Resident’s Name: Joanne Lewis Date: November 13, 2009
Article title: Wearability and physiological effects of custom-fitted vs. self-adapted mouthguards
Author(s): Viera, D. et al
Journal: Dental Traumatology
Volume (number): 24
Month, Year: 2008
Major topic: mouthguards
Type of Article: research
Main Purpose: to measure the comfort, wearability, physiological effects and its influence on athletes’ physical performance, of custom-fitted compared with self-adapted mouthguards.
Overview of method of research: 11 rugby players, all males between 21 and 23 years of age with similar training levels, were selected to participate in the study. Each player received a “boil-and-bite” self-adapted mouthguard (MG2) and a custom fitted mouthguard (MG3). Each player made a weekly effort test randomly using either MG2, MG3, or no mouthguard for 3 consecutive weeks. The performance test was evaluated using counter-movement jumps (CMJ) and rebound jumps (RB). Forced vital capacity (FVC), forced expiratory air volume at 1 s (FEV1), peak expiratory flow rates (PEF), FEV1/FVC, and mid-expiratory flow (MEF) were recorded. The players completed a 10-point visual analog scale questionnaire concerning breathing, oral dryness, tiredness, thirst, speaking, taste, nausea, difficulty in drinking, adaptability, and comfort.
Findings: MG3 interferes less with breathing, speaking, and oral dryness, and has better adaptability, more comfort, less nausea, and is easier to drink while wearing than MG2 – these differences are statistically significant. There are no statistically significant differences in CMJ between MG2 and MG3; for RB, there are statistically significant differences between not wearing a MG and MG3 – not wearing a MG gives values from 0 to 8 cm higher. PEF rates were significantly reduced by wearing either MG.
Key points/Summary: MG3 are the favorite and have the highest level of acceptance for most of the players. MG3 is the most effective and highly recommended to prevent sports injuries. The use of MG may impact a player’s performance, and might restrict forced expiratory air flow. Dentists should be proactive in promoting the use of mouthguards.
Assessment of article: Results not surprising.
Friday, November 13, 2009
Thursday, November 12, 2009
A Technique for Fabricating Modern Athletic Mouthguards
Department of Pediatric Dentistry
Lutheran Medical Center
Date: 11/13/2009
Article title: A Technique for Fabricating Modern Athletic Mouthguards
Author(s): Ray R Padilla, DDS
Journal: CDA Journal
Volume (number): Vol. 33, No 5
Month, Year: May 2005
Major topic: Mouthguard fabrication
Minor topics: Althletic Mouthguards
Type of Article: Technique article
Main Purpose: Instruct general dentists on the proper fabrication of a pressure laminated mouthguard
Overview of method of research: Review of literature included as preface to fabrication instructions.
Findings:
As more dental patients become active in athletic endeavors, oral-facial injuries are on the rise. Proper mouthguard use can significantly reduce injury and general dentists must be able to educate patients on the need for mouthgaurds as well as provide means to obtain such.
Key points/Summary :
There are 3 major types of mouthguards
Type I: store bought, one size fits all. Research does not support their use.
Type II: store bought boil-and-bite. May fit better than type I, but there is some “research” suggesting that they may be worthless.
Type II: professionally made, custom fitted. The holy grail of mouthguards. The standard are 3-4mm thick pressure laminates.
The literature only supports the professional recommendation of custom mouthguards.
A quality mouthguard should have 3mm labial thickness, 2mm palatal and 3mm occlusally.
The material of choice is ethylene vinyl acetate with shore hardness of 80.
As with any appliance, a great impression is imperative; the author recommends Accu-Dent multicolloid.
After pouring model, mark the highest level of the vestibule with a pencil and trim to that point.
Lube the model
Use 2 layers of 3mm ethylene vinyl acetate in two steps. One step will not allow for proper thickness in all areas needed.
Make sure that the lingual area is not bulky.
Trim areas of muscle attachment well and equilibrate occlusion by gently heating the mouthguard and having the patient bite together until all teeth are in contact.
Assessment of article: I with we had a pressure laminate system. I’ve made a few of these using our vacum system and if this author’s sources are right, they may have been as useful as not having a mouthguard at all. Still, this is a great service and can be a great practice builder. Good article for practical application.
Thickness and stiffness characteristics of custom made mouthguard materials
Department of Pediatric Dentistry
Lutheran Medical Center
Resident’s Name: Craig Elice Date: 11/13/2009
Article title: Thickness and stiffness characteristics of custom made mouthguard materials
Author(s): Waked EJ, Caputo AA.
Journal: Quintessence Int.
Volume (number): 36:462-6
Month, Year: 2005
Major topic: Custom made mouthguards, stiffness and thickness
Minor topic(s):
Type of Article: Research article
Purpose: This study compares the thickness and stiffness of three different mouthguard materials and determines the suitability for concussion, and dental trauma prevention
Overview of method of research: Ten specimens were used in this study with models for each group. Porous stone models were used for vacuum formed mouthguards and soaped vacuum formed models were used for the pressure formed mouthguards. The three mouthguard materials included a 3mm regular Drufosoft material, the 4mm colored mouthguard and the 4mm prelaminated Proform mouthguards. Thicknesses were measured at three locations: the lingual cusp of the first molars, the distal marginal ridge of the first premolars and the facial of the central incisor. Stiffness was determined by the penetration of a 10lb force applied at the location of the lingual cusp of the first molars.
Findings: Key points/Summary: The thicknesses in all three locations were comparable for the two vacuum formed materials (1.5-2.5mm depending upon the location). However the pressure formed mouthguard materisl were significantly thicker at all three location (3.25-4.99mm). In terms of stiffness, the two vacuum formed mouthguards showed less deformation but even after deformation the pressure formed mouthguard was significantly thicker.
Discussion:
Recommendations/ Conclusions: For prevention of a concussion, a mouthguard thickness of greater than 3mm is suggested. Overall, the pressure laminated mouthguard proided better thickness; therefore, it would provide better protection against a concussion.
Assessment of article: Study was simple and supported the conclusion that pressure formed mouthguards were thicker.
Lutheran Medical Center
Resident’s Name: Craig Elice Date: 11/13/2009
Article title: Thickness and stiffness characteristics of custom made mouthguard materials
Author(s): Waked EJ, Caputo AA.
Journal: Quintessence Int.
Volume (number): 36:462-6
Month, Year: 2005
Major topic: Custom made mouthguards, stiffness and thickness
Minor topic(s):
Type of Article: Research article
Purpose: This study compares the thickness and stiffness of three different mouthguard materials and determines the suitability for concussion, and dental trauma prevention
Overview of method of research: Ten specimens were used in this study with models for each group. Porous stone models were used for vacuum formed mouthguards and soaped vacuum formed models were used for the pressure formed mouthguards. The three mouthguard materials included a 3mm regular Drufosoft material, the 4mm colored mouthguard and the 4mm prelaminated Proform mouthguards. Thicknesses were measured at three locations: the lingual cusp of the first molars, the distal marginal ridge of the first premolars and the facial of the central incisor. Stiffness was determined by the penetration of a 10lb force applied at the location of the lingual cusp of the first molars.
Findings: Key points/Summary: The thicknesses in all three locations were comparable for the two vacuum formed materials (1.5-2.5mm depending upon the location). However the pressure formed mouthguard materisl were significantly thicker at all three location (3.25-4.99mm). In terms of stiffness, the two vacuum formed mouthguards showed less deformation but even after deformation the pressure formed mouthguard was significantly thicker.
Discussion:
Recommendations/ Conclusions: For prevention of a concussion, a mouthguard thickness of greater than 3mm is suggested. Overall, the pressure laminated mouthguard proided better thickness; therefore, it would provide better protection against a concussion.
Assessment of article: Study was simple and supported the conclusion that pressure formed mouthguards were thicker.
Policy on Prevention of Sports-related Orofacial Injuries
Resident: Adam J. Bottrill
Date: 13NOV09
Region: Providence
Article title: Policy on Prevention of Sports-related Orofacial Injuries
Author(s): AAPD council on Clinical Affairs
Journal: Oral Health Policies Reference Manual
Page #s: p. 45
Year: 2005-2006
Major topic: Prevention of Sports-related Orofacial Injuries
Minor topic(s): Official Recommendations
Type of Article: Policy Statement
Main Purpose: Disseminate the AAPD’s Official Recommendations Regarding Sports-related Injuries.
Overview of method of research: NA
Key points in the article discussion:
A. Purpose:
1. The AAPD is concerned…. (I sure hope so)
2. Increased competitiveness has resulted in a large increase in orofacial and dental injuries.
a. represent a high percentage of the total injuries experienced in sports.
B. Background:
1. Mandatory protective equipment:
a. college football, lacrosse and ice hockey have demonstrated significant reduction of dental and facial injuries with the use of mouthguards.
2. Other sports lag behind significantly in this area.
a. baseball, basketball, soccer, field hockey, softball, wrestling, volleyball and gymnastics.
3. Leisure activities can also benefit from this type of protection.
a. skateboarding, inline or roller skating and bicycling
4. Mouth guards distribute forces of impact, reducing risk of severe orofacial injury and concussion.
a. must be fitted and worn properly.
5. 3 types
a. stock, mouth formed, custom fit (listed in reverse order of protectiveness)
C. Policy Statement:
1. Dentists play an active role in educating the public in the use of protective equipment. (prevent injuries AND reduce health care costs)
2. Continuation of preventive practices instituted by the previously mentioned sports organizations.
3. For baseball and softball, ASTM-certified face protector should be required.
4. Mandating mouthguards will help protect against orofacial injuries in many other sports.
5. Coaches and administrators of sports should consult with a dentist for recommendations for immediate management of sports-related injuries (eg, avulsed teeth).
6. Continuation of R&D for a more comfortable and efficacious mouthguard is needed to facilitate more widespread usage of the devices.
7. The International Academy of Sports Dentistry should be recognized as a valuable resource for the professions and the public.
Assessment of article: No shenanigans here. Just the straight scoop.
Parental attitudes toward mouthguards 11/13/2009
Resident: Hencler
Date: 11/13/2009
Article title: Parental attitudes toward mouthguards
Author(s): Diab, DMD; Mourino, DDS, MSD
Journal: Pediatric Dentistry-19:8, 1997
Major topic: Mouthguards and orofacial injuries during sports
Type of Article: Survey
Main Purpose: Evaluate parental attitudes towards mouthguard use in order to promote education in this area.
Overview of method of research: A simple one page survey was mailed to 1800 parents with children between the 4th and 9th grade (9-14 years old). 365 surveys were returned of which 359 were usable in this study.
Findings: Reasons given for not wearing a mouthguard include: didn’t think of it, uncomfortable, difficult to speak, don’t like it, uncool, looks funny, difficult to breath, comes out, and too costly. Most of these reasons would not be an issue if a custom mouthguard was fabricated. There were 206 survey reported injuries with 88% of these injuries occurring when a mouthguard was not being worn. Medical treatment was sought for 43 injuries with 31 being treated by a dentist. Sustained injuries from most to least common were: cut lip, bruised face, chipped tooth, loose tooth, and fractured jaw. Of the total injuries sustained 19% were in basketball, 17% in baseball, and 11% in soccer. Parents reported coaches and parents should be the responsible parties for enforcing mouthguard use.
Key points in the article discussion: Mouthguards reduce the potential harm to the face and head area by absorbing and diffusing the force from a traumatic blow. Past studies using cadavers have shown that mouthguards significantly decrease the amount of intracranial pressure and bone deformation in the skull when trauma occurs. Mouthguards have also been found to reduce the number of concussions, cerebral hemorrhages, incidences of unconsciousness, and general neck problems. Other benefits include decreasing the number of jaw fractures by preventing the condyle from being displaced upward and backward against the glenoid fossae and also by displacing soft tissue away from teeth preventing laceration and bruising of the lips and cheeks.
Summary of conclusions: Parents generally felt:
1. Mouthguard enforcement is the responsibility of both parents and coaches.
2. Mandatory mouthguard rule for football, boxing, ice hockey, wrestling, and the ancient art of karate.
3. There is a lack of perceived need for mouthguards in basketball. Baseball, and soccer, although these are the sports with the most frequently reported injuries
4. There is a lack of perceived need for mouthguards unless the child had sustained an injury previously or played a contact sport or mandatory mouthguard sport.
5. Mouthguards should be required more for boys than girls who participate in sports.
Assessment of article: Information not particularly surprising but relevant to any pediatric dentist. Could be a great practice builder if you promoted and made mouthguards for local sports teams.
Date: 11/13/2009
Article title: Parental attitudes toward mouthguards
Author(s): Diab, DMD; Mourino, DDS, MSD
Journal: Pediatric Dentistry-19:8, 1997
Major topic: Mouthguards and orofacial injuries during sports
Type of Article: Survey
Main Purpose: Evaluate parental attitudes towards mouthguard use in order to promote education in this area.
Overview of method of research: A simple one page survey was mailed to 1800 parents with children between the 4th and 9th grade (9-14 years old). 365 surveys were returned of which 359 were usable in this study.
Findings: Reasons given for not wearing a mouthguard include: didn’t think of it, uncomfortable, difficult to speak, don’t like it, uncool, looks funny, difficult to breath, comes out, and too costly. Most of these reasons would not be an issue if a custom mouthguard was fabricated. There were 206 survey reported injuries with 88% of these injuries occurring when a mouthguard was not being worn. Medical treatment was sought for 43 injuries with 31 being treated by a dentist. Sustained injuries from most to least common were: cut lip, bruised face, chipped tooth, loose tooth, and fractured jaw. Of the total injuries sustained 19% were in basketball, 17% in baseball, and 11% in soccer. Parents reported coaches and parents should be the responsible parties for enforcing mouthguard use.
Key points in the article discussion: Mouthguards reduce the potential harm to the face and head area by absorbing and diffusing the force from a traumatic blow. Past studies using cadavers have shown that mouthguards significantly decrease the amount of intracranial pressure and bone deformation in the skull when trauma occurs. Mouthguards have also been found to reduce the number of concussions, cerebral hemorrhages, incidences of unconsciousness, and general neck problems. Other benefits include decreasing the number of jaw fractures by preventing the condyle from being displaced upward and backward against the glenoid fossae and also by displacing soft tissue away from teeth preventing laceration and bruising of the lips and cheeks.
Summary of conclusions: Parents generally felt:
1. Mouthguard enforcement is the responsibility of both parents and coaches.
2. Mandatory mouthguard rule for football, boxing, ice hockey, wrestling, and the ancient art of karate.
3. There is a lack of perceived need for mouthguards in basketball. Baseball, and soccer, although these are the sports with the most frequently reported injuries
4. There is a lack of perceived need for mouthguards unless the child had sustained an injury previously or played a contact sport or mandatory mouthguard sport.
5. Mouthguards should be required more for boys than girls who participate in sports.
Assessment of article: Information not particularly surprising but relevant to any pediatric dentist. Could be a great practice builder if you promoted and made mouthguards for local sports teams.
Tuesday, November 10, 2009
Compliance of children and youngsters in the use of mouthguards 11/13/09
LUTHERAN MEDICAL CENTER
Dental Residency Program
Literature Review Form
Resident: Murphy Date: 11/12/09 Region: Prov.
Article title: Compliance of Children and youngsters in the use of mouthguards
Author(s): Matalon, Vered. Ilana Brin, et al
Journal: Dental Traumatology
Volume #; Number; Page #s): 24. 462-467
Year: 2008
Major topic: Children’s compliance wearing mouthguards during sports
Minor topic(s): Parents understanding of why a mouthguard is necessary
Type of Article: Clinical Study, Survey
Main Purpose: Assess why children do or do not wear their mouthguards.
Overview of method of research: Originally, 80 children were chosen for the study. The only criteria were that they have fully erupted incisors(they did not specify which incisors). The mean age was of the children was 12.7. There were 42 boys, 27 girls, and 21 of the children were siblings. A year later, 69 children and their parents completed a survey to gain information on terms of compliance regarding the appliance.
Findings: A mouthguard can be defined as a resilient appliance placed inside the mouth to protect against injuries to the teeth, lacerations to the mouth, fractures, and dislocations of the jaw. There is also evidence that they can protect against concussion and injury to the cervical spine. 26% of all oral injuries are a result of sports. According to the study, only 27% of athletes are aware that mouthguards should be worn, and only 3% reported using a mouthguard. In terms of compliance, 29% said they never wore it, 32 percent said they wore it sometimes, 23 percent said when they first got it they wore it all the time, but not so much anymore, and 16% wore it all the time. Reasons for not wearing the appliance were numerous, with the three most common being, ‘I forget to wear it’, it’s not comfortable’(55% said this), and ‘I’m embarrassed to wear it because none of my friends wear one’. 32% of the children lost their appliance. 4.5% lost the appliance after one week, 36.4% after a month, and 59.1% more than a month. With regards to the parents, 46% stated that using a mouthguard is essential, 40% didn’t know if it was helpful, and 6.3% said it was unnecessary. Additionally, 37.5% of parents thought that asking the child to use it was unrealistic. 77% said that their children did not previously have a mouthguard because they didn’t know it was available. Also, 47.9% said their dentist never offered them one.
Summary of conclusions: There are three predictors that the study focused on. Gender, boys are more likely to wear the appliance, age, younger children are less likely to wear the appliance, and sibling position, children that were born later in the sibling order were less likely to comply. Most children who didn’t use their mouthguards did so because of forgetfulness(45%) or discomfort(42%). History of family oral trauma did not increase parent’s awareness of mouthguard importance. More than half of the parents said that their child did not have a mouth guard because their dentist or physician never told them about it. After one year, 68% of the children still had their mouthguard, but a third of them never used it.
Assessment of article: Overall a very good article with relevant facts regarding the use and compliance of mouthguards with respect to children. The take home message is offer mouthguards to your patients, and the younger they are, the lower they are on the sibling tree, and whether they’re a boy or a girl will give you a fairly good idea if they’re going to wear it….or “lose it" before they reach the parking lot.
Dental Residency Program
Literature Review Form
Resident: Murphy Date: 11/12/09 Region: Prov.
Article title: Compliance of Children and youngsters in the use of mouthguards
Author(s): Matalon, Vered. Ilana Brin, et al
Journal: Dental Traumatology
Volume #; Number; Page #s): 24. 462-467
Year: 2008
Major topic: Children’s compliance wearing mouthguards during sports
Minor topic(s): Parents understanding of why a mouthguard is necessary
Type of Article: Clinical Study, Survey
Main Purpose: Assess why children do or do not wear their mouthguards.
Overview of method of research: Originally, 80 children were chosen for the study. The only criteria were that they have fully erupted incisors(they did not specify which incisors). The mean age was of the children was 12.7. There were 42 boys, 27 girls, and 21 of the children were siblings. A year later, 69 children and their parents completed a survey to gain information on terms of compliance regarding the appliance.
Findings: A mouthguard can be defined as a resilient appliance placed inside the mouth to protect against injuries to the teeth, lacerations to the mouth, fractures, and dislocations of the jaw. There is also evidence that they can protect against concussion and injury to the cervical spine. 26% of all oral injuries are a result of sports. According to the study, only 27% of athletes are aware that mouthguards should be worn, and only 3% reported using a mouthguard. In terms of compliance, 29% said they never wore it, 32 percent said they wore it sometimes, 23 percent said when they first got it they wore it all the time, but not so much anymore, and 16% wore it all the time. Reasons for not wearing the appliance were numerous, with the three most common being, ‘I forget to wear it’, it’s not comfortable’(55% said this), and ‘I’m embarrassed to wear it because none of my friends wear one’. 32% of the children lost their appliance. 4.5% lost the appliance after one week, 36.4% after a month, and 59.1% more than a month. With regards to the parents, 46% stated that using a mouthguard is essential, 40% didn’t know if it was helpful, and 6.3% said it was unnecessary. Additionally, 37.5% of parents thought that asking the child to use it was unrealistic. 77% said that their children did not previously have a mouthguard because they didn’t know it was available. Also, 47.9% said their dentist never offered them one.
Summary of conclusions: There are three predictors that the study focused on. Gender, boys are more likely to wear the appliance, age, younger children are less likely to wear the appliance, and sibling position, children that were born later in the sibling order were less likely to comply. Most children who didn’t use their mouthguards did so because of forgetfulness(45%) or discomfort(42%). History of family oral trauma did not increase parent’s awareness of mouthguard importance. More than half of the parents said that their child did not have a mouth guard because their dentist or physician never told them about it. After one year, 68% of the children still had their mouthguard, but a third of them never used it.
Assessment of article: Overall a very good article with relevant facts regarding the use and compliance of mouthguards with respect to children. The take home message is offer mouthguards to your patients, and the younger they are, the lower they are on the sibling tree, and whether they’re a boy or a girl will give you a fairly good idea if they’re going to wear it….or “lose it" before they reach the parking lot.
A Modified Method of Mouthguard Fabrication for Orthodontic Patients
LUTHERAN MEDICAL CENTER
Dental Residency Program
Literature Review Form
Resident: Boboia Date: 11/9/09
Article title: A Modified Method of Mouthguard Fabrication for Orthodontic Patients
Author(s): Maeda et al.
Journal: Dental Traumatology
Volume #; Number; Page #s): 24, 475-442
Year: 2008
Purpose: Describe a method for custom-made MG fabrication using sheet and tube materials
Orthodontic appliances are a major risk factor for traumatic injuries during sport events. Taking precise impressions is difficult resulting in poorly fitting mouthguards.
Summary Fabrication Procedure:
1) Take alginate impressions and pour
2) Apply a catheter tube material to the surface of the brackets by making a cut and fixing it with cyano-acrylate adhesive
3) Use a 3mm thick sheet and vacuum former and to make mouth guard
4) Make necessary adjustments after trimming and polishing
Discussion:
In fabricating mouthguard one must minimize bulk, maximize retention, leave space available for tooth movement, achieve retention to the anchor tooth positions.
Assesment: Good article for those people who have never made a athletic mouthguard. The only item worth noting is the use of a tube as a block out material for orthodontic brackets and arch wire.
Dental Residency Program
Literature Review Form
Resident: Boboia Date: 11/9/09
Article title: A Modified Method of Mouthguard Fabrication for Orthodontic Patients
Author(s): Maeda et al.
Journal: Dental Traumatology
Volume #; Number; Page #s): 24, 475-442
Year: 2008
Purpose: Describe a method for custom-made MG fabrication using sheet and tube materials
Orthodontic appliances are a major risk factor for traumatic injuries during sport events. Taking precise impressions is difficult resulting in poorly fitting mouthguards.
Summary Fabrication Procedure:
1) Take alginate impressions and pour
2) Apply a catheter tube material to the surface of the brackets by making a cut and fixing it with cyano-acrylate adhesive
3) Use a 3mm thick sheet and vacuum former and to make mouth guard
4) Make necessary adjustments after trimming and polishing
Discussion:
In fabricating mouthguard one must minimize bulk, maximize retention, leave space available for tooth movement, achieve retention to the anchor tooth positions.
Assesment: Good article for those people who have never made a athletic mouthguard. The only item worth noting is the use of a tube as a block out material for orthodontic brackets and arch wire.
Monday, November 9, 2009
Dentist attitudes towards mouthgaurd protection
Resident: Roberts
Article title: Dentist attitudes toward mouthgaurd protection
Author: Maestrello, Christopher et al.
Journal: American Academy of Pediatric Dentistry
Volume: 21: 6 pages 340 – 345
Year: 1999
Issues/Findings:
From the last 30 years numerous articles have been published citing studies that targeted the attitudes of ball players, coaches, referees, school and league officials, however, none cited the attitude of the dentist towards mouthgaurds – until this paper. Presently only the amateur sports of football, ice hockey, boxing, men’s lacrosse, and women’s field hockey and the professional sport of boxing mandate the use of mouthgaurds. Studies indicate the use of mouthgaurds in contact sports and show that up to 1/3 of all dental trauma occur in sports accidents.
Three types of mouthgaurds exist: stock, mouthformed, and custom made. Class 1 and 2 dentitions receive maxillary mouthgaurds, while class 3 pts receive mandibular mouthgaurds. The most desirable qualities of a mouth guards are protection, retention, comfort, fit, ease of speech, resistance to tear, and ease of breathing – all of these which are best obtained via a custom mouthgaurd.
Interesting fact: 72% of high schools report using sales reps as a source for selecting mouthgaurds, 33% report using publications and literature, 11% consult a dentist.
In this study 2500 dentist were surveyed in Virginia: 1999 GP’s, 213 Orthodontist, 88 pediatric dentists. A response rate of 834(38%) of GP’s, 113 (53%) of orthodontists, and 45(51%) of Pediatric dentist were obtained.
Conclusions:
1. Recent graduates are more likely to have an understanding of mouthgaurds
2. Dentist that recommend mouthgaurds and types
a. GP’s 66% custom, mouthformed, stock
b. Ortho 97% stock, custom, mouthformed
c. Ped 85% custom, mouthformed, stock
Sports most likely recommended to use by dentist in order
Football, basketball, boxing, ice hockey, field hockey, wrestling, martial arts, soccer, lacrosse, baseball, rollerblading, ice skating, volleyball, gymnastics, bicycling, skiing, water sports, tennis, track and field…
Reasons dentist did not recommend mouthgaurds
1. Pt could get less expensive mouthgaurd somewhere else
2. Dentist had no formal training on how to use or fabricate mouthgaurds
3. Not the responsibility of the dentist to recommend
4. Not profitable
5. other
Article title: Dentist attitudes toward mouthgaurd protection
Author: Maestrello, Christopher et al.
Journal: American Academy of Pediatric Dentistry
Volume: 21: 6 pages 340 – 345
Year: 1999
Issues/Findings:
From the last 30 years numerous articles have been published citing studies that targeted the attitudes of ball players, coaches, referees, school and league officials, however, none cited the attitude of the dentist towards mouthgaurds – until this paper. Presently only the amateur sports of football, ice hockey, boxing, men’s lacrosse, and women’s field hockey and the professional sport of boxing mandate the use of mouthgaurds. Studies indicate the use of mouthgaurds in contact sports and show that up to 1/3 of all dental trauma occur in sports accidents.
Three types of mouthgaurds exist: stock, mouthformed, and custom made. Class 1 and 2 dentitions receive maxillary mouthgaurds, while class 3 pts receive mandibular mouthgaurds. The most desirable qualities of a mouth guards are protection, retention, comfort, fit, ease of speech, resistance to tear, and ease of breathing – all of these which are best obtained via a custom mouthgaurd.
Interesting fact: 72% of high schools report using sales reps as a source for selecting mouthgaurds, 33% report using publications and literature, 11% consult a dentist.
In this study 2500 dentist were surveyed in Virginia: 1999 GP’s, 213 Orthodontist, 88 pediatric dentists. A response rate of 834(38%) of GP’s, 113 (53%) of orthodontists, and 45(51%) of Pediatric dentist were obtained.
Conclusions:
1. Recent graduates are more likely to have an understanding of mouthgaurds
2. Dentist that recommend mouthgaurds and types
a. GP’s 66% custom, mouthformed, stock
b. Ortho 97% stock, custom, mouthformed
c. Ped 85% custom, mouthformed, stock
Sports most likely recommended to use by dentist in order
Football, basketball, boxing, ice hockey, field hockey, wrestling, martial arts, soccer, lacrosse, baseball, rollerblading, ice skating, volleyball, gymnastics, bicycling, skiing, water sports, tennis, track and field…
Reasons dentist did not recommend mouthgaurds
1. Pt could get less expensive mouthgaurd somewhere else
2. Dentist had no formal training on how to use or fabricate mouthgaurds
3. Not the responsibility of the dentist to recommend
4. Not profitable
5. other
Fabricating a better mouthguard. Part I: Factors influencing mouthguard thinning.
Resident’s Name: Brian Schmid DMD Date: 11/13/09
Article title: Fabricating a better mouthguard. Part I: Factors influencing mouthguard thinning.
Author(s): De Rossi G. Leyte Bidal MA.
Journal: Dental Traumatology
Month, Year: 2007
Major topic: Mouthguard fabrication and thermoforming effect on mouthguard thickness
Type of Article: Technique analysis
Findings: Fifteen patients had alginate impressions taken and each was poured up 3 times. They were trimmed for mouthguard fabrication with cast thicknesses of 20, 25 and 30mm. The mouthguards were made via pressure lamination with EVA in a Drufomat machine. The thickness of various parts of the mouthguard including the occlusal table and the facial of the incisors and canines were measured and analyzed. There was a significant difference in incisor and canine thickness between the 3 groups, with the shortest cast being the thickest progressing up to the tallest cast being the thinnest. Also, the thinnest group kept the difference between anterior and posterio thickness to a minimum suggesting that a shorter cast will provide a mouthguard with the most uniform thickness, which has been shown to be the most comfortable and allow the greatest freedom of speech and breathing. The short cast mouthguards were also analyzed for thickness related to jaw size and arch length for which there was a positive correlation.
Key points/Summary: Shorter casts will generally give you a mouthguard of uniform thickness and increased protection in the anterior. Patients with larger arch length and jaw size may be at an advantage since the fabrication process lends itself to thicker mouthguards for these patients.
Assessment of article: A small N, particularly for the arch length/area analysis, makes this study a step in the right direction but well shy of a definitive study. Also, they fabricated their mouthguards with a landing present on the casts; all of the instruction I’ve seen has you grind off the landing, which allows you to make the cast even shorter. Definitely an interesting opportunity for future research.
Article title: Fabricating a better mouthguard. Part I: Factors influencing mouthguard thinning.
Author(s): De Rossi G. Leyte Bidal MA.
Journal: Dental Traumatology
Month, Year: 2007
Major topic: Mouthguard fabrication and thermoforming effect on mouthguard thickness
Type of Article: Technique analysis
Findings: Fifteen patients had alginate impressions taken and each was poured up 3 times. They were trimmed for mouthguard fabrication with cast thicknesses of 20, 25 and 30mm. The mouthguards were made via pressure lamination with EVA in a Drufomat machine. The thickness of various parts of the mouthguard including the occlusal table and the facial of the incisors and canines were measured and analyzed. There was a significant difference in incisor and canine thickness between the 3 groups, with the shortest cast being the thickest progressing up to the tallest cast being the thinnest. Also, the thinnest group kept the difference between anterior and posterio thickness to a minimum suggesting that a shorter cast will provide a mouthguard with the most uniform thickness, which has been shown to be the most comfortable and allow the greatest freedom of speech and breathing. The short cast mouthguards were also analyzed for thickness related to jaw size and arch length for which there was a positive correlation.
Key points/Summary: Shorter casts will generally give you a mouthguard of uniform thickness and increased protection in the anterior. Patients with larger arch length and jaw size may be at an advantage since the fabrication process lends itself to thicker mouthguards for these patients.
Assessment of article: A small N, particularly for the arch length/area analysis, makes this study a step in the right direction but well shy of a definitive study. Also, they fabricated their mouthguards with a landing present on the casts; all of the instruction I’ve seen has you grind off the landing, which allows you to make the cast even shorter. Definitely an interesting opportunity for future research.
Thursday, October 8, 2009
Arch width changes from 6 weeks to 45 years of age 10/9/09
Resident: Murphy
Date: 10/9/09
Article title: Arch width changes from 6 weeks to 45 years of age
Author(s): Bishara, Samir, Jane Jakobsen, et al.
Journal: American Journal of Orthodontics and Dentofacial Orthopedics
Vol.: 111, No. 4, pages 401-409
Major topic: Evaluation of maxillary and mandibular changes in arch widthType of Article: Clinical ReviewMethods: The purpose of this study was to study the changes in intercanine and intermolar widths over a 45 year span. In this study, 2 pools of patients were selected. In the first pool, 28 female and 33 male, healthy full term babies that would be accessible for frequent recall visits over the next 8 years(or so). These children were evaluated at 6 weeks, 1 year, and upon completion of the deciduous dentition. The second pool of was selected from the Iowa Growth Study. Originally 89 boys and 86 girls were selected to have models taken semiannually during childhood, annually during adolescence, and once in adulthood. Of the 175 children originally selected, 16 female and 15 males completed all the follow ups. On all of the casts, 5 maxillary and 7 mandibular landmarks were set from which the measurements were taken(see article for listing of landmarks). Variability between clinicians measurements was determined to be
Findings: There was a significant increase in max. interk9 width and intermolar arch width from 6 weeks to 2 years old in both boys and girls. The largest increase was between 6 weeks to 1 year. There was also a large increase in interk9 width from 3-8 years of age. Width decreased from age 13-45, however this was only statistically significant in the female subjects. In the mandible, interk9 and intermolar width increases up to 8 in boys and 13 in girls. After 13, there was a decrease in width in both sexes (correlating with the complete eruption of the permanent dentition). Furthermore, mandibular interk9 width is essentially set by 8 years of age, or after the complete eruption of the 4 incisors. (maybe it’s me, but the previous sentence stated that the width increases up to 13. Maybe this is just for the intermolar width, because the study ALSO says the interk9 width is set at 8. Am I missing something or is the study contradicting itself?)
Conclusions: Arch widths will change from birth to adulthood. The direction and magnitude of these changes do not provide a basis for expanding the arches in the average patient beyond its established dimension when canines and molars are completely erupted. Essentially, in terms of arch width, it is what it is, and we have to make due with what we’ve got.
Assessment of article: I think it’s a good article. Absolutely relevant to our ortho practice. As I stated previously, I found it a bit contradicting in places…or maybe it just didn’t clarify things well. Or maybe it’s me and I’m just slowly losing my mind.
Date: 10/9/09
Article title: Arch width changes from 6 weeks to 45 years of age
Author(s): Bishara, Samir, Jane Jakobsen, et al.
Journal: American Journal of Orthodontics and Dentofacial Orthopedics
Vol.: 111, No. 4, pages 401-409
Major topic: Evaluation of maxillary and mandibular changes in arch widthType of Article: Clinical ReviewMethods: The purpose of this study was to study the changes in intercanine and intermolar widths over a 45 year span. In this study, 2 pools of patients were selected. In the first pool, 28 female and 33 male, healthy full term babies that would be accessible for frequent recall visits over the next 8 years(or so). These children were evaluated at 6 weeks, 1 year, and upon completion of the deciduous dentition. The second pool of was selected from the Iowa Growth Study. Originally 89 boys and 86 girls were selected to have models taken semiannually during childhood, annually during adolescence, and once in adulthood. Of the 175 children originally selected, 16 female and 15 males completed all the follow ups. On all of the casts, 5 maxillary and 7 mandibular landmarks were set from which the measurements were taken(see article for listing of landmarks). Variability between clinicians measurements was determined to be
Findings: There was a significant increase in max. interk9 width and intermolar arch width from 6 weeks to 2 years old in both boys and girls. The largest increase was between 6 weeks to 1 year. There was also a large increase in interk9 width from 3-8 years of age. Width decreased from age 13-45, however this was only statistically significant in the female subjects. In the mandible, interk9 and intermolar width increases up to 8 in boys and 13 in girls. After 13, there was a decrease in width in both sexes (correlating with the complete eruption of the permanent dentition). Furthermore, mandibular interk9 width is essentially set by 8 years of age, or after the complete eruption of the 4 incisors. (maybe it’s me, but the previous sentence stated that the width increases up to 13. Maybe this is just for the intermolar width, because the study ALSO says the interk9 width is set at 8. Am I missing something or is the study contradicting itself?)
Conclusions: Arch widths will change from birth to adulthood. The direction and magnitude of these changes do not provide a basis for expanding the arches in the average patient beyond its established dimension when canines and molars are completely erupted. Essentially, in terms of arch width, it is what it is, and we have to make due with what we’ve got.
Assessment of article: I think it’s a good article. Absolutely relevant to our ortho practice. As I stated previously, I found it a bit contradicting in places…or maybe it just didn’t clarify things well. Or maybe it’s me and I’m just slowly losing my mind.
Subscribe to:
Posts (Atom)