K L Quarrie^1,4, S M Gianotti², D J Chalmers³, W G Hopkins⁴

Objectives: To document the effects of compulsory mouthguardwearing on rugby related dental injury claims made to ACC, theadministrator of New Zealand’s accident compensation scheme.

Methods: An ecological study was conducted. Estimates of mouthguardwearing rates were available from prospective studies conductedin 1993, 2002, and 2003. Rugby related dental injury claimswere available for the period 1995–2003. Player numberswere available from 1998. Mouthguard wearing was made compulsoryduring match play for rugby players at under 19 level and belowat the beginning of the 1997 season, and for all grades of domesticrugby at the beginning of the 1998 season. Greater powers ofenforcement were provided to referees at the beginning of the2003 season.

Results: The self reported rate of mouthguard use was 67% ofplayer-weeks in 1993 and 93% in 2003. A total of 2644 claimswas reported in 1995. There was a 43% (90% confidence interval39% to 46%) reduction in dental claims from 1995 to 2003. Onthe reasonable assumption that the number of players and player-matchesremained constant throughout the study period, the relativerate of injury claims for non-wearers versus wearers was 4.6(90% confidence interval 3.8 to 5.6). The cumulative savingsin claim costs compared with the cost per year if claim numbershad remained constant from 1995 is $1.87 million NZD.

Conclusion: Although ecological studies have acknowledged weaknesses,the findings provide evidence that mouthguard use is a simpleand effective injury prevention strategy for rugby players.The use of mouthguards for all players in both matches and contactpractice situations is strongly recommended.

Abbreviations: IRB, International Rugby Board; NZRU, New Zealand Rugby Union; RIPP, Rugby Injury and Performance Project; RISP, Rugby Injury Surveillance Project

Keywords: mouthguards; rugby; injury; dental

 

 

S Gianotti^1,2, P A Hume², W G Hopkins², J Harawira¹, R Truman¹

¹ Accident Compensation Corporation, Wellington, New Zealand
² Institute of Sport and Recreation Research New Zealand, Faculty of Health and Environmental Science, AUT University, Auckland, New Zealand

Mr S Gianotti, Accident Compensation Corporation, PO Box 242, Wellington, New Zealand; simon.gianotti@acc.co.nz

Background: In January 2007 the International Rugby Board implemented anew law for scrum engagement aimed at improving player welfareby reducing impact force and scrum collapses. In New Zealandthe new law was included in RugbySmart, an annual compulsoryworkshop for coaches and referees.

Objective: To determine the effect of the new law on scrum-related moderateto serious neck and back injury claims in 2007.

Methods: Claims filed with the Accident Compensation Corporation (theprovider of no-fault injury compensation and rehabilitationin New Zealand) were combined with numbers of registered playersto estimate moderate to serious scrum-related claims for playerswho take part in scrums (forwards). Poisson linear regressionwas used to compare the observed claims per 100 000 forwardsfor 2007 with the rate predicted from data for 2002–6.

Results: The observed and predicted claims per 100 000 forwards were52 and 76, respectively (rate ratio 0.69; 90% CI 0.42 to 1.12).The likelihoods of substantial benefit (rate ratio <0.90)and harm (rate ratio >1.1) attributable to the scrum lawwere 82% and 5%, respectively.

Conclusion: The decline in scrum-related injury claims is consistent witha beneficial effect of the new scrum law in the first year ofits implementation. Another year of monitoring should providemore evidence for the efficacy of the new law.

ADA COUNCIL ON ACCESS; AND PREVENTION AND INTERPROFESSIONAL RELATIONS; AND ADA COUNCIL ON SCIENTIFIC AFFAIRS

Background. This report reviews the available literature onthe types and properties of athletic mouthguards, current fabricationmethods and the role of mouth protectors in reducing the incidenceand severity of sports-related oral injuries.

Overview. For more than 50 years, the American Dental Associationhas promoted the protective value of wearing properly fittedmouthguards while participating in athletic or recreationalactivities that carry a risk of dental injury. Safety is essentialto maintaining oral health, and a properly fitted mouthguardcan minimize the risks of sustaining oral injuries during participationin sports.

Conclusions. The dental literature supports the use and protectivevalue of mouthguards in reducing sports-related injuries tothe teeth and soft tissues. Dentists are encouraged to educatepatients regarding the risks of oral injury in sports, fabricateproperly fitted mouthguards, and provide appropriate guidanceon mouthguard types and their protective properties, costs andbenefits. Further studies addressing the effectiveness of currentlyavailable mouthguard types and population-based interventionsfor reducing oral injuries are recommended.

Clinical Implications. Participants in sporting and recreationalactivities are often susceptible to oral injury. To reduce theincidence and severity of sports-related oral trauma, the useof a properly fitted mouthguard is recommended in any athleticor recreational activity that carries a risk of injury.

Key Words: Mouthguard; mouth protector; sports dentistry; injury prevention; preventive dentistry.