Page 141 - JSOM Summer 2020

An Ongoing Series

Mouthguards for the Prevention of
Orofacial Injuries in Military and Sports Activities

Part 1: History of Mouthguard Use

Joseph J. Knapik, ScD *; Blake L. Hoedebecke, DDS ; Timothy A. Mitchener, DMD, MPH 3
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ABSTRACT
This is the first of a two-part series on the history and effec- that included all inpatient and outpatient oral-maxillofacial
tiveness of mouthguards (MGs) for orofacial injury protection. injuries across the entire US military showed that in the 2000–
Military studies have shown that approximately 60% of oro- 2005 period, injury rates ranged from 110 to 150/10,000 per-
facial injuries are associated with military training activities son-years. A structured interview of 311 paratroopers in the
and 20% to 30% with sports. MGs are hypothesized to reduce Israel Defense Force revealed that 28% had experienced inju-
orofacial injuries by separating the upper and lower dentation, ries in the orofacial region, with 59% of these due to military
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preventing tooth fractures, redistributing and absorbing the training and 30% due to sport activities. Among Israeli Spe-
force of direct blows to the mouth, and separating teeth from cial Forces soldiers, 27% reported an orofacial injury; 58%
soft tissue, preventing lacerations and bruises. In 1975, CPT of those were injuries attributed to military training or oper-
Leonard Barber was the first to advocate MGs for military ations and 29% ascribed to sports. In contrast to sports and
sports activities. In 1998, Army health promotion campaigns military training, during recent combat operations, the causes
promoted MG education and fabrication. A US Army basic of injuries to the oral-maxillofacial region were primarily due
training study in 2000–2003 showed that more MG use could to explosives and ballistics. 4,5
reduce orofacial injuries and the Army Training and Doctrine
Command subsequently required that basic trainees be issued In the civilian sector, many orofacial injuries are attributed to
and use MGs. Army Regulation 600-63 currently directs com- sport activities. According to a US Surgeon General’s report on
manders to enforce MG use during training and sports activi- oral health, sports accounted for up to one-third of all cranio-
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ties that could involve orofacial injuries. In the civilian sector, facial injuries. The incidence of orofacial injury in sports has
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MGs were first used by boxers and then were required for been widely reported, but there are considerable differences
football. MGs are currently required nationally for high school among studies with regard to injury case definitions, level of
and college football, field hockey, ice hockey, and lacrosse, and play, populations examined, methods of data collection, time
are recommended for 29 sport and exercise activities. over which injury data were collected, and sports investigated.
Retrospective surveys of various groups of athletes have
Keywords: dental health; dental injury; maxillofacial injury; shown that 10% to 70% of respondents report having expe-
mouthguards; orofacial injury rienced at least one orofacial injury during participation in
sports. 8–16 . Orofacial injuries can have considerable, long-term
functional, psychological, and financial consequences.
Introduction
Since the early 20th century, mouthguards (MGs) have been
Servicemembers participating in military operations, exercise, promoted as a way to reduce the incidence of orofacial in-
and sports activities are exposed to risk of orofacial injury. juries. 17–19 The American Society for Testing and Materials
A 1975 study involving 16 Army posts found a “accidental defines a MG as “a resilient device or appliance placed in-
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dentofacial” injury rate of 38 cases/10,000 person-years, with side the mouth (or inside and outside), to reduce mouth inju-
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20% of injuries due to sport activities. More recently, a survey ries, particularly to teeth and surrounding structures.” An
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*Correspondence to joseph.knapik@JSOMonline.org
1 MAJ (Ret) Knapik served in the US Military as a wheel vehicle mechanic, medic, Medical Service Corps officer, and Department of Defense civil-
ian. He is currently a senior epidemiologist/research physiologist with the Henry M. Jackson Foundation and an adjunct professor at Uniformed
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Services University, Bethesda, MD; and Bond University, Robina, Australia. MAJ Blake Hoedebecke is a dental officer in the US Air Force as
a periodontist. He is currently a staff member of the Advanced Education in General Dentistry residency at Nellis AFB, Las Vegas, NV. He is
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also an assistant professor at Uniformed Services University. COL Timothy Mitchener has served in the US Army Dental Corps since 1991. He
currently is assigned to the 18th Medical Command (Deployment Support) out of FT Shafter, HI, as a public health dentist and is serving as an
oral-maxillofacial injury epidemiologist with the US Army Institute of Surgical Research out of Joint Base San Antonio, TX.
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