MOUTH GUARDSAchal Chhina Charlie Peralta Hengameh Babahadi

TARGET AUDIENCEf Target Group: Batch of 23 students playing Taek won doo in the age

group of 10-16 years.f Location: Y.M.C.A located on 931 college street, Toronto, Ontario,

M6H181f Phone number: 416-536-9622

http://www.ymcaacademy.org/?page_id=111

http://mail.ctrc.sk.ca/cms/homepage/1latest-news/827-ywca-toronto-lifeskills-coach-certificate-trainingprogram

WHY THIS TARGET GROUP?f Reason why we chose our target group: We were busy as usual

trying to find a target group in downtown Toronto and possibly thought of all oral health deficits but it was actually Charlie who pointed out that her three children play Taek won doo and she is always worried that they might hurt themselves since they do not wear a mouth guard. This lead us to wonder whether children are supposed to wear a mouth guard while playing martial arts or not. And again our motive was to promote the awareness among young players to wear mouth guards and be safe. So we researched a lot on mouth guards and chose this group as our target group.

INTRODUCTIONf Mouth guard Intro video f http://www.youtube.com/watch?v=lkS37AWxCvQ f Mission statement: We are committed to the promotion of oral

health and prevention of oro facial injuries amongst young players advocating the need to wear a mouth guard.

LITERATURE REVIEW BEGINS: MOUTHGUARDSf The mouth guard, also referred to as a gum shield or mouth protector,

is defined as a resilient device or appliance placed inside the mouth to reduce oral injuries, particularly to teeth and surrounding structures. It was constructed to protect the lips and intraoral tissues from bruising and laceration, to protect the teeth from crown fractures, root fractures, luxations, and avulsions, to protect the jaw from fracture and dislocations, and to provide support for edentulous space. The tremendous popularity of organized sports have an associated risk of orofacial injuries due to falls, collisions, contact with hard surfaces, and contact from sports-related equipment. Considering that 13-39% of all dental injuries are sports related the need for effective methods of orofacial protection is crucial. (Rayes, Arenson, Chudasama, Siracusa, & Wu, 2007)

LITERATURE REVIEWf The Academy for Sports Dentistry (ASD) recommends the use of a properly fitted mouth guard. It

encourages the use of a custom fabricated mouth guard made over a dental cast and delivered under the supervision of a dentist. The ASD strongly supports and encourages a mandate for use of a properly fitted mouth guard in all collision and contact sports. (Clinical Affairs Committee, American Academy of Pediatric Dentistry, 1991) f Children with untreated trauma to permanent teeth exhibit greater impacts on their daily lives than those without any traumatic injury. The yearly costs of injuries, including orofacial injuries, sustained by young athletes have been estimated to be as high as 1.8 billion dollars. Traumatic dental injuries have additional indirect costs that include a childs hours lost from school and parents hours lost from work, leading to lower incomes and financial burden. The majority of sport-related dental and orofacial injuries affect the upper lip, maxilla, and maxillary incisors, with 50-90% of dental injuries involving the maxillary incisors. Use of a mouth guard can protect the upper incisors .The frequency of dental trauma is significantly higher for children with increased overjet and inadequate lip coverage. Initiating preventive orthodontic treatment in early- to middle-mixed dentition of patients with an overjet >3 mm has the potential to reduce the severity of traumatic injuries to permanent incisors. (Clinical Affairs Committee, American Academy of Pediatric Dentistry, 1991)

PSYCHOLOGICAL, SOCIAL, AND ECONOMIC COSTSf Children with orofacial injuries are faced with embarrassment,emotional

problems, avoide social contact and eating. These findings point to the possibility of long-term psychological and social distress. Mandibular fractures, dentoalveolar fractures, and temporomandibular joint injuries can also occur in sports and may require long-term care The direct treatment costs in Ontario are estimated at between$3.2 million and $4.98 million per year. Using data derived from international cost estimates, the total health service costs in Ontario, including direct and indirect costs, were estimated to be between US$22 million andUS$25 million. Another study estimated the total costs for repairing one avulsed tooth at more than 20 times the cost of a custom-fabricated mouth guard and the lifetime costs associated with this one tooth may exceed $15,000.The cost of a mouth guard appears to be well worth the expense, since it can prevent costly treatment of injuries. (Canadian Dental Hygienists Association, 2005)

EVIDENCE FOR MOUTH GUARD EFFECTIVENESSf The Canadian Academy of Sport Medicine (CASM) conducted a

systematic review of the literature on the topic of mouth guards and concussion and found that the evidence for prevention of concussions is poor. On one side, they found four studies suggesting a possible benefit; however, on the other side there are three studies that failed to show any benefit. One study shows that a blow to the jaw is responsible for only 1.6% of concussion whereas another indicates that the use of the upper extremity or the head, and not a blow to the mandible, was most likely to cause a head or neck injury, including concussion.The literature reviews combined with the etiological evidence indicate that one should be cautious when claiming that mouth guards prevent concussion. (Canadian Dental Hygienists Association, 2005)

EVIDENCE FOR MOUTH GUARD EFFECTIVENESSf The prevalence of orofacial injuries depends on the type of sport played,

the degree of contact, and the age, gender and geographical location. For instance, football and rugby have the highest prevalence of orofacial injury at 54% males appear to be at greater risk than female and in contact sports, the risk of an individual acquiring and sustaining an orofacial injury is 10% .

f Conclusion: f Despite the availability of mouth guards and their role in reducing oral

injuries, much more can be done to educate patients about mouth guard use and the risks of dental trauma in sports and recreational activities. Athletes often are hesitant to wear mouth guards with regularity during play. Participants in noncontact sports tend to consider mouth guards unnecessary, intrusive,cumbersome, uncomfortable or, in the case of the custom-made mouth guard, too expensive.

MOUTH GUARD SURVEY QUESTIONSf Do you know what a mouth guard is?f f

Yes - 20 No - 3 Yes - 8 No - 15 Local store or sports shop - 8 Custom made in the dental office 3 In mostly all sports - 2 Only in competitions - 10 Sometimes - 1 Never - 9

f Do you require a mouth guard?f f

f In case you have one, where did you buy it from?f f

f When do you wear a mouth guard?f f f f

MOUTH GUARD SURVEY QUESTIONSf Have you ever been recommended to wear a mouth guard?f Yes - 7 f No - 16

f Do you know that a single blow to your mouth or jaw can cause serious

dental damage that is very painful and expensive to treat?f Yes - 17 f No - 6

f Do you know that mouth guards become less effective over time, and

should be replaced when they get torn, or become too loose or too thin?f Yes -11 f No 12

ASSESSMENT ANALYSIS25

20

15

Yes No A

10

B C D

5

0 Q1 Q2 Q3 Q4 Q5 Q6 Q7

ASSESSMENT ANALYSISf 86% of the target population has an adequate knowledge about mouth f f f f f f

guards. 34% of the target audience was convinced that a mouth guard is required 34% of the target audience wore mouth guards which were bought from local stores/sports shop 43% of the group believed that mouth guards are only worn during sports competition. 30% of the target audience was recommended to wear a mouth guard while 69% havent received a recommendation to wear a mouth guard. 73% of the target audience was well aware of the serious consequences of dental related injuries using a mouth guard while playing contact sports. 52% of the target audience has no idea that mouth guards become less effective in time.

LESSON PLANf Title: Play safe and wear a mouth guard! f Target Group: Batch of 23 students playing Tae kwon do in the age group f

f f f f f

of 10-16 years. Educational Goal: To advocate and encourage the use of mouth guards among teenagers specifically in the age group of 10- 16 years while playing contact sports. Instructional Objectives: To educate and emphasize the use of mouth guards while playing contact sports.. Describing the types of mouth guards and their related advantages and disadvantages Advocating the regularity of using mouth guards while playing sports Discussing how to maintain and clean a mouth guard.

http://www.flickr.com/photos/pafringe/4 492167990/

http://www.flickr.com/photos/pafringe/4492051286/

LESSON PLANf Instructional materials: - Brochures and posters,YouTube

videos, PowerPoint presentation and mouth guards.f Learning activity: A Bingo game on mouth guards. f Instructional set: We will divide the group into three segments and

one person shall be discussing mouth guards per segment.f We will be putting up a table top presentation with mouth

guards fitted on phantom heads.f We will be also displaying posters made by us and the C.D.H.A. f We will begin with the definition of a mouth guard.

MOUTH GUARD FUNCTIONSf The mouth guard works by absorbing the energy at the site of

impact and by dissipating the remaining energy. The three factors involved are: f Time:The greater the force applied, the greater the damage. Mouth guards are made from a flexible and compressive material which allows the impacting object to slow down and halt over a longer period of time and hence the resulting transmitted force is reduced. f Area: Apply a force to a small area and the result can be destructive. Now apply exactly the same force but use a mouth guard to spread it over a significantly larger area and the force applied to each point under the mouth guard is dramatically reduced. f Elasticity: A mouth guard is made from flexible material, which will compress on impact and then return to its original shape (if the distorting force is within the mouth guards elastic limit).

MOUTHGUARD CLASSIFICATIONf The American Society for Testing and

Materials (ASTM) classifies mouth guards by 3 categories: f Type 1: Custom-fabricated mouth guards are produced on a dental model of the patients mouth by either the vacuum-forming or heatpressure lamination technique. The ASTM recommends that for maximum protection, cushioning, and retention, the mouth guard should cover all teeth. The custom-fabricated type is superior in retention, protection, and comfort. When this type is not available, the mouth-formed mouth guard is preferable to the stock or preformed mouth guard.

http://www.flickr.com/photos/pafringe/4492051 286/

MOUTH GUARD CLASSIFICATIONf 2.Type II Mouth-formed, also

http://www.vivomed.co.uk/GUM100_oprosbl/ Opro_Boil_and_Bite_Gumshield_-_Silver.html

known as boil-and-bite, mouth guards are made from a thermoplastic material adapted to the mouth by finger, tongue, and biting pressure after immersing the appliance in hot water. These are the most commonly used among athletes but vary greatly in protection, retention, comfort, a nd cost.

MOUTH GUARD CLASSIFICATIONf 3.Type III Stock mouth guards are

purchased over-the-counter. They are designed for use without any modification and must be held in place by clenching the teeth together to provide a protective benefit. Clenching a stock mouth guard in place can interfere with breathing and speaking and, for this reason; stock mouth guards are considered by many to be less protective. Despite these shortcomings, the stock mouth guard could be the only option possible for patients with particular clinical presentations (eg, use of orthodontic brackets and appliances, periods of rapidly changing occlusion during mixed dentition).

http://www.gentletouchdentalhygiene.com/mou thguards.htm

RELEVANCE AND SIGNIFICANCE OF MOUTH GUARDSf Relevance and Significance of Mouth Guards: Mouth guards are essential

pieces of protective equipment in contact sports. The dental profession strongly supports and promotes the use of mouth guards in a variety of sports activities. Hundreds of thousands of injuries to the mouth and jaw occur each year and as dental hygiene students, it is our aim to share with the audience what we have learned from school about the relevance of mouth guards. According to a research, orofacial injury in sports is prevalent, thus, a mouth guard is fabricated to prevent such serious injuries to occur such as concussions, cerebral hemorrhages, incidents of unconsciousness, jaw fractures, and neck injuries where the lower jaw gets jammed into the upper jaw. Mouth guards are also effective in moving soft tissues away from teeth, preventing bruising and lacerating your lips, gums, and cheeks. Sports such as basketball, softball, wrestling, boxing, soccer, football, lacrosse, rugby, in-line skating, martial arts like Tae kwon do or karate, as well as skateboarding, and bicycling should use mouth guards while competing or practicing.f http://www.cdha.ca/pdfs/Profession/Publications/Journal_November_2005.pdf

INCIDENCE , TREATMENT & PREVENTIONf Incidence and rates of occurrence: The prevalence of orofacial

injuries depends on the type of sport played, the degree of contact, the age, gender and geographical location. For instance, football and rugby have the highest prevalence of orofacial injury at 54% with the males being at a greater risk than females. In contact sports, the risk of an individual acquiring and sustaining an orofacial injury is 10% .f Treatment and prevention of sport-related orofacial injuries is of

prime importance. Physically, orofacial injuries can result in the fall of primary teeth, failure in permanent teeth to erupt, color changes in teeth, development of painful abscesses, and tooth loss resulting in wide spaces giving an unpleasant appearance.

EVALUATIONf Evaluation is the judgement of the merits and worth about a program.

The first step is of course to review the program goals and then to examine the specific measurable objectives achieved.The bottom line in any evaluation is responsibility or accountability. Evaluation determines whether the program accomplishes what it was designed to achieve. (Geurink, 2002)

CLIENT FEEDBACK FORMf In order to ensure that our presentation meets the requirements of our

Clients, we wish to have your views on the service provided. As a Client you have the opportunity to convey your view and concerns to us so that we can adapt to our clients needs. We kindly ask you to complete our Client Feedback form, as this helps us to improve the quality of service offered..

CLIENT FEEDBACK FORMf Using a scale with 1 being the strongest and 4 being the weakest: f 1. Strongly Agree f f f f f f

2. Agree 3. Disagree 4. Strongly Disagree. How would you rate this session of mouth guard presentation? (1 2 3 4) How satisfied were you with the session taught? (1 2 3 4) Did our students appear knowledgeable when delivering the session and answering questions? (1 2 3 4) How would you rate your overall experience? (1 2 3 4) Would you recommend this session to family, friends, or relatives? (1 2 3 4) How satisfied were you with the courteousness of the dental hygiene students conducting the session? (1 2 3 4)

f http://www.youtube.com/watch?v=y2m-Nd124kM

BIBLIOGRAPHYCanadian Dental Hygienists Association. (2005, November). Putting More Bite into Injury Prevention: CDHA Position Paper on Sports Mouthguards. Retrieved January 29, 2011, from Canadian Dental Hygienists Association: http://www.cdha.ca/pdfs/Profession/Publications/Journal_November_2005.pdf Clinical Affairs Committee, American Academy of Pediatric Dentistry. (1991). Policy on Prevention of Sportsrelated Orofacial Injuries. Retrieved January 29, 2011, from American Academy of Pediatric Dentistry: http://www.aapd.org/media/policies_guidelines/p_sports.pdf Darby, M. L., & Walsh, M. M. (2010). Dental Hygiene Theory and Practice. St. Louis: Saunders Elsevier. Geurink, K.V. (2002). Community oral health practice for the dental hygienist. Philadelphia: W.B. Saunders. Little, J. W., Falace, D. A., Miller, C. S., & Rhodus, N. L. (2007). Dental Management of the Medically Compromised Patient. St. Louis: Mosby Elsevier. Rayes, M. A., Arenson, L., Chudasama, D., Siracusa, D., & Wu, A. (2007, April 5). Do Intraoral Mouthguards Work? Retrieved January 29, 2011, from University of Toronto: Do Intraoral Mouthguards Work?