Oral health behaviors, dental injuries and mouthguard awareness among a sample of Portuguese athletes: a cross sectional study.

  • Luís Azevedo Institute of Health Sciences, Universidade Católica Portuguesa, Viseu, Portugal.
  • David Simões Martins Institute of Health Sciences, Universidade Católica Portuguesa, Viseu, Portugal.
  • Joana Fialho Polytechnic Institute of Viseu, Portugal.
  • Nélio Veiga Institute of Health Sciences, Universidade Católica Portuguesa, Viseu, Portugal. Center for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, Viseu, Portugal.
  • André Correia Institute of Health Sciences, Universidade Católica Portuguesa, Viseu, Portugal. Center for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, Viseu, Portugal.
  • Peter Fine UCL Eastman Dental Institute, 123 Gray's Inn Road, London.


Aim: To determine the oral health behaviors, the prevalence of dental injuries, the level of information about first-aid procedures in the case of dental avulsion and the mouthguard awareness in a sample of Portuguese athletes. Materials and Methods: Cross-sectional researchamong 1,048 athletes from the district of Viseu, Portugal. A self-administered questionnaire included demographic data and questions about: I) oral hygiene habits, II) occurrence of orofacial trauma, III) use of mouthguards and IV) athletes’ knowledge regarding first-aid management in case of dental avulsion was given. The comparison between different variables was made by Chi-square test with level of significant set at p-value ≤0.05. Results: The mean age of the sample (76.24% male) was 18.14±8.17 years. Overall, the results demonstrated a low use of dental floss (25.48%) and a high number of athletes (21.94%) that had not visited a dentist in more than a year. The prevalence of dental trauma was 5.06% and the most common dental injuries experienced by athletes were crown fractures (60.38%). Nearly half of the participants (45.23%) reported not knowing how to act following a dental avulsion. The rate of mouthguard use was very low (9.73%). There was a significant relationship between the prevalence of dental injuries and the use of mouthguards (p=0.000; Cramér’s V=0.145). Conclusion: The prevalence of dental trauma in our population was low. A low number of athletes use a mouthguard and there is a lack of knowledge concerning dental trauma issues.  Prevention programs and promoting actions among this population are important and should be adopted.


1. Smith JJ, Eather N, Morgan PJ, Plotnikoff RC, Faigenbaum AD, Lubans DR. The health benefits of muscular fitness for children and adolescents: a systematic review and meta-analysis. Sport Med. 2014;44(9):1209–23.
2. Eime RM, Young JA, Harvey JT, Charity MJ, Payne WR. A systematic review of the psychological and social benefits of participation in sport for children and adolescents: informing development of a conceptual model of health through sport. Int J Behav Nutr Phys Act. 2013;10(1):98.
3. Needleman I, Ashley P, Petrie A, Fortune F, Turner W, Jones J, Niggli J, Engebretsen L, Budgett R, Donos N, Clough T, Porter S. Oral health and impact on performance of athletes participating in the London 2012 Olympic Games: a cross-sectional study. Br J Sports Med. 2013;47(16):1054–8.
4. Ashley P, Di Iorio A, Cole E, Tanday A, Needleman I. Oral health of elite athletes and association with performance: a systematic review. Br J Sports Med. 2015;49(1):14–9.
5. Needleman I, Ashley P, Meehan L, Petrie A, Weiler R, McNally S, Ayer C, Hanna R, Hunt I, Kell S, Ridgewell P, Taylor R. Poor oral health including active caries in 187 UK professional male football players: clinical dental examination performed by dentists. Br J Sports Med. 2016;50(1):41-4.
6. Gay-Escoda C, Vieira-Duarte-Pereira D, Ardevol J, Pruna R, Fernandez J, Valmaseda-Castellon E. Study of the effect of oral health on physical condition of professional soccer players of the Football Club Barcelona. Med Oral Patol Oral y Cir Bucal. 2011;16(3):e436–9.
7. Bryant S, Mclaughlin K, Morgaine K, Drummond B. Elite Athletes and Oral Health. Int J Sport Med. 2011;32:720–4.
8. Peinado A, Rojo-Tirado M, Benito P. Sugar and physical exercise; the importance of sugar for athletes. Nutr Hosp. 2013;28(Supl.4):48–56.
9. Touger-Decker R, Van Loveren C. Sugars and dental caries 1–4. Am J Clin Nutr. 2003;78:881–92.
10. Budd SC, Egea J. Sport and Oral Health: A Concise Guide. 1st Ed. Springer Inter Publ. 2017.
11. Mulic A, Tveit AB, Songe D, Sivertsen H, Skaare AB. Dental erosive wear and salivary flow rate in physically active young adults. BMC Oral Health. 2012;12(1):8.
12. Frese C, Frese F, Kuhlmann S, Saure D, Reljic D, Staehle HJ, Wolff D. Effect of endurance training on dental erosion, caries, and saliva. Scand J Med Sci Sport. 2015;25(3):e319–26.
13. Ranalli DN. Sports dentistry and dental traumatology. Dent Traumatol. 2002;18(5):231–6.
14. Ramagoni NK, Singamaneni VK, Rao SR, Karthikeyan. J. Sports dentistry: A review. J Int Soc Prev Community Dent. 2014;4(Suppl 3):S139-46.
15. Tuna EB, Ozel E. Factors affecting sports-related orofacial injuries and the importance of mouthguards. Sport Med. 2014;44(6):777–83.
16. Maxén M, Kühl S, Krastl G, Filippi A. Eye injuries and orofacial traumas in floorball - a survey in Switzerland and Sweden. Dent Traumatol. 2011;27(2):95–101.
17. Persic R, Pohl Y, Filippi A. Dental squash injuries - A survey among players and coaches in Switzerland, Germany and France. Dent Traumatol. 2006;22(5):231–6.
18. Müller KE, Persic R, Pohl Y, Krastl G, Filippi A. Dental injuries in mountain biking–a survey in Switzerland, Austria, Germany and Italy. Dent Traumatol. 2008;24(5):522–7.
19. Lin S, Levin L, Emodi O, Fuss Z, Peled M. Physician and emergency medical technicians’ knowledge and experience regarding dental trauma. Dent Traumatol. 2006;22(3):124–6.
20. Ram D, Cohenca N. Therapeutic protocols for avulsed permanent teeth: review and clinical update. Pediatr Dent. 2004;26(3):251–5.
21. Schwartz-Arad D, Levin L, Ashkenazi M. Treatment options of untreatable traumatized anterior maxillary teeth for future use of dental implantation. Implant Dent. 2004;13(2):120–8.
22. Emerich K, Nadolska-Gazda E. Dental trauma, prevention and knowledge concerning dental first-aid among Polish amateur boxers. J Sci Med Sport. 2013;16(4):297–301.
23. Waldén M, Hägglund M, Ekstrand J. UEFA Champions League study: A prospective study of injuries in professional football during the 2001-2002 season. Br J Sports Med. 2005;39(8):542–6.
24. Hägglund M, Waldén M, Ekstrand J. Injury incidence and distribution in elite football—a prospective study of the Danish and the Swedish top divisions. Scand J Med Sci Sports. 2005;15(1):21–8.
25. Ueblacker P, Mueller-Wohlfahrt H-W, Ekstrand J. Epidemiological and clinical outcome comparison of indirect (‘strain’) versus direct (‘contusion’) anterior and posterior thigh muscle injuries in male elite football players: UEFA Elite League study of 2287 thigh injuries (2001–2013). Br J Sport Med. 2015;49(22):1461–5.
26. Quarrie KL, Gianotti SM, Chalmers DJ, Hopkins WG. An evaluation of mouthguard requirements and dental injuries in New Zealand rugby union. Br J Sports Med. 2005;39(9):650–1.
27. Marshall SW, Loomis DP, Waller AE, Chalmers DJ, Bird YN, Quarrie KL, et al. Evaluation of protective equipment for prevention of injuries in rugby union. Int J Epidemiol. 2004;34(1):113–8.
28. Fasciglione D, Persic R, Pohl Y, Filippi A. Dental injuries in inline skating - Level of information and prevention. Dent Traumatol. 2007;23(3):143–8.
29. Lang B, Pohl Y, Filippi A. Knowledge and prevention of dental trauma in team handball in Switzerland and Germany. Dent Traumatol. 2002;18:329–34.
30. Perunski S, Lang B, Pohl Y, Filippi A. Level of information concerning dental injuries and their prevention in Swiss basketball - A survey among players and coaches. Dent Traumatol. 2005;21(4):195–200.
31. Blignaut JB, Carstens IL, Lombard CJ. Injuries sustained in rugby by wearers and non-wearers of mouthguards. Br J Sports Med. 1987;21(2):5–7.
32. McCrory P. Do mouthguards prevent concussion? Br J Sports Med. 2001;35(2):81–2.
33. Schildknecht S, Krastl G, Kühl S, Filippi A. Dental injury and its prevention in Swiss rugby. Dent Traumatol. 2012;28(6):465–9.
34. Lang B, Pohl Y, Filippi A. Knowledge and prevention of dental trauma in team handball in Switzerland and Germany. Dent Traumatol. 2002;18(6):329–34.
35. Veiga NJ, Pereira CM, Ferreira PC, Correia IJ. Oral health behaviors in a sample of portuguese adolescents: an educational issue. Heal Promot Perspect. 2014;4(1):35–45.
36. Nonoyama T, Shimazaki Y, Nakagaki H, Tsuge S. Descriptive study of dental injury incurred by junior high school and high school students during participation in school sports clubs. Int Dent J. 2016;66(6):356–65.
37. Collins CL, McKenzie LB, Ferketich AK, Andridge R, Xiang H, Comstock RD. Dental injuries sustained by high school athletes in the United States, from 2008/2009 through 2013/2014 academic years. Dent Traumatol. 2016;32(2):121–7.
38. Ferrari CH, De Medeiros JMF. Dental trauma and level of information: mouthguard use in different contact sports. Dent Traumatol. 2002;18(3):144–7.
39. Levin L, Friedlander LD, Geiger SB. Dental and oral trauma and mouthguard use during sport activities in Israel. Dent Traumatol. 2003;19(5):237–42.
40. Tiwari V, Saxena V, Tiwari U, Singh A, Jain M, Goud S. Dental trauma and mouthguard awareness and use among contact and noncontact athletes in central India. J Oral Sci. 2014;56(4):239–43.
41. Berg R, Berkey DB, Tang JMW, Altman DS, Londeree KA. Knowledge and attitudes of Arizona high-school coaches regarding oral-facial injuries and mouthguard use among athletes. J Am Dent Assoc. 1998;129(10):1425–32.
42. Levin L, Jeffet U, Zadik Y. The effect of short dental trauma lecture on knowledge of high-risk population: An intervention study of 336 young adults. Dent Traumatol. 2010;26(1):86–9.
43. Gassner R, Tuli T, Hächl O, Rudisch A, Ulmer H. Cranio-maxillofacial trauma: A 10 year review of 9543 cases with 21 067 injuries. J Cranio-Maxillofacial Surg. 2003;31(1):51–61.
44. Poi WR, Sonoda CK, Martins CM, Melo ME, Pellizzer EP, de Mendonça MR, Panzarini SR. Storage media for avulsed teeth: A literature review. Braz Dent J. 2013;24(5):437–45.
45. Scott J, Burke FJ, Watts DC. A review of dental injuries and the use of mouthguards in contact team sports. Br Dent J. 1994;176(8):310.
How to Cite
AZEVEDO, Luís et al. Oral health behaviors, dental injuries and mouthguard awareness among a sample of Portuguese athletes: a cross sectional study.. Journal of Oral Research, [S.l.], v. 8, n. 3, p. 177-184, aug. 2019. ISSN 0719-2479. Available at: <http://joralres.com/index.php/JOR/article/view/839>. Date accessed: 17 sep. 2019. doi: https://doi.org/10.17126/jor.v0i0.839.