Oral protection measures should be taken for teenagers to participate in ice hockey
With the 2022 Beijing Winter Olympic Games approaching, the implementation outline for ‘driving 300 million people to participate in ice and snow sports’ issued by the National Ministry of Sports in 2018 came into effect. Ice and snow sports are becoming increasingly popular. One of the sports promotion programs for young people, the General Administration of the People's Republic of China, issued guidelines for the ice hockey program jointly with the Ministry of Education of the People's Republic of China. However, there was no direct relationship between the increase in ice hockey participation and participants' awareness of sports injuries.
Ice hockey is one of the fiercest antagonistic sports, and the incidence of sports injuries is high. Oral injury, especially dental injury, has a long-term effect on injured athletes' function; there are also external and psychological effects on injured athletes. In recent years, athletes participating in antagonistic sports have paid more attention to oral protection in sports. According to a national electronic injury monitoring system of the United States in 2001, 175000 people were injured playing football every year, of which 43% were 8 to 14 years of age. A total of 30% of the injuries were oral and maxillofacial injuries, including tooth avulsions, tooth fractures, and jaw fractures [11, 12]. Because ice hockey allows a certain degree of collisions, the risk of sports-related injuries is higher. In the present study, 20 individuals reported periodontal injuries (7.14%), and eight reported tooth injuries (2.86%).
Tooth guards are thought to be effective oral protective devices that reduce the impact force in sports via a significant buffering effect; they reduce the incidence of tooth fractures, tooth avulsions, jaw fractures, and other injuries [5]. The National Federation of high schools and the University Sports Association both require mouthguards in hockey, rugby, ice hockey, and lacrosse [1, 6]. The American Dental Association and the American Society of Pediatric Dentistry also recommend using dental protectors for athletes participating in competitive sports [2]. China's 2018 Haidian District Youth Ice Hockey League's competition requirements clearly state that participants must wear dental protectors. However, in the survey, only 22.17% of the athletes reported wearing tooth guards, and 62.5% of the athletes reported never having worn one. One investigation in the United States was not optimistic; Collins et al. surveyed young athletes who participated in basketball, football, and other aggressive sports in 21 middle schools [13]. A total of 22.6% of the athletes never knew that they needed to wear tooth protectors, and only 12.3% often wear them or used to wear them in sports. Chukwudi et al. performed a survey of Nigeria in which 19.16% of young athletes reported wearing tooth guards [14]. It can be seen that, although tooth protectors are known to protect teeth, it remains difficult to promote their use among young athletes. To improve young people's safety in antagonistic sports, we should further understand the difficulties and obstacles they encounter in self-protection to provide targeted help and guidance.
Young ice hockey players and their parents lack knowledge of sports-related oral injury
Although the mouthguard wearing rate in this survey was not high, more than half of the respondents reported knowing that athletes are at risk of oral injury; however, they reported not knowing much about it. A total of 43.58% of the respondents reported not knowing that the injuries could occur and even believed that oral injury would not occur. A total of 48.10% of the respondents reported knowing that they need to wear tooth protectors in ice hockey matches because of notices issued by the ice hockey association. Most of these notices came from the ice hockey association's requirements regarding protective gear in competition but do not mention the necessity or correct method of wearing tooth protectors. Only 18.31% of the respondents' information came from coaches’ guidance. It can be seen that the ice hockey coach's understanding of the mouthguard is not profound. Although modern medicine has been paying increasing attention to oral health care, oral health professionals, and social health propaganda do not provide Titles in BMC Oral Health appear to be in sentence case (only first words, proper nouns, and acronyms capitalized health guidance for athletes. Among the respondents who reported being guided by stomatologists, eight reported oral injuries and learned relevant information during treatment. Two parents of athletes reported that their occupation was stomatologist. Also, 8.31% of the respondents had never obtained any relevant information.
Most of the respondents expressed their desire to know the relevant information through ice hockey coaches or sports associations' publicity and requirements. Because the respondents reported believing that they should understand the risks associated with ice hockey, athletes contact them most, it is easier for them to obtain information. The athletes have higher compliance with coaches’ guidance. Only 10.23% of the respondents chose oral health care personnel as the best way to obtain information, even lower than social media. This may indicate that China's medical resources remain deficient at present, and the focus of dental specialists remains focused on the treatment of oral diseases. Lack of community service, inability to provide routine oral examinations, prevention, and treatment of potential oral diseases, and other health care services all suggest that there remains a long way to go to achieve ideal ‘national oral health.’ Respondents reported believing that it takes a long time to wait in line to listen to stomatologists or nurses' professional guidance, and doctors often did not have time to provide detailed health guidance for patients. Without oral diseases, there is no opportunity to meet dental professionals; therefore, it is difficult to obtain health guidance. To achieve national oral health, dental specialist medical staff must go deep into community hospitals to ensure that the community can obtain convenient oral health guidance, regular examinations, and other basic services.
How to improve the rate of wearing tooth guards among Chinese teenagers
To further study the tooth guard wearing rate among teenagers in China, we investigated the factors that affect the wearing of dental protectors. According to our previous analysis, 89.64% of the parents stated that this was the most important reason why the athletes did not wear tooth protectors. This is consistent with the survey results of Chukwudi et al. [14] who found a significant correlation between compliance with wearing oral protective equipment and the athletes' knowledge of the risk and consequences of oral injury. We believe that our athletes lack the channels to obtain information regarding oral protective equipment and that oral health education related to sports is very important.
A total of 67.14% of the respondents reported not wanting to be different from others because of wearing the mouthguard. Another 17.50% of respondents reported unwillingness to accept the change of the image entailed in wearing a mouthguard. The discomfort and communication difficulties after wearing the mouthguard also reduced compliance. However, in ice hockey, helmets, padding, and other protective equipment are very common, and there is no movement resistance. Therefore, the perfect implementation of the relevant regulations of competition requirements and sports safety are the best measures to promote the use of teeth guards. A total of 77.14% of the parents reported believing that the formulation and enforcement of the relevant regulatory agencies' standards were important measures to encourage young athletes to wear mouthguards. Coach supervision was reported to be the most important (54.64%). At present, many countries require coaches of antagonistic sports to receive safety education related to injuries and to master emergency treatment interventions for tooth avulsions, tooth fractures, and other injuries. The coaches must pass a strict examination before they can obtain the qualification. This can reduce the impact of sports-related injuries and the adverse consequences of injury worthy of our learning and reference.
Future efforts of oral medical professionals should focus on the comfort of tooth guards and reduce the costs of wearing them. There are three main types of tooth guard sleeves: The first type is the ordinary tooth guard. It is preformed and is ready to wear. It is inexpensive; however, it is uncomfortable. It causes pain, nausea, dyspnoea, and other symptoms. The second type is the heated and occlusive type of tooth guard, worn for the first time after being heated in water, to make it suitable for various people to wear. This kind of tooth guard is the most popular one; it is more comfortable than the ordinary one. However, due to its substantial thickness, it may affect normal communication in sports. There are also uncomfortable symptoms, such as foreign body sensation. The third type is the custom-made tooth guard, which doctors and technicians make based on imaging techniques. It is characterized by accurate retention and stable wearability. It can prevent oral injury while ensuring comfort and durability. However, athletes need to go to clinics often and cooperate with doctors during the customization process; this requires a long time and is expensive. Therefore, it is of great significance to develop a tooth guard characterized by strong resistance and ease of wearing.