to 13 by 2026.

The changes, which are already in place in some other states, are being introduced in an attempt to increase junior participation numbers and protect children from external pressure. They come amid growing concerns about the long-term impact of contact sports.

Yet while it’s the threat of head concussions and potential brain injury that draws most of the attention when it comes to contact sports, the risk of dental injuries, including soft tissue injuries of the lips and mouth, and hard tissue injuries such as tooth loss and jaw fractures are equally concerning.

Each year the Australian Dental Association (ADA) collects data from parents through an annual national survey, part of which looks at the issue of children who have suffered damage to their teeth while playing sport.

In 2021, the survey found that 32 per cent of children had suffered damage to their teeth as a result of a fall, bump or other incident—around a quarter of which were injuries sustained while playing sport.

Similarly, a 2020 review of child traumatic dental injuries that presented to the pediatric emergency department in an Adelaide children’s hospital found that males more commonly present with injuries. 

“The predominance of males in school-age and adolescent groups is believed to be attributed to participation in more dangerous or aggressive games and contact sports,” the review noted.

However, according to the ADA, the real number of those who endure dental injuries as a result of sports participation could be much higher. The ADA says this is because over 85 per cent of dental care is provided in private dental clinics. Should Australians with sport-related dental injuries present to a private dental practice for treatment, this may act as a data collection barrier, it says.

The ADA says such injuries can impact significantly on appearance, eating and drinking, and speech. If not attended to quickly enough, they can result in tooth loss or severe injury, causing lost productivity, pain and suffering, and a loss of self-esteem.

A systematic review undertaken in 2018 determined that mouthguards—whether single layer, dual layer or a dual layer mouthguard with hard insert-style—are very effective in preventing dental and facial injuries in sport. 

Dental injuries can result in time off school or work to recover, can be painful, and may involve lengthy and complex dental treatment. In cases of injury associated with sport, the cost of an injury to the teeth or jaw far exceeds the cost of a custom-made mouthguard.

Dr Mikaela Chinotti, oral health promoter, ADA

The same review found there was no impact on athletic performance. 

The ADA has long been advocating for mandatory mouthguard policies, some of which are not even implemented for professional athletes.

Dr Mikaela Chinotti, the ADA’s oral health promoter, says sports during which the use of mouthguards is strongly recommended by the ADA include off-road bike riding, skateboarding, rock climbing, white-water rafting, trampolining, combat sports, football, basketball, squash and field hockey. 

Sports during which oral protective equipment is not normally worn but where mouthguard use could be justified under certain circumstances and are advocated by the ADA include high diving, surfboarding and skiing.

Dr Chinotti says as well as dissipating forces to the upper and lower jaws, jaw joints and skull, the purpose of a sports mouthguard is to reduce the stresses and absorb the energy generated by impact to the teeth to prevent or minimise consequent injury to the teeth and associated structures while participating in sporting activities. 

She says the benefits of wearing a sports mouthguard include reducing the risk or injury to the maxillary and mandibular anterior teeth and/or to the posterior teeth of either jaw following a traumatic closure of the mandible; intraoral and perioral lacerations; tongue damage at impact; fracture of the body of the mandible and the mandibular condyles; and/or damage to the temporomandibular joint. 

But there is a clear difference between mouthguards purchased off the shelf (which typically retail for between $15 and $60), and those that have been custom made by a dental professional (which can cost several hundred dollars), she says.

The ADA survey showed that while 32 per cent of children use a mouthguard for playing contact sports (an increase of only four per cent over eight years), the vast majority, 69 per cent, are store bought and 26 per cent are custom-made by a dentist.

In addition, three per cent of respondents who answered ‘other’ on the mouthguard source question said their child’s mouthguard was provided by either a sports organising body (team, school, local sporting association), handed down from a sibling, or included as a free gift with the purchase of football boots or other sporting equipment.

Dr Chinotti says upper jaw mouthguards that are custom-fitted by a dental professional are not only cost-effective but also a proven way of minimising damage to the teeth and face.

This is because they offer a precision fit and typically use better quality materials. Mouth-formed and stock mouthguards have disadvantages with respect to possible lack of retention, single-tooth contact, inadequate thickness, lack of retention and often rapid material deterioration with a consequent risk of injury, she says.

“Dental injuries can result in time off school or work to recover, can be painful, and may involve lengthy and complex dental treatment. In cases of injury associated with sport, the cost of an injury to the teeth or jaw far exceeds the cost of a custom-made mouthguard.”  

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