Evaluation of Level of Awareness and Perception among Sports Instructors Regarding Usage of Mouthguards in South Chennai Region: A Cross-sectional Study

INTRODUCTION

Sports are becoming a vital part of an individual’s lifestyle due to their increasing benefits on health. However, participating in sports increases the risk of accidents by 6 times compared to work-related accidents and by 3 times compared to driving accidents.¹ Sports-related trauma is a serious public health concern due to its high frequency, high cost of care, lengthy recovery period, and psychological effects.² The British Dental Association (BDA) recommends the use of a well-made mouthguard for anyone engaged in contact sports and the International Academy of Sports Dentistry (IASD) recommends that mouthguards should be used in 29 sports and exercise activities.^3,4 It has been demonstrated that wearing mouthguards reduces the chance of suffering injuries to the hard and soft tissues of the face by offering a strong, protective surface that distributes and dissipates transmitted stresses upon impact.⁵

A mouthguard, also known as a gumshield, mouth protector, or sports guard, has been defined as “a resilient device or appliance placed inside the mouth (or inside and outside), to reduce mouth injuries, particularly to teeth and surrounding structures.”⁶ Mouthguards are typically made for the maxillary arch, but mandibular and bimaxillary mouthguards have also been described.^7–9 They are of three types namely, Stock, boil, and bite, and custom-made mouthguards.

According to Levin et al., while 27% of research participants were aware that mouthguards were necessary, just 3% of them actively wore them.¹⁰ The most commonly mentioned obstacles to using a mouthguard during practice, according to a study by Aljohani et al. in Saudi Arabia, were difficulties utilizing it during practice, not understanding its significance, and lack of awareness of its availability.¹¹ Therefore, the purpose of the present cross-sectional study was to evaluate awareness and perception among sports instructors for the usage of mouthguards in South Chennai.

MATERIALS AND METHODS

This cross-sectional study assessed the awareness and perception of mouthguards among sports instructors regarding the usage of mouthguard in South Chennai. The study population comprised all active sports instructors from South Chennai. The study was carried out between 2 March 2023 and 30 April 2023, for around 
3 months. Everyone who participated in the study gave their prior consent. The study received ethical clearance from the Sathyabama University Dental College Ethics Committee.

RESULTS

A total of 47 sports instructors participated in this cross-sectional survey, of which 35–44-year-old males were higher in number than other age-groups and females. Majority of the instructors had a bachelor’s degree and more than 5 years of experience. However, it was found that there were no statistically significant differences seen between the socio-demographic variables and their awareness level of mouthguards (p > 0.05) (Table 1).

There were statistically significant differences seen on the awareness level on mouthguards between the kinds of sports they teach. Similarly, those participants who were already aware of the appliance called the mouthguard also showed significant differences in their awareness level of the mouthguard (p < 0.05) (Table 2).

DISCUSSION

Despite efforts in reducing the number of dental trauma, most current studies indicate that the incidence of dental trauma remains unchanged and is at a relatively high level for children and young adults.¹² Of all childhood dental injuries, 10–38% are related to sports-related incidents.¹³ The likelihood of orofacial trauma from contact or collision with sports equipment (bats, balls, and sticks), other competitors’ bodies, and playing surfaces increases with the thousands of hours that athletes spend training and competing.¹⁴ Orofacial protectors could prevent injuries around the mouth, which account for 50% of all sports-related injuries, according to the American Dental Association (ADA).¹⁵ Hence, the objective of the study was to assess the awareness and perception among sports instructors.

In this current survey, among 47 sports instructors, only 76.6% (36 instructors) were aware of the mouthguards. Furthermore, they were instructors of contact sports (88.8%) who recommend the usage of a stock mouthguard in their academy (69.4%) (Fig. 1). 
Nonetheless, according to Guérard et al., the customized mouthguard offers better protection because the stock mouthguard may become misaligned during use and interfere with its capacity to absorb impacts from the outside.¹⁶ Moreover, the American Society for Testing and Materials (ASTM) recommends custom-fabricated mouthguards for maximum protection, cushioning, and retention, which cover all teeth in at least one arch, customarily the maxillary arch, less the third molar.¹⁷

About 33% of sports instructors recommended wearing mouthguards during all levels of tournaments (Fig. 2). On the contrary, mouthguards are not typically worn by athletes during practice or competition. This is most likely because, as this study and earlier research have shown, athletes’ and sports instructors’ inadequate knowledge.^18–21

We also observed that the awareness of mouthguards among the sports instructors during the training is significantly higher (76.6%) but the usage of mouthguards is minimal (56%). Despite the awareness of mouthguards, 40.4% of sports instructors did not recommend the usage of mouthguards for various reasons such as interference with breathing, improper fit, uncomfortable, difficulty to wear or not being economical. This is similar to our study conducted by Neeraja et al., however, the reasons stated were, that 40% of the athletes refrained from using the appliance due to the lack of availability, whereas 27% due to the lack of proper fitting of the appliance, 10% due to the difficulty in swallowing, and 8% had difficulty in speech (Fig. 3).²² Among 40.4% of sports instructors who did not recommend mouthguard usage, 9% had a misconception that mouthguard negatively influences the performance of athletes (Fig. 4), which is in concordance with a questionnaire study conducted by Di Leone et al.²³

It was observed that 55.3% of the instructors think it is essential for a dental surgeon to be part of the team. As 68.1% of sports instructors demonstrated interest in acquiring more information about the appliance, dental professionals must be educated regarding the availability and usage of mouthguards (Table 3).

CONCLUSION

The results showed that the majority of sports instructors in the South Chennai region are aware of mouthguards but do not recommend their usage at all times. To raise knowledge about mouthguard availability and place an emphasis on oral trauma prevention, a multidisciplinary team made up of pediatric dental surgeons, sports physicians, and sports instructors is needed.

ORCID

Sumaiyya Saleem https://orcid.org/0000-0002-4890-6667

Vishnu Rekha Chamarthi https://orcid.org/0000-0002-3623-770X

Santhosh Priya Appiya Krishnan Ramnath Babu https://orcid.org/0000-0003-0887-8507

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