http://dx.doi.org/10.

1590/1981-863720170002000083110
ORIGINAL | ORIGINAL

Dental trauma in contact sports

Traumatismos dentários em esportes de contato

Luísa Bandeira Pires Monteiro LOPES1

Joana Freire FERREIRA2

ABSTRACT
Objective
Investigate the prevalence of dental traumas in participants of two contact sports (Judo and Taekwondo) and characterise some related factors.

Methods
Cross-sectional pilot study of observational nature, conducted by observing and collecting data and information. The sample consisted of 60
individuals of both genders aged between 5 and 15 years old, participants of Judo or Taekwondo. The statistical analysis involved descriptive
and inferential statistical measures.

Results
The prevalence of dental trauma in the studied sample was of 38,3%, with the majority occurring outside the practice of sport (82,6%). Only
4 children suffered trauma whilst playing their sport, corresponding to a prevalence of 6,67%. In addition, all 4 cases pertained to the practice
of Judo. The most affected teeth were the primary maxillary central incisors followed by the permanent maxillary central incisors, with only
one injured tooth in most cases. The lips were the soft tissue with greatest number of registered traumatic lesions. A statistically significant
relationship was observed between risk factors and the occurrence of trauma.

Conclusion
A high prevalence of dental trauma in the studied population was found. Despite no record of traumatic lesions in Taekwondo, this prevalence
was particularly noticeable in Judo.

Indexing terms: Martial arts. Mouth protectors. Tooth injuries.

RESUMO

Objetivo
Investigar a prevalência de traumatismos dentários na população praticante de dois esportes de contacto (Judo e Taekwondo) e caraterizar
alguns fatores associados.

Métodos
Estudo piloto transversal com carácter observacional, realizado com recurso a observação e registo de dados e informações. A amostra foi de
60 indivíduos com idades compreendidas entre os 5 e os 15 anos, de ambos os sexos, praticantes de Judo ou Taekwondo no Parque de Jogos
1º de Maio - INATEL. A análise estatística envolveu medidas de estatística descritiva e estatística inferencial.

Resultados
A prevalência de traumatismos dentários na população em estudo foi de 38,3%, em que a maioria ocorreu fora da prática desportiva (82,6%).
Apenas 4 crianças sofreram traumatismos durante a prática desportiva, correspondendo a uma prevalência de 6,67%. O único esporte
predisponente para o trauma neste estudo foi o Judo. Os dentes mais atingidos foram os incisivos centrais superiores decíduos seguidos dos
incisivos centrais superiores definitivos, e a maioria das situações afetou apenas um dente. O lábio foi o tecido mole com maior número de
lesões traumáticas registadas. O hábito de utilização de protetor oral teve frequência nula. Verificou-se relação estatisticamente significativa
entre a ocorrência de trauma e os fatores de risco estudados.

Conclusão
Foi encontrada uma alta prevalência de traumatismos dentários na população estudada. Esta mostrou-se alta no Judo, no entanto no
Taekwondo não houve qualquer registo de lesões traumáticas.

Termos de indexação: Artes marciais. Protetores bucais. Traumatismos dentários.

1
Instituto Superior Ciências Saúde Egas Moniz, Departamento de Odontopediatria. Campus Universitário, Quinta da Granja, Monte de Caparica,
2829-511, Almada, Portugal. Correspondência para / Correspondence to: LBPM LOPES. E-mail: <[email protected]>.
2
Cirurgiã-dentista. Lisboa, Portugal.

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LBPM LOPES et al.

INTRODUCTION The inadequate lip coverage was determined at

the start of observation by visual inspection, before the
Dental trauma is considered a public health child noticed he/she was being observed. An adequate
problem, both due to its high prevalence and the impact coverage is defined as the full cover of the maxillary incisors
it has on the life of who is affected1. Its occurrence can at rest, whilst an inadequate lip coverage is an incomplete
have serious consequences and be at the root of various cover of the incisors at rest, with about 2/3 being visible
problems, not just physical but also social, psychological, and exposed12-13.
behavioural, functional, aesthetic and economic1-2. The excess overjet of more than 3 mm was
Contact sports are one of the most common evaluated centrally and visualising the space from the
aetiological factors and are defined as sports in which vestibular face of the most protruded mandibular incisor to
there is physical interaction between players, in the sense the vestibular incisor cusp of the most protruded maxillary
of trying to stop the opposing player or team to win3-8. Oral central incisor13-14.
and maxillofacial lesions are therefore frequent amongst The statistical analysis was performed with SPSS
participants of such sports9. (Statistical Package for the Social Sciences) version 20.0 for
In addition, there are physical risk factors, like Windows.
excess overjet (more than 3mm) and inadequate lip This analysis involved descriptive statistical
coverage, that can contribute to a higher predisposition to measures (absolute and relative frequencies, means and
traumatic dental lesions6,10-11. standard deviations) and inferential statistics. In the latter,
The aim of this assignment is to provide a non-parametric statistics were used since our dependent
perspective on dental trauma in a young population within variables are qualitative. The Chi-squared test of
the practice of two contact sports. independence was used to test the relationship between
qualitative variables. The hypothesis analysed was that no
METHODS more than 20,0% of the cells had expected frequencies
below 5. When this hypothesis was not satisfied, the
The study was conducted at Parque de Jogos 1º de Monte Carlo simulation Chi-squared test was employed.
Maio - INATEL, Lisbon, Portugal. The differences were examined with the support of
Cross-sectional pilot study of observational nature adjusted standardised residuals. In 2 x 2 tables (gl = 1), the
conducted at the gyms where Judo and Taekwondo classes Fisher test was used. The Binomial test was used to test the
took place. Sample of 60 individuals from both genders difference between two proportions.
between the ages of 5 and 15 (year of birth 1999-2009), Tthe significance level was set as (α) ≤ 0.05.
participants in a contact sport. However, any differences significant at a level of (α) ≤ 0.10
The study was carried out resorting to observation were duly commented.
and direct and personal interviews with the participants
and father/mother/legal guardian, from which the
following data and information were collated: gender; date RESULTS
of birth; type of contact sport; dental trauma occurrence;
circumstances regarding the dental trauma (outside or Of the 60 children who participated in the
during sport practice, or both); area of incidence of trauma study, most were male (80.0%, n = 48), with females
(dental and/or soft tissue); occlusion; risk factors (excess constituting the other 20.0% of the sample (n = 12). The
overjet of more than 3 mm and inadequate lip coverage); mean age was 9.9 years (sd = 2.7 years) and the mode was
habits regarding the use of mouthguard and type of 9 years (20.0%). The youngest subjects (5 years of age)
mouthguard; and orthodontic treatment (at the time of represented 3.3% of the total and the oldest (15 years)
the study). 6.7%. The same number of children doing Judo (n = 30)
The observation was conducted in the location/ and Taekwondo (n = 30) were observed.
room where the sports training took place (with the In total, traumas occurred in 23 children,
presence of artificial lighting), with the subject standing up corresponding to a prevalence of 38.3%, with most of
facing the observer, and the father/mother/legal guardian these (82.6%) occurring outside the practice of sport. The
next to him or her. prevalence of trauma during sport was 6.67%, i.e. only

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 Dental trauma in contact sports

4 children suffered traumatic lesions whilst playing their The majority of children did not present any risk
sport. factor (93.3%) and that registering the highest occurrence
Of these 4 children, all of them did Judo; therefore, was excess overjet (3.3%).
there was a higher occurrence of trauma associated with For a significance level of (α) ≤ 0.10, the
the practice of the martial art of Judo compared to the relationship between trauma occurrence and risk factors is
occurrence of trauma in the practice of Taekwondo (13.3% statistically significant (p = 0.088). Children with the excess
vs 0.0%) even though the difference is not statistically overjet risk factor registered higher occurrence of traumas
significant (p = 0.112) (Figure 1). (8.7% vs 0%). All individuals with excess overjet or both
risk factors suffered traumatic lesions, whereas no trauma
was registered for the individual with only inadequate lip
coverage. In children without any risk factors, the absence
of traumas was higher than their presence (Figure 3).

Figure 1. Occurrence of traumas in sport and sport breakdown.

It was detected that most dental traumas (n =

12) occurred in only one tooth. The teeth that carried
the largest number of traumatic lesions were the primary Figure 3 . Occurrence of trauma and risk factors.
maxillary central incisors (63.6%), followed by the
permanent maxillary central incisors (31.8%) (Figure 2). The habit of using a mouthguard was nonexistent,
since none of the children in either Judo or Taekwondo
used it during the practice of their sport. Even so, 10
children indicated that they wore a helmet with visor whilst
taking part in martial arts and they all did Taekwondo,
representing 33.3% of those who played this sport.
There was a higher proportion of traumas in male
compared to female children (41.7% vs 25.0%) although
the difference was statistically insignificant (p = 0.340).
Considering the large range of ages of the sample,
a subdivision of the ages under study was performed in
order to conduct correlation analysis. Two groups were
formed, one with ages between 5 and 10 years old and the
Figure 2 . Number of traumatic lesions (dental and/or soft tissue). other with individuals older than 10 years. The proportion
of trauma was higher in children older than 10 years
Soft tissue lesions occurred in 15 individuals (41.7% vs 36.1%) although the difference was statistically
(25.0%), with the majority of these occurring only on the insignificant (p = 0.788).
lips (66.7%), followed by the gum. Combining teeth and The occurrence of traumas is greatest in the
soft tissue lesions, the most affected regions were thus the bilateral class I (69.6%) and lowest in the bilateral class
primary maxillary central incisors in first place and then the III (4.3%), despite the difference not being statistically
lips (Figure 2). significant (p = 0.242).

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LBPM LOPES et al.

DISCUSSION occurred in the maxillary central incisors (primary and

permanent)1,11-15,18-20,27-28. However, the primary teeth,
The prevalence was defined as the percentage of specifically the primary maxillary central incisors (right
children doing Judo and Taekwondo that suffered dental or left), were the most affected by trauma. This result is
and soft tissue traumas during and outside the practice of identical to that achieved in the study by Chan et al.28 that
their sport. It was 38.3% (n = 23), which translates into includes both dentitions. This seems to be related to the
a high prevalence. Various studies present wide-ranging start of development of motor skills and the accidents
values, from 4.15% to 44.2%1,11,13,15-20. This rate varies during this developmental stage28. Nonetheless, other
considerably between studies, since the methodology studies that include both dentitions refer that, contrary to
employed in each differs significantly. The type of study, what this investigation reports, the teeth suffering most
classification of traumatic lesions, diagnosis criteria, age trauma were the permanent maxillary central incisors11,27.
intervals, type of dentition and geographical location are The maxillary central incisors are the set of teeth
all factors that affect results. most affected by trauma probably due to their earlier
In this investigation, the prevalence of dental eruption, being predisposed to a longer exposure period1.
traumas found in children during the practice of their The dental traumas observed were found to occur
sport was 6.67%, corresponding to 4 occurrences. Within predominantly in only one tooth (n = 12), in agreement
the several mentioned studies, this value varies between with the literature1,11,13,15,18,20.
8.5% and 44.2%9,21-25. The resulting differences may be In terms of soft tissue traumatic lesions, the most
due to a number of factors. It must be considered that the affected region was the lips, similarly to the results of the
sports evaluated in each study as well as age intervals vary study by Chan et al.28.
between studies; this means they are not always the same The relationship between the studied risk factors
and differ from those in this essay. and the occurrence of dental trauma is an extensively
In this study, a relationship was found between researched topic and this relationship was found to be
dental and soft tissue traumas occurring whilst taking part statistically significant in this investigation. Many of the
in sport and the type of sport, with Judo being the only other studies also support the relationship between both
one with occurrences and Taekwondo having none. risk factors and the presence of dental trauma11-12,15-16.
All 4 occurrences happened in Judo, thus Others mention that a relationship was not found or
corresponding to a prevalence of 13.3% in this sport. was not statistically significant in both cases1,18. The
Studies that relate to Judo present similar values, ranging study by Çetinbas et al.14 additionally tells us that there
from 2.7% to 22.3%21,23,26. is a statistically significant relationship with respect to the
With respect to Taekwondo the prevalence found overjet risk factor but not in the case of inadequate lip
was 0%, differing from the results of all studies referenced coverage; the results of this study support this finding,
in this essay; these put forward values varying between as a relationship between risk factors and the occurrence
16.7% and 17.3%9,22. Apart from the factors described of trauma was found, particularly with regards to excess
above, this difference may be due to Taekwondo being overjet.
a sport focusing on self-defence and to the conditions in Within the population participating in contact
which the athletes at the location of the study practice; sports, the use of mouthguards was nonexistent (0%).
i.e. the fact that only 10 out of the 30 young Taekwondo The habit of using mouthguards whilst participating
players participate in combats where there is direct physical in sport varies considerably between studies, since they deal
contact may have limited the prevalence observed. Most with different sports and competitive frameworks. Most
of the younger athletes only perform combat moves of these put forward higher values than the one found in
individually, progressing to actual combats at an older this study; even so, they consider the use of mouthguards,
age or after reaching a more advanced level. Of the 10 especially within martial arts, to be lower21,24,29. In addition,
Taekwondo athletes (33.3%) that already participated in only two of the referenced studies obtained a figure of 0%
direct contact combats, all wore a helmet with visor and with respect to the use of mouthguards14,23.
other protection accessories, which may have also been an Even though the difference is not statistically
advantage in the protection of the oral cavity (teeth and significant, there is a higher proportion of traumas in
soft tissues). children above 10 years of age compared to those below
The majority of traumatic dental lesions 10 (p = 0.788). The occurrence of dental traumas tends

240 RGO, Rev Gaúch Odontol, Porto Alegre, v.65, n.3, p. 237-242 jul./sep., 2017
 Dental trauma in contact sports

to increase with age, probably due to the more frequent essential. As such, the development of educational policies
participation in sport, as well as training and competitions directed at parents, health professionals, students, teachers
becoming more intense in older ages14-15,20-22,26. and coaches are central.
In this investigation most of the athletes were Apart from his or her role in the treatment of
male (80%). Furthermore, a relationship between the male traumatic lesions, the Dentist has a crucial role to play in
gender and the occurrence of dental trauma was found, acting towards the prevention, awareness, education and
although similarly to other studies it was not statistically information of the problem.
significant (p = 0.340)17. This may be related to a higher
participation of boys in contact sports and more physically
aggressive activities1.
Collaborators
CONCLUSION
LBPM LOPES was responsible for the bibliographical
Due to the high prevalence of dental traumas research and writing of the article. JF FERREIRA was
(including soft tissue lesions), preventative measures are responsible for data collection and statistical treatment

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