Australasian Dental Practice 2001; Vol 12 (2): 50, 52
BY ASSOCIATE PROFESSOR CAROLINE FINCH, BSC MCS PHD AND JULIAN HODGES BA DMS
Sports injury prevention strategies should be targeted at both the most frequent and the most severe injuries.
Australian football is a popular participant activity in many parts of Australia. Its predominance in available injury statistics ranks this sport as a priority for injury prevention activities. Indeed, football consistently ranks as the sporting activity associated with the highest number of presentation for sports injury treatment, generally accounting for more than 20% of all cases. For example, Victorian data from sports medicine centres, emergency departments and general practice clinics indicates that Australian football is generally the sport associated with the highest number of injuries in Victoria.
Although not all football injuries are severe, in a significant proportion of cases they have a major impact on the health and well being of participants. The most severe injuries tend to occur to the head/neck/orodental regions and we estimate them to be associated with annual medical costs of $15 million.
In its 1995 report Football Injuries to the Head and Neck, the National Health And Medical Research Council identified the prevention of these injuries as requiring urgent attention because they are associated with major adverse outcomes including the risk of permanent brain or spinal damage; reduced scholastic performance in children and adolescents; neuropsychological deficits; cumulative trauma; and orodental surgery, including replacement of teeth.
From a community and public health viewpoint, sporting head/neck/orodental injuries result in reduced participation in sport and exercise, with a resultant decrease in health and longevity; high medical costs; and high social costs (e.g.work/school absenteeism). If just 50% of these injuries could be prevented, the annual savings would be of the order of $8 million.
The two most commonly used and/or promoted counter measures for head/neck/orodental injuries in Australian football are mouthguards and protective headgear. Mouthguards are widely recommended as an essential piece of protective equipment for players participating in sports such as football. Whilst no compulsory in football, mouthguard use is widespread, at least at the higher levels of competitive play. At the community level, usage rates fall to approximately 40% of players. Despite the widespread support given to mouthguard use as an injury prevention measure in football, controlled trials of mouthguards in the field have not been undertaken.
A large-scale 3-year field-based randomised controlled trial study (the Australian Football Injury Prevention Project, or AFIPP), funded by the Victorian Health Promotion Foundation, and to be conducted with the Eastern Football League in Victoria, is undertaking further investigation into the effectiveness of mouthguards in football. This is being complemented by research into the barriers to mouthguard use and injury surveillance activities.
The Research Team realised the inherent deficiencies in all ‘boil and bite’ mouthguards. It realised too that there are wide discrepancies in the levels of protection of custom-made mouthguards. For the study it required a mouthguard that could be produced to a consistently high standard. It required proven performance and a mouthguard that had been extensively and independently researched and tested (Figure 1) as an entire mouthguard and not only as a piece of material.
As a result, the first scientific field trial into sports injury prevention to be conducted in Australia will exclusively use Playsafe Custom Laminated Mouthguards. Research by the University of Tubingen, published in Endodontics and Dental Traumatology, proved the greater ‘total cushioning effect’ of correctly made and fitted Playsafe Mouthguards (Figure 2). In addition, yet to be published Tubingen research, showed the superior retention of pressure custom laminated mouthguards.
With this evidence, the selection of the type and brand of mouthguard for the study was simplified. Indeed many years earlier, Dr Paul McCrory, a noted Sports Neurologist, expert on concussion in football and editor of the British Journal of Sports Medicine, had identified the superiority of custom laminated mouthguards.
In 1995 the NHMRC had recommended the creation of an Australian Standard for mouthguards. As a member of the NHMRC panel, Dr McCrory was keenly aware of the need. Although a technical committee has been formed, it is not feasible to estimate with any certainty, when a Standard will be available for review. The committee meets infrequently and there has been little obvious progress.
The lack of a standard and the absence of a controlled field study, places limits on the soundness and consistency of the advice that dentistry provides to its patients and the sporting community. Likewise, educators, trainers, coaches and sports organisations are also limited in the safety advice that they are able to give to players and parents. In this continuing data vacuum, unsubstantiated or doubtful claims or advice is possibly being inadvertently made.
In a media release, Associate Professor Caroline Finch said, “Before we advise people to wear this protective equipment (mouthguards and protective headgear), we need to make sure that it also works in the context of the sporting field.”
The Australian Football Injury Prevention Project may therefore solve the dilemma. The results from the Study could have wide-ranging implications, not only for the entire sporting community but for the dental profession too.
The research team
Associate Professor Caroline Finch – Chief Investigator, Member of AFL Research and Development Board.
Dr Paul McCrory – Neurophysician, Sportsphysician, Expert on Concussion in Football.
David Parkin – President AFL Coaches Association (Vic), Lecturer School of Health Sciences Deakin University.
Dr Andrew McIntosh – Biochemist, Expert on Biomechanics in Sport.
Associate Professor Caroline Finch was awarded the Australian Injury Prevention Network Award for 2000 for excellence in injury prevention research. She is widely regarded as Australia’s leading sports injury epidemiologist. A/Prof Finch has been appointed the inaugural chair of three national committees responsible for sports safety. Her sports injury research has been disseminated through more than 60 authored publications.
Julian Hodges is an international thermoforming and mouthguard consultant. He introduced pressure laminated mouthguards to Australia in 1984. He lectures on the concepts and trains dental specialists in mouthguard fabrication. Julian represents the ADIA on the Standards Australia Technical Committee for Sports Mouthguards. He is author of the acclaimed in-office training program, ‘Mouthguard Mastery – How To Be Your Own Mouthguard Expert’.