The Bureau of Dental Health Education and the Bureau of Economic Research and Statistics, 1964, found that prior to the advent of the face guard, about one half of all injuries of football players were in and around the oral cavity. Since the wearing of the face guard has become mandatory, injuries in and around the mouth have been reduced about 50%.

Stenger et al., 1964, Heintz, 1968, Turner, 1977, Hargreaves et al., 1981, and; Josell and Abrams, 1982, reported that the incidence of orofacial injuries has fallen from 2.26%, before mandatory face guard and mouthguard legislation, to 1.20%, with the use of face guards, and from 0.29% to 0.63%, with the addition of mouthguards. Face guards have reduced the number of dental injuries by almost half; mouthguards have virtually eliminated the remainder of injuries.

Hickey et al., 1967, studied the relation of mouthguards to cranial pressure and deformation in a survey of 116 National Hockey League players. They found that 66% had lost anterior teeth as a direct result of hockey injury.

Moreover, Heintz, 1968, added that with mouthguards there were estimated 25,000 to 50,000 fewer injuries during the 1967 football season.

Clegg, 1969, noted 33% of rugby league players had at some time in their playing career fractured teeth or lacerated the peri-oral soft tissues. He noted that after wearing of the mouthguards there were no further broken teeth and the incidence of fractured jaws was reduced.   

 McDonald and Avery, 1978, and Hargreaves et al., 1981, found that in Hockey leagues; in Toronto, Canada, where using mouthguards was obligatory, there has been a significant reduction in the incidence of tooth injuries. One league, involving 7000 players, reported only two oral injuries in the entire season.

          Bureau of Health Education and Audiovisual Services, and Council on Dental Materials, Instruments, and Equipment, 1984, found that face guards and mouthguards prevent more that 200,000 orofacial injuries in football alone annually.

Garon et al., 1986, observed that despite the reported reduction of oral injuries related to football and ice hockey, other sports continued to have a potential for oral trauma. Baseball and basketball have been reported to have a significant potential for producing to hard and soft oral tissues. They also found that of the 754 players surveyed, 93 (12%) reported oral injuries and 29 (4%) reported concussion while participating in various sports. Sixty-three of the traumatic injuries and 14 of the concussions, or 63% of the total traumatic injuries, occurred while the players were not wearing mouthguards. They found oral trauma in: American football, unorganized American football, baseball, basketball, swimming, ice hockey, wrestling, bicycling, boxing, volleyball, surfing, motocross and water skiing. They found concussions in American football, unorganized American football, baseball, bicycling, motocross, wrestling and water skiing. They found that 52% of all orofacial injuries and 38% of concussions were reported in sports other than football. The authors concluded that the use of mouthguards should be used in sports other than football, especially baseball and basketball.

Sane and Ylipaavalniemi, 1987, studied the maxillofacial and dental soccer injuries in Finland and concluded that maxillofacial and dental traumas account for 6% of all soccer injuries.

          McNutt et al. 1989, conducted a study of high-school athletes in which they interviewed 2470 junior and senior high-school football players. The results indicated that 9% of all athletes sustained some form of orofacial injury and 3% reported a loss of consciousness. Also they found that 56% of all concussions and 75% of all orofacial injuries occurred while the athletes were not wearing the mouthguards. They also stated that mouthguards should be mandatory in baseball and basketball as they had found that 40% of orofacial injuries occurred in these two games.                              

          Maesterllo-de Moya and Primosch, 1989, surveyed high-school basketball players in Florida to determine the prevalence of orofacial injuries and correlated them with the effectiveness of mouthguards. They reported that 43 (4.2%) were wearing mouthguards. Players who used mouthguards sustained only two injuries, and these injuries involved cuts to the oral tissues and did not require professional attention. On the other hand, 32% of the athletes who were not wearing mouthguards were reported to have been injured. The authors finally concluded that there is a high risk of orofacial injury in basketball and that not wearing of a mouthguard while competing increases the player’s chance of orofacial injury about seven times.

Castaldi, 1991, revealed that dental injuries are not prevented by facemasks, as these do not stop the hockey stick from penetrating the wire mesh.

Schmidt et al., 1991, studied injuries among young soccer players. They found that head and facial injuries constituted 11.3% of the total body injuries.

Lee-Knight et al., 1992, found that the highest incidence of orofacial injury for the male athletes was noted in wrestling and basketball. For the female athletes, the highest incidence of orofacial injuries occurred in basketball and field hockey. None of the athletes was wearing a mouthguard.

          Persson and Kiliaridis, 1994, found that wrestling was associated with increased risk of dental trauma to the frontal region of the maxilla. They concluded that the injuries seen in this study could probably have been avoided if a well-fitting mouthguard had been used.

Douglas and Rempas, 1994, recommended that mouthguards should be made available to all horse riders, especially young and inexperienced ones.

          Flanders and Bhat, 1995, conducted a pilot study of all injuries occurring in football and basketball in selected Illinois high schools. The data indicated that the rate of orofacial injuries during competition and practice in football was 1.4 injuries per 10.000 athletic exposures.

Kujala et al., 1995, studied acute injuries in soccer, ice hockey, volleyball, basketball, judo, and karate and found that fractures and dental injuries were most common in ice hockey and karate and least frequent in volleyball. They concluded that in ice hockey and many other sports mouthguards would substantially reduce dental injuries and should be designed according to the characteristics of each sport. They found that to prevent dental injuries the wearing of mouthguards should be encouraged, especially in ice hockey, karate, and basketball.

Kumamoto et al., 1997, concluded that mouthguards should be worn when playing basketball, either recreationally or competitively. They found the mouthguard might prevent teeth from becoming entangled in the basketball net.

Yamada et al., 1998, studied oral injury and mouthguard usage by athletes in Japan. They investigated oral injuries and awareness concerning mouthguards among Japanese high school soccer and rugby players. They found that the incidence of oral injuries was 32.3% for soccer athletes and 56.5% for rugby athletes, with 0.8% and 24.1% of the respective groups having mouthguards.

          Benson et al., 1999, studied head and neck injuries among ice hockey players wearing full face shields Vs half face shields. It was observed that teeth fractures occurred with the athlete wearing a full-face shield but not a mouthguard.

Kvittem et al., 1999, found that the incidence of orofacial injuries in wrestling and basketball, were extremely high. Approximately one-quarter of the soccer players, one-half of the basketball players, and three-quarters of the wrestlers sustained an orofacial injury.

Roberts, 2000, stated that team physicians and dentists should encourage the use of mouthguards in such sports as football, ice hockey, field hockey, rugby, lacrosse, wrestling, basketball, and soccer, as well as for baseball and softball infielders.

Bastone et al., 2000, reviewed of the literature on epidemiology of dental trauma. They found that swimming and diving constituted 4.9% of the all-dental injuries.

 Holmes, 2000, reviewed Mouth protection in sport in Scotland, and found that in some sports, such as cycling, horse-riding and skateboarding, the younger age group were most at risk of dental injury because they were learning, but in team sports the highest risk was in young adults aged 20-30 because they play more frequently. The risk of injury also increased with higher levels of competition when players were more committed and probably had more exposure. The risk in cricket is highest in 40-49 year olds, which was a reflection of the age at which people play cricket.

Ferrari et al., 2002, studied dental trauma, level of information and mouthguard use in different sports and found that a total of 28.7% of the 1029 athletes reported dental trauma and was as follows: 32.1%, mrtial arts; 11.5% hockey; 36.4%, basketball; 37.1%, handball and 23.1%, soccer. Of these 1029 athletes, only 158 (15.4%) mentioned the use of mouthguard.

          Lang et al., 2002, studied knowledge and prevention of dental trauma in team handball in Switzerland and Germany and found that conclusive data about the frequency and type of dental injuries did not exist although handball belongs to sports activities with a medium risk for suffreig dental trauma. Thirty two of 112 trainer, player and goalkeeper had seen or observed a dental injury. Moreover, 12 of those questioned had experienced a dental injury themselves.

Female orofacial injuries and mouthguards:

                Bureau of Health Education and Audiovisual Services, and Council on Dental Materials, Instruments, and Equipment, 1984, found that the injury patterns observed among female athletes are similar to those observed among male athletes participating in similar sports.

          However, Morrow and Bonci, 1989, found that orofacial injury rates for women’s basketball, volleyball, soccer, softball, field hockey, and lacrosse exceeded that of men’s football. They attributed this to sparse mouthguard use among women athletes.

          Morrow et al., 1991, studied oral injuries in southwest conference women’s basketball players. They found that during the 1990-91 basketball season, the injury rate was 2.8 percent for those who wore mouthguards and 30.3 percent for those who did not.

          Scott et al., 1994, found that women might be more susceptible to dental injury than men, as it has been traditional for them not to use mouth protection.

Some clinical situations of special attention:

Bureau of Health Education and Audiovisual Services, and Council on Dental Materials, Instruments, and Equipment, 1984, and Yamada et al., 1997, stated that for the athlete who has a prognathic mandible, the protector is formed on the mandibular dentition. It was also stated that athletes should not wear removable orthodontic appliances when participating in contact sports. Orthodontic appliances that are fixed to the teeth need not be removed, however, to make the impression. If the athlete has fixed orthodontic appliances, the dentist can block these out during the impression or on the cast, so that the mouthguard will fit over them. Moreover, if the athlete has rapidly emerging primary teeth, this growth can be accommodated in the mouthguard. One method is to place a damp paper towel over these teeth to serve as a spacer.

           Bishop et al., 1985, found that mouthguards are important for the partially edentulous and edentulous athlete, because if a denture- wearing player sustains an injury in a contact sport, there is the possibility of inhalation of a fractured portion of the denture. If the denture is not worn and the mandible receives a severe blow, there is possible dangers of overclosure and fracture of the condyle.     

           Johnsen and Jackson, 1991, stated that anticipated tooth movement and brackets could be blocked-out with silicon putty material, light cured resin, or simply with plaster.

Oikarenin and Salonen, 1993, stated that a player with a removable prosthesis should replace it with a mouthguard. Also, those with orthodontic appliances should pay more attention to intra-oral protection of teeth, as forceful contacts between the teeth and the mucosal tissues can cause large lacerations and wounds if labial brackets are in position.

          Feldman et al., 1997, conducted a program as a part of the New Jersey Summer Special Olympics Games, and assessed a pilot-tested model for collecting epidemiologic data. He concluded that the final element of the program involved the distribution of mouthguards to athletes participating in contact sports.

Kvittem et al., 1998, found that soccer players and basketball players wearing fixed orthodontic appliances were twice as likely to sustain an orofacial injury as those who did not wear fixed orthodontic appliances. Since so many wrestlers sustained orofacial injuries (three-quarters), the significance of fixed orthodontic appliances could not be established. Because the risk of orofacial injuries for wrestlers is so high, the additional risk posed by wearing a fixed orthodontic appliance is relatively minimal when compared to the other sports.

The Interntional Academy for Sports Dentistry (IASD), 1998, created the Position Statement for "A Properly Fitted Mouthguard". It states that the criteria for the fabrication or adaptation of a "properly fitted mouthguard" must include the following considerations:

1.        Pertinent Medical History.

2.        Dental Status.

3.        Dental caries.

4.        Periodontal Status.

5.        Developmental Occlusion.

6.        Orthodontic or Prosthodontic Appliances.

7.        Congenital/Pathological Conditions.

8.        Jaw Relationships.

9.        Demographic Factors.

          Demas, 2000, reported that using of mouthguards had reduced repeated mandibular dislocations in athletes.

          Camp, 2000, studied management of sports-related root fractures and found that maxillary central incisors were the most frequently injured. The author also added that excessive overjet with protrusion of maxillary incisors and insufficient lip closure had lead to double the injuries as compared with children with normal dentition.

Perlman, 2000, stated that in 1999 Special Olympics, more than 8000 athletes with disabilities were provided with mouthguards. He added that when people with disabilities were able to gain access to dental care, maintain their oral health, and receive regular dental care, it would be a giant step toward independence and better health.

Bimaxillary mouthguards:

Milward and Jagger, 1995, studied the bimaxillary mouthguard that was provided for more than 20 sportsmen including two international rugby squad players. One of them had a recent history of mandibular fracture and another with recurrent tempromandibular joint pain. They found that the added coverage would provide extra protection against frontal and lateral blows to the mandibular teeth. It also provided bracing against frontal and lateral impact that should reduce forces transmitted to the tempromandibular joint. They concluded that the main disadvantages were the tendency of the athlete to develop dry mouth, speech difficulties and the relatively high price.

         Milward et al., 1995, studied the heat-cure silicon bimaxillary mouthguard and founded that this type is used by athletes who required or appreciated the extra protection. They concluded that experiences showed that silicon bimaxillary mouthguard was readily tolerated by most athletics after a short adaptive period.          

        However, Greasly et al., 1998, found that clinicians promote the use of two or double mouthguards to protect both the upper and lower jaw. This help to minimize the risk of concussion, but mouthguards of this type have proved almost universally unacceptable because they introduce breathing and communication difficulties, especially in team sports.

This review is intended only to be representative of some of the knowledge in the area involving Dentistry and Sports. The listed references represent the opinions of their authors and not necessarily those of SPORTS DENTISTRY ON WEB. On the other hand, as it is not intended to publish complete Literature Review of this subject area, readers should consult other sources available to obtain a complete review on this topic. Meanwhile, our efforts are always directed to periodically to update this review as new research information becomes available.