An Investigation into Player Compliance and Level of Protection Afforded by Mouthguards worn by Children Playing Sport in Ireland

Abstract

Background: Dental trauma is a significant global public health issue, affecting 1 billion people worldwide. Up to 40% of dental injuries are sports related and preventable through the use of mouthguards. In Ireland, the Gaelic Athletic Association (GAA) introduced rules requiring the use of ?properly fitted? mouthguards by players of all levels in 2014. Aims: This study aimed to investigate compliance with GAA mouthguard rules among children playing Gaelic football in Ireland, and to establish the types and quality of mouthguards being worn. Knowledge, attitudes and behaviours of children and parents on dental trauma and mouthguard use were investigated. Materials and methods: An observational cross-sectional cohort study was carried out using a convenience sample of 9-16-year-old boys and girls and their parents recruited from 4 Gaelic football teams from across Dublin city. Child and parent knowledge and attitudes regarding mouthguard use were established using questionnaires. Trained calibrated examiners examined the children?s dentition and mouthguards. Data were analysed using descriptive statistics, binary logistic regression analysis, and linear regression analysis. Results: One hundred and twenty-one children with 118 parents participated in the study. The median age of the sample was 12 years (interquartile range = 10-13) and there were slightly more males (56.67%) than females (43.33%). It was a highly active population with most children playing multiple sports. There was poor agreement between child (17.5%) and parent (6.84%) reports of past dental trauma and dentist-observed signs of dental injury (11.66%). Mouthguard use was greater for Gaelic football matches (99.17%) than for training (80.8%); binary logistic regression analysis concluded that older children are less likely to comply with mouthguard rules for training (OR = 0.18, p < .001). Most children were only wearing their mouthguard for Gaelic football. Most children (N = 87, 72.50%) reported that they liked their MG with few reported difficulties with wear (e.g. breathing, ability to speak). Knowledge of both parents and children regarding mouthguard hygiene was poor. Parents were willing to pay a median price of ?35.00 (IQR = ?20.00 - ?50.00) for a custom mouthguard. Mouth-formed mouthguards were the most popular type in this study; only 4 children (3.77%) had custom mouthguards. Most mouthguards (>80%) had inadequate retention and labial extension. Mean labial and occlusal thicknesses were greater than those recommended in the literature. Mouth-formed mouthguards were significantly thicker than both stock and custom mouthguards. Conclusion: Mouthguards are routinely worn by children playing Gaelic football, with greater compliance during competition than during training. Compliance with mouthguard rules during training reduced as children grew older. Children and parents displayed favourable attitudes towards the use of mouthguards, though knowledge of hygiene measures was lacking. Most children were wearing mouth-formed mouthguards with poor retention and inadequate labial extension. The quality and fit of the majority of mouthguards worn by children in this study was poor. There is a need for dentists to liaise with GAA clubs, players and parents to educate them on what constitutes a properly fitted mouthguard and how to care for these devices.