Page 116 - JSOM Fall 2020

An Ongoing Series

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

Part 2, Effectiveness of Mouthguard for Protection From Orofacial Injuries

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Joseph J. Knapik, ScD *; Blake L. Hoedebecke, DDS ; Timothy A. Mitchener, DMD, MPH 3
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ABSTRACT
This is second of a two-part series on the history and effec- and lower dentation, thus preventing tooth fractures; (2) redis-
tiveness of mouthguards (MGs) for protection from orofacial tributing and absorbing the force of direct blows to the mouth;
injuries. MGs are hypothesized to reduce orofacial injuries by and (3) separating teeth from soft tissue which helps prevent
separating the upper and lower dentation, preventing tooth lacerations and bruises.
fractures, redistributing and absorbing the force of direct
blows to the mouth, and separating teeth from soft tissue This is the second of a two-part series on MGs. Part 1 covered
which helps prevent lacerations and bruises. The single study the background and history of MG use in the US military and
on MG use in military training found that when boil-and-bite among athletes. In part 2, we discuss evidence for the effective-
MGs were required for four training activities, orofacial in- ness of MGs for the prevention of orofacial injuries in military
jury rates were reduced 56% compared with when MGs were training and sport activities.
required for just one training activity. A recent systematic re-
view on the effectiveness of MGs for prevention of orofacial Mouthguards in Military Training
injuries included 23 studies involving MG users and nonusers
and a wide variety of sports. For cohort studies that directly The only study on the effectiveness of MGs in military train-
collected injury data, the risk of an orofacial injury was 2.33 ing was conducted in 2000–2003 during basic training at Fort
times higher among MG nonusers (95% confidence interval, Leonard Wood, Missouri. The researchers found that when
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1.59–3.44). More well-designed studies are needed on the boil-and-bite MGs were required for one training activity
effectiveness of MGs during military training. Despite some (i.e., pugil stick exercises), the orofacial injury rate was 3.35
methodological limitations, the current data suggest that MGs cases/10,000 person-months. When MGs were required for
can substantially reduce the risk of orofacial injuries in sport four training activities (namely, pugil stick, rifle/bayonet, un-
activities. MGs should be used in activities where there is a armed combat, and confidence/obstacle course), orofacial in-
significant risk of orofacial injuries. jury rates were reduced to 1.90 cases/10,000 person-months, a
76% lower injury risk reduction (risk ratio [4 events/1 event] =
Keywords: mouthguards; orofacial injury; sports injuries; oral 1.76; 95% confidence interval [CI], 1.17–2.67). Unfortunately,
health. this study was not able to examine the incidence of orofacial
injuries when no MGs were provided. Nonetheless, results in-
dicated that when MGs were required for a greater number of
training activities, orofacial injuries were substantially reduced.
Introduction
Servicemembers participating in military operations, exercise, Mouthguards in Sports Activities
and sports activities, as well as civilians involved in sports
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and exercise activities 5–15 are at risk for injuries to the mouth Two systematic reviews with meta-analyses have been con-
and face (i.e., orofacial injuries). Mouthguards (MGs) have ducted on the effectiveness of MGs for the prevention of
been proposed to reduce this risk by (1) separating the upper orofacial injuries in sport activities. 17,18 In the latest review
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*Correspondence to joseph.j.knapik.ctr@mail.mil
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 Hoedebecke serves as 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 also
an assistant professor at Uniformed Services University. COL Mitchener has served in the US Army Dental Corps since 1991. He currently is as-
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signed to the 18th Medical Command (Deployment Support) out of FT Shafter, HI, as a public health dentist and is serving an oral-maxillofacial
injury epidemiologist with the US Army Institute of Surgical Research out of Joint Base San Antonio, TX.
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