Orofacial Injuries Research Articles

THE INCIDENCE OF OROFACIAL INJURIES IN SPORTS: A PILOT STUDY IN ILLINOIS

This pilot study of sports-related injuries in Illinois confirms that football players do not encounter orofacial injuries as often as other athletes. The authors attribute this to mandatory use of faceguards and mouth protectors in football and recommend that mouthguards be used by all players of contact sports.

EVALUATION, DIAGNOSIS, AND TREATMENT OF THE TRAUMATIZED PATIENT

This article discusses the early assessment of the patient who has sustained an oral injury. The various types of orofacial injuries are reviewed, with emphasis on their early management. The dentist's early assessment of the patient must include a general evaluation of the patient as well as a more specific dental evaluation because the general dentist is often the first person to assess a patient who has been injured.

Comparing Comfort and Wearability: Custom-Made vs. Self-Adapted Mouthguards

Several studies have shown that mouthguards can reduce orofacial injuries among athletes. Comfort and wearability factors were compared among 40 high-school athletes for custom-made and self-adapted mouthguards. Both offered adequate protection, but overall the participants preferred the custom-made mouthguard.

A review of dental injuries and the use of mouthguards in contact team sports.

Dental injuries are the commonest type of orofacial injury sustained during participation in sports. Of the types which are currently available, custom-made mouthguards fitted by a dentist have been demonstrated to provide the greatest protection from dental injuries. Such mouthguards should therefore be recommended for use by those who participate in contact sports, and their provision should be actively encouraged by dental care workers.

Attitudes to mouthguards and prevalence of orofacial injuries in four teams competing at the second Rugby World Cup.

The opportunity was taken to conduct a questionnaire survey of the members of four competing countries at the second Rugby World Cup tournament (Australia, Ireland, Scotland, Wales) regarding the prevalence of orofacial injuries and attitudes to mouthguards. The results show that while all players in each team believed that mouthguards provided local protection, approximately one in five of each team did not wear one. The average age when players first started wearing mouthguards varied from 12.7 years for Australia to 18.1 years for Wales, while the percentage of wearers willing to play without their mouthguard ranged from only 4.6% for Australia to 15.8% for Wales. Just less than half of the total group had previously sustained an orofacial injury playing rugby.

A Contemporary Approach to the Clinical Evaluation of Trigeminal Nerve Injuries

SUMMARY In this article, the authors propose an algorithm for the evaluation of patients with orofacial nerve injury. The algorithm is specifically designed to grade the extent of impairment in sensory capacity and its behavioral impact (for the patient with decreased sensation) and the “complexity” of the pathophysiologic mechanism underlying the pain (for the patient with unpleasant sensation and/or pain). The rationale for this approach is based on limited clinical data that suggest the following. First, different criteria are most appropriately employed to judge whether patients with decreased sensation and with dysesthesia/pain are candidates for definitive surgical treatments.12- 21- 48- 49 Second, patients with decreased sensation appear to benefit from these surgical treatments in proportion to their preoperative impairment in sensory capacity and perceived functional deficits.12,48,49,50 Specifically, factors that support a clinical decision for surgical treatment and are assessed by the algorithm include (1) a patient report of altered sensation that is “bothersome” and affects daily function or behavior,21 (2) physical evidence of self-induced trauma or injury, (3) moderate or severe impairment in sensory capacity,48 and (4) complete anesthesia.12,21,48 In contrast, factors that do not favor the surgical option include (1) a patient report of altered sensation that is rarely noticed and does not affect daily function or behavior, (2) no or little physical evidence of self-induced trauma or injury, and (3) only mild impairment or normal sensory capacity.12,48 Third, patients with dysesthesia/pain fail to benefit from surgical treatments in proportion to the extent that their pain reflects multiple pathologic CNS and autonomic changes.13,29,49 For example, the dysesthetic patient with peripherally mediated allodynia or hyperalgesia has a good prognosis for pain relief, whereas a patient with anesthesia dolorosa is highly unlikely to benefit from nerve exploration/ repair microsurgery. Patients whose primary complaint is pain rather than “numbness” represent a major challenge to the profession because their sensory disorders may be debilitating and re- fractory to surgical treatments. Gregg recently reported that of 84 patients exhibiting chronic posttraumatic orofacial pain, only the hyperalgesic and hyperpathic components of their discomfort were notably reduced by microsurgical treatments.13 Pain was not significantly reduced in patients whose sensory disorders were diagnosed as anesthesia dolorosa or SMP. It was proposed that anesthesia dolorosa and SMP, in contrast to hyperalgesia and hyperpathia, were maintained by complex central and autonomic pathologic mechanisms. In agreement with Gregg's findings, other clinical investigators have expressed little optimism for the surgical alleviation of pain when there is evidence for “central maintenance” of the pain complaint.29- 49 Such patients can often be identified by their report of constant pain and the lack of pain relief from local anesthetic blocks proximal to the site of injury.29 Unfortunately, these very same patients often fail to benefit from alternative pharmacologic, physical, and psychological therapies. Accordingly, it has been suggested that the best treatment for the more complex dysesthesias is one of prevention: Any patient who has spontaneous or stimulus-induced pain during a consecutive 3- to 4-week period or “bothersome” paresthesia(s) and areas of total anesthesia 6 months after injury should be evaluated for microsurgery.13,29 The rationale for this recommendation is that the development of pathologic changes within the CNS, which are associated with pain and are refractory to treatment, can be aborted by early surgical intervention. However, there is little scientific evidence to support this position.49 Finally, the authors recognize that the proposed algorithm does not apply to all patients. It does, however, represent an important first step in defining a systematic approach by which high-quality care can be provided to most patients who have experienced orofacial nerve injury and in establishing a hypothetical approach for the purpose of refinement by additional clinical data. Given the growing number of nerve-injured patients presenting to the clinic for evaluation and treatment, the current need for both is unquestionable.

The Effect of Thromboxane on Contraction of Canine Mesenteric and Lingual Arteries

Thromboxane A2 (TXA2), a potent vasoconstrictor agent, is released from platelets and smooth muscle during inflammation and trauma. TXA2 may cause lingual artery (LA) contraction, leading to lingual paresthesia. The effects of U-46619, a TxA2 mimetic, on isolated rings of canine LA and mesenteric artery (MA) were examined. U-46619 (1 nmol/L to 1 mumol/L) caused a triphasic contraction of LA and MA; a rapid, phasic contraction; a slow, sustained contraction; and, upon washout of U-46619, a maintained contraction. The MA relaxed slowly, but the LA remained contracted for at least three h after washout. Decreasing extracellular calcium ion (Ca2+o) to less than 0.1 mumol/L with 2 mmol/L EGTA relaxed MA, but not LA. EGTA (4 mmol/L) partially relaxed the maintained contraction of LA. Inhibition of protein kinase C with amphotericin B or staurosporine inhibited the phasic and sustained contractions of LA, but did not affect the maintained contraction in the presence or absence of EGTA. Thus, CA2+o was required for the initial contraction of the LA by U-46619, but did not appear to be required for the maintained contraction following washout of U-46619. The data support the conclusion that following a brief exposure to U-46619, maintained contraction of LA persists by a unique mechanism that may be independent of Ca2+ and protein kinase C. Sustained LA contraction after exposure to endogenous TXA2 during inflammation and trauma may contribute to impaired lingual blood flow and orofacial tissue injury.

Oro-facial and dental injuries in club rugby union players.

Oro-facial and dental injuries are of particular importance as dental tissues have a low potential for recovery when damaged and such injuries can give rise to functional, aesthetic and psychological disfigurement. Also their repair can be costly, distressing and time consuming. This study sought to clarify the nature and severity of oro-facial injuries amongst rugby players in a first division club in Scotland. A secondary aim of the study was to examine the influence of position and standard of play on injury rates. The results show that oro-facial injuries are common amongst rugby players, and that players in the first fifteen were at the greatest risk. Although injuries may still occur when mouthguards are used, their severity will be reduced by use of such protective devices.

Orofacial injuries and international rugby players' attitudes to mouthguards.

This is the first such study of British rugby and the third yet published, the other two involving the 1984 Australian Wallabies and the 1987 United States Eagles. The report shows that while all 30 players believed mouthguards provided local protection, nine did not wear a mouthguard. Only one of the 21 who wore a mouthguard was willing to play without it, while eight mouthguard wearers felt mouthguards should be compulsory for adult rugby players. Twelve players had previously sustained an orofacial injury playing rugby which required treatment, only one of whom was wearing a mouthguard at the time. The full results are presented and compared with those of the previous two reports.

CDC Expands Dental Disease Prevention Role

IN RESPONSE to changes occurring in dentistry and public health, the CDC has broadened the role of its Dental Disease Prevention Activity (DDPA) to include the prevention of bottle tooth decay, oral cancer, orofacial injuries, and the transmission of blood-borne pathogens among dental health providers. Functioning within the office of the director of the Center for Prevention Services, the DDPA unit started in the late 1970s with a single mission—to prevent dental caries by promoting community water-fluoridation systems. Now with a staff of 16, the unit has expanded its efforts to five other oral health areas, says its chief, Lawrence J. Furman, DDS, MPH. In addition to continuing to promote community water fluoridation and dental sealants, the DDPA is working with the Healthy Mothers, Healthy Babies Coalition to prevent a major cause of severe tooth in young children. Called baby bottle tooth decay or nursing caries, this pattern

Mouthguards and the role of sporting team dentists.

With the increased popularity of contact sports and encouragement to participate at an early age, the role of the dental profession in relation to prevention of dental and other orofacial sporting injuries has become more important. Provision of professionally-fitted (custom) mouthguards for persons involved in contact sports, recognition of the 'injury prone dentition', and expertise in immediate management of dental injuries form the basis of sports dentistry. The aim of this review paper is to increase professional awareness and interest. Additionally, it is hoped to stimulate dentists to become involved as sporting club consultants.

Trauma to the Oral Cavity

Sports events, particularly those in which mouth protectors are not commonly used, can be associated with injuries to the oral structures. While the incidence of sports-related orofacial injuries is not as high as for other traumatic events, the incidence could be reduced further by increased use of mouth and face protection. When injuries occur, quick action by primary health care providers can significantly improve the final outcome of the definitive treatment. Also important is appropriate follow-up evaluation and care since the effect of trauma on teeth is not always immediately apparent. Destructive resorption, unnecessary tooth loss, and possible alveolar infections may be prevented by referral to appropriate health care providers for evaluation following the initial urgent care of trauma patients.

The pattern of use of mouthguards in rugby league (a study of the 1986 Australian Rugby League touring team).

Generally speaking, in contact sports the higher the grade of competition the greater the risk of a player sustaining any type of injury. Therefore it is important to conduct studies periodically of international sporting teams from different countries to detect any changes in regional injury patterns, besides assessing attitudes to the use of available protective equipment. A study of the prevalence of orofacial injuries and use of mouthguards by members of the 1984 Great Britain Rugby League Touring Team has previously been reported (Chapman, 1985a). In order to obtain a suitable basis for comparison of those results, a similar study of the members of the 1986 Australian Rugby League Touring Team to Great Britain was conducted. The most important finding was the much higher usage rate of mouthguards by the Australian footballers when compared with the British figure. Results of the study also support the function of mouthguards in reducing the incidence of orofacial injuries in contact sports.

The bimaxillary mouthguard: a preliminary report of use in contact sports.

AbstractThe bimaxillary mouthguard provides a new concept in the prevention of orofacial and concussional sporting injuries. Its use is generally recommended for participants in the various contact sports, especially by those at increased risk of sustaining such injuries. This mouthguard was developed by the author and has been successfully used for more than three years. The results of a questionnaire study of 30 sportsmen who had been fitted with a bimaxillary mouthguard is presented together with details of fabrication. The acceptance rate was found to be very high (97 per cent), no orofacial injuries were sustained whilst the mouthguard was being worn, and none of the wearers would consider reverting to a standard custom mouthguard.

The prevalence of orofacial injuries and use of mouthguards in Rugby Union.

Abstract— Mouthguards are important for those involved in contact sports and their use in such sports is recommended by authorities as they provide considerable protection for the orofacial structures. The use of mouthguards in contact sports in part reflects the success of community awareness programmes designed to encourage such practice. A comprehensive study of 116 Rugby Union footballers was undertaken in 1984 to study the prevalence of orofacial injuries and the use of mouthguards in that sport and the results are presented in this paper. The grades ranged from club level through to international level of competition. Overall the usage of mouthguards was high and ranged from 79–96 per cent in the various teams. This study is the most complete ever recorded in Rugby Union.

Orofacial injuries and mouthguards: a study of the 1984 Wallabies.

As mouthguards provide protection of the teeth, jaws, adjacent soft tissues and also protect the brain against concussion following impacts to the mandible, the use of mouthguards in contact sports is strongly recommended. It is therefore essential to gauge regularly the use of mouthguards in the various contact sports at all levels of competition. Of the 30 members of the 1984 Australian Rugby Union Touring Team (the Wallabies), 80% wore mouthguards and of these, 75% believed that wearing mouthguards should be made compulsory for Rugby players. A comparison of these and other findings is made with previous studies in Rugby, and also with a similar study of the 1984 Great Britain Rugby League Touring Team.

Orofacial injuries and the use of mouthguards by the 1984 Great Britain Rugby League touring team.

Mouthguards are considered by most authorities to be an essential part of equipment for players in any body-contact sports, especially the combative type e.g. Rugby Union, Rugby League, American Football (gridiron), boxing, etc. (Turner, 1977). The qualities provided by the mouthguard are dental protection, especially of the upper anterior teeth, soft tissue protection around the mouth, a reduction in the risk of fracture of the mandible, and a reduction in the concussion force from a blow to the mandible (Clegg, 1969; Upson, 1982; Davies et al, 1977). Of the 28 players interviewed, only 7 (25%) wore mouthguards, the commonest reason for not using a mouthguard being difficulty with breathing, a finding in common with other similar surveys (Davies et al, 1977). In view of the fact that 17 (60.7%) had sustained oral injuries - dental and jaw injuries, intra-oral and circumoral lacerations, in the past, it was a surprising response to find that only 2 (7.2%) stated that mouthguards should be compulsory when playing Rugby League football.

Evaluation of high blood pressure control programs using provider surveys as instruments for process measurement: Anthony V. Sardinas, Connecticut State Department of Health, 79 Elm Street, Hartford, Connecticut, 06115; Maria A. Buatti

Objective. The purposes of this study were to compare the sociodemographic and health-related characteristics of orofacial injury patients who miss appointments with those of patients who do not and to determine which patient characteristics best predict missed-appointment behaviors (eg, the number of missed clinic visits). Study design. A total of 190 patients (134 African American and 56 Hispanic) treated for mandible fractures at the King/Drew Medical Center, Los Angeles, participated in a prospective study involving structured interviews at 4 points (denoted recalls 1-4 ) over a 6-month period. To be included in the study, patients were required to have attended recall 1. Most patients in the study sample were male, more than 32 years of age, unmarried, and unemployed; most had completed high school; and most had sustained their injuries as a result of assault. Results. Only 22% of the patients attended all 4 recall clinic appointments. However, 42% completed 3 recall visits, and 69% completed 2 recall visits. Patients who missed appointments were more likely to be African American than Hispanic and more likely to be unemployed than employed. There was a significant negative association between perceived social support and missed appointments (r = –0.18, P = .01). Patients who missed more appointments perceived themselves to have less social support than those who missed fewer or no appointments. The data revealed no associations between missed appointment behavior and age, gender, marital status, or education. None of the health-related variables investigated were associated with missed appointments. Multiple regression analysis confirmed that race, unemployment, and perceived social support were the best predictors of missed appointments. Conclusions. Social variables have a greater impact than health variables in predicting missed-appointment behavior. Unemployed African American patients are at the greatest risk for missing recall clinic appointments; however, this finding is independent of health insurance. Accessing and enlisting patients’ social networks to support follow-up medical care has potential for improving appointment-keeping behavior and should be further examined. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:405-10)

Automobile Injuries—The Forgotten Area of Public Health Dentistry

Although vehicle design changes have significantly decreased the severity of body injuries, the orofacial region is traumatized in one fifth to two thirds of those injured. Impacts with the instrument panel, steering wheel, windshield, or other forward structures cause a wide range of orofacial injuries that are routinely treated by the dentist. However, the expertise of the dental profession has not been focused on the preventive aspects of orofacial injuries received in car crashes. These could be implemented, through national dental leadership and a guidance program, by the practicing dentist.