|Year : 2020 | Volume
| Issue : 1 | Page : 26-31
Assessment of knowledge, attitude, and practices toward orofacial injuries among students engaged in sports from Davangere city: A cross sectional survey
DJ Veeresh1, Apoorva Shukla1, Abhirami Srikanth2, Anshul Jain2, Bishakha Lalani2, Carol Winnie Lobo2
1 Department of Public Health Dentistry, Bapuji Dental College and Hospital, Davangere, Karnataka, India
2 Inters, Bapuji Dental College and Hospital, Davangere, Karnataka, India
|Date of Submission||10-Jul-2019|
|Date of Acceptance||11-Nov-2019|
|Date of Web Publication||16-Jul-2020|
Dr. Apoorva Shukla
Post Graduate, Department of Public Health Dentistry, Bapuji Dental College and Hospital, Davangere, Karnataka
Source of Support: None, Conflict of Interest: None
Context: Traumatic dental injury (TDI) is a common occurrence during sports practice and training sessions which can be determined by the intensity and frequency of the contact. To prevent sport-related oral and facial injuries, the sports personnel should have adequate knowledge regarding occurrence, severity, and prevention of trauma. Studies with regard to awareness about orofacial injuries among sports personnel in Davangere city were not found.
Aim: The aim is to assess the knowledge, attitude, and practices toward orofacial injuries among students of sports academy in Davangere city.
Settings and Design: Sports academy and Hostel, Davangere; cross-sectional survey.
Subjects and Methods: A descriptive cross-sectional survey was conducted among 305 sports students in sports academy in Davangere city. A twenty items self-designed structured, close-ended questionnaire was administered to the participants.
Statistical Analysis Used: Results were generated in terms of frequencies and percentages using the Statistical Package for the Social Sciences Software 20 version IBM 20.
Results: Out of 305 students, majority of the students were males. Forty-four percent of the participants had suffered from injuries to the face while playing sports. The most common type of injury was the fracture of a part of the tooth (51.4%). Falling during sports was the major cause of injury (48.81). Many of the participants were unaware of the fact about replantation of an avulsed tooth. Only 32.1% of the participants had used mouth guards. Seventy-two percent have never interacted with medical or dental experts regarding safety measures for the face and mouth during the sport activities.
Conclusions: The study participant's knowledge was inadequate; attitude was moderate and poor practice toward prevention and management for orofacial injuries. Hence, they should be sensitized to the knowledge of sports-related injuries and its prevention and treatment.
Keywords: Mouthguard, sports, tooth loss, traumatic dental injuries
|How to cite this article:|
Veeresh D J, Shukla A, Srikanth A, Jain A, Lalani B, Lobo CW. Assessment of knowledge, attitude, and practices toward orofacial injuries among students engaged in sports from Davangere city: A cross sectional survey. Int J Oral Health Sci 2020;10:26-31
|How to cite this URL:|
Veeresh D J, Shukla A, Srikanth A, Jain A, Lalani B, Lobo CW. Assessment of knowledge, attitude, and practices toward orofacial injuries among students engaged in sports from Davangere city: A cross sectional survey. Int J Oral Health Sci [serial online] 2020 [cited 2020 Dec 4];10:26-31. Available from: https://www.ijohsjournal.org/text.asp?2020/10/1/26/289876
| Introduction|| |
Physical activity is a strong means for the prevention of diseases among people of all ages and conditions and cost-effective methods to improve public health across the population., Participating in such activities increases risk for injury, including dental trauma, which can be prevented by proper protective care.
Incidence and distribution of sports-related injuries during competition and practice sessions vary based on sport affiliation, participation level, gender and player position, intensity, and frequency., Elimination and identification of risk factors are essential while designing the rehabilitation protocol for prevention.
There is a higher risk of dental trauma in direct contact sports, including boxing, football, and kabaddi which result into loss related to dental health. Young athletes are vulnerable to different injuries than adults, which includes injuries to cartilage, apophysis, and growth plates. As the competitive element intervenes young athletes train harder and longer which leads to sports-related In addition to injury-specific rehabilitation. Mouthguards usage to protect dental and periodontal tissues is an appropriate measure in reducing the occurrence of trauma, but usage is not widely accepted due to complaints of restriction of breathing, communicative problems, and disagreeable esthetics.,,,,,,,,,,
The data extent on sports injuries is likely under-reported, and existing data demonstrate variability in study design. Hence, this study is attempt to find knowledge, attitude, and practice in relation to orofacial injuries among students from sports stadiums in Davangere city.
What is the knowledge, attitude, and practices toward orofacial injuries among students from the sports academy in Davangere city?
| Subjects and Methods|| |
The study design was a descriptive cross-sectional survey.
Purposive sampling is employed for the selection of participants.
After explaining the purpose of the study, those participants who were willing to participate and had given informed written consent were selected for the study.
An investigator-designed, open- and close-ended, self-administered questionnaire was used as a tool to assess the knowledge, awareness, and attitude among the sports personals. It was pretested for its clarity and ambiguity.
The questionnaire consisted of two sections:
Section I: Contained twenty questions to collect the information regarding the knowledge, attitude, and practice among the sports personals of Davangere city.
In this, first 10 questions starting from question number 1 to question number 10 were regarding the previous history of sports injury and usage practice of mouthguards, 11–16 questions were framed for the assessment of knowledge, and 17–20 was for the assessment of attitude toward sports injuries.
Section II: It consisted of six questions to elicit the information regarding demographic details of the participants such as age, gender, and year of completion.
Before the submission of the final study proposal to the Institutional Review Board of Dental College, a pilot survey was conducted among 12 students to check the validity of the questionnaire. The questionnaire was administered to the study participants in March 2017. They were informed about the purpose of the study and informed written consent was obtained from those who were willing to participate.
After 10 days, the questionnaire was distributed to the same participants. The responses were reported and then entered into MS Excel sheets and compared using the Statistical Package for the Social Sciences (SPSS) IBM version 20 software (IBM Corp. in Armonk, New York, USA). The Cronbach's α value obtained was 0.73, which was acceptable (Landis and Koch 1). The responses obtained during the pilot study were not included in the final survey.
A full study protocol was presented to the Institutional Review Board of Dental College, on April 7, 2017. The protocol was scrutinized, and the ethical clearance to conduct the study was obtained (Ref no. BDC/Exam/77/2017-18).
Training and calibration of the investigators
Before the start of the study, all the team members were trained and calibrated by the primary investigator.
Of the 16 team members, 8 members distributed questionnaires in various sports academies and hostel in Davangere city. The administration of the questionnaire began in October and was completed in the month of November 2018.
Implementation/execution of survey
After obtaining permission from the sports academy in Davangere city, the list of sports students were collected. Three hundred and fifty-three athletes were approached in their respective sports ground. The purpose of the study was briefed and the written consent from the participants was obtained. Then, the questionnaire was distributed to the study participants. Instructions were highlighted and any queries were clarified. Questionnaires were given to the participants when they were relatively free. Forty participants, however, were preoccupied and hence could not fill the questionnaire. They were excluded from the final analysis. The response rate was 95%, and it was found to be high.
- The collected data were reviewed, organized, tabulated, and coded in MS Excel sheets then subjected to statistical analysis using SPSS software 20 version IBM 20
- Results were generated in terms of frequencies and percentages.
| Results|| |
A total of 305 sports personal participated in the study. Majority of them were males (78%) with a wide age group ranging from 10 to 47, with a mean age of 21. The majority of the participants were practicing sports from 1 to 5 years (41%) or 6–10 years (32.5%). Contact sports w5e played by 33.1% of the participants [Graph 1]. Majority of the students had witnessed a sports injury to the mouth or face while practicing sports, of which 78.6% of the participants observed multiple injuries. Approximately 15.7% were injuries to the tooth, 16.4% was the injury to the nose, deep cuts to the face and mouth was 8.2% and fracture of the jaw was witnessed by 7.9% [Graph 2]. Injuries to the eye were witnessed by 2.6% and 18.6% had multiple injuries.
Fall during sports was the major cause of injury (48.81%) followed by getting hit by a hard object (32.1%) [Graph 3]. 44.8% of the participants had got injured while playing sports. Fifty-one percent of these injuries are related to fractures of the tooth [Graph 4], 27.9% had mobile tooth because of trauma. Avulsed tooth due to injury was 7.5% [Graph 4]. After suffering from injuries most of the participants went to hospital or clinic (60.6%), some did not receive any type of dental care (25.5%) and few of the participants had taken the home remedy. The treatment was done within 1 day (40.7%) of the accident or within 1 week (30.7%). Many of the participants were unaware of the fact that avulsed tooth can be replanted to the socket. For the question for the time period within which the tooth should be replanted only 12.1% of the participants had the knowledge of replacement for avulsed tooth and 37% of the participants did not aware of the replacement. Half of them believed that immediate action was necessary for a successful outcome for tooth replantation into the socket. On the question about the correct method for carrying tooth, which comes out in-toto to the dentist, only 36.6% of the participating sports personal gave the correct answer.
Use of the mouthguard was not known for many of the participants in the study (41.6%). Only 32.1% of the participants had used mouthguards. The reason for not using mouthguards was majorly difficulty in breathing (30.2%) and followed by communication problem (24.6%) and esthetics (19%). Most of the participants had a positive attitude toward recommending mouth guards to other athletes (72.1%). However, most of them (72.1%) have never interacted with medical or dental experts regarding safety measures for the face and mouth in the sport.
| Discussion|| |
Reason for conducting the study
Sports practice is beneficial and healthy, although some practices can increase the risk of traumatic injuries to dental and oral tissues. Many sports predispose to the occurrence of dental trauma. The literature search about the knowledge, attitude, and practice related to sports injuries among sports practicing personals in Davangere city is limited. Many emergency procedures can be handled by untrained people who witness the accident, not only by the dentist, thus, knowledge of dental trauma by sports participants is fundamental. Understanding these attitudes is important for dental educators, policymakers, and dental organizations which embrace the profession's mission to protect and improve the oral health of the individual and society. Hence keeping this in mind about the current survey was conducted among the dental students of Bapuji Dental College and Hospital and College of Dental Sciences to explore their knowledge, attitude, and practice about sports injuries among sports personal in Davangere city.
Why there is a need to know?
Dental traumatic injuries are a major public health problem with a high prevalence and morbidity. A good proportion of it is due to sports-related injuries. Sports personal have a higher prevalence of dental traumatic injuries. The knowledge use of protective equipment's are known to decrease traumatic injuries and its complication. To impart this knowledge to the sports professional, the assessment of current knowledge is important. This may also help in future for policymaking and advocacy in the same regard.
For the study purpose, participants were defined as sports practicing personal of the in-door and out-door stadiums and sports professionals residing in sports hostel Davangere. Moreover, sports was defined as an activity involving physical exertion and skill, in which an individual or team competes against another or others.
In the present study sample, we found most of the participants were males (78%) interesting fact; in this study, the prevalence of dental injuries among professional sport athletes in Davangere was 44.8.2%. Which was more than the studies conducted by Rouhani et al., Ferrari and Mori et al. reported that 26.2%, 28.8%, and 28.4% of athletes had experienced some sort of dental trauma in three different studies, respectively. The increased prevalence of these types of injuries may be due to improper use and the lack of awareness regarding preventive measures. Fracture of part of a tooth was cited by 51.4% of athletes were the most common type of tooth injury, followed by tooth falling out of mouth (27.9%). This was similar to the study conducted by Mori et al. and Kececi et al. reported that crown fractures were the most common type of dental injury. However, in the study by Rouhani et al., the most common type of injuries to be luxation of the tooth.
In our study, 25% of the athletes with traumatic dental injury did not seek any treatment after dental injury. This shows the lack of awareness toward oral health. This improper attitude is an indication for the oral health perspectives of this type of population in Davangere. Similar results were obtained in a study performed in Brazil by Mori et al. and Rouhani et al., 40.7% of the participants were aware of replanting the tooth in its socket which was in contrast with previous study (51.1%) by Mori et al. (51.1%). Majority of the participants being not aware of the treatment modalities might increase the morbidity related to dental injuries. About 36.36% of the participants had were not aware of media needed to carry avulsed tooth. Milk was considered the ideal storage medium for the avulsed tooth by 6.6% of the participants.
The majority of the athletes (58%) were aware of using mouthguards as a protective device. Tulunoglu and Ozbek found that all boxers and 72.5% of taekwondo practitioners were aware of using mouthguards.[16-18] In the present study even with the awareness of a protective devise such as a mouthguard most of the participants were not using the devise. Ferrari and Ferreria de Mederios reported that the level of awareness of using mouthguards was 71.9% for martial arts and 51% for handball players, respectively. In the present study, only 10.3% reported having used them.
Some important factors which influence wearing mouthguards by athletes include comfort, ability to speak, breathing, and esthetics. The main reasons related to not using mouthguard were a difficulty in breathing (30.2%) and lack of esthetics (19.2%) this was in accordance with previous studies done by Rouhani et al. and Mori et al. There is special mouth guard available which have berating holes that helps reduce breathing impairment. Furthermore, mouth guards available in a variety of colors that can be used which produce good esthetics. The athletes should be made aware of the availability of these mouthguards. The present study results reinforce the need for educational campaigns emphasizing the important role of the mouthguard in the prevention of dental trauma among sports practitioners.
Literature regarding orodental trauma is still lacking in most countries, particularly in developing countries. Some countries reported dental trauma in about 15% of schoolchildren, whereas the prevalence of 5%–12% have been found in children aged 6–12 years in the Middle East. Furthermore, studies from certain industrialized countries have revealed that the prevalence of dental traumatic injuries is on the increase, ranging from 16% to 40% among 6-year-old children and from 4% to 33% among 12–14-year-old children. A significant proportion of dental trauma relates to sports, unsafe playgrounds or schools, road accidents or violence.
This study also adds to the present data regarding orofacial trauma prevalence in sports personal results of this study pertain only to the sports practicing personals of Davangere city, and cannot be generalized to other parts of India as this population cannot be seen as being generally representative of India.
| Conclusions|| |
The present study results showed an evident lack of knowledge among sports participants regarding dental trauma and management and preventive strategies.
- Most of the participants had suffered from some form of dentofacial injuries in their carrier or seen someone get injured
- Most common type of dental injury suffered was the loss of a part of the tooth for which most of them had taken medical help dentist
- Participants lacked in knowledge regarding treatment for avulsed tooth
- Most of the participants did not have a positive attitude towards the use of mouthguards
- Majority of the participants had never used a mouthguard
- The reason for not using the mouth guards was difficulty in breathing while using mouthguard
- Interaction of the athletes in the present study with medical or dental experts for preventive strategies for protection against oro-facial injuries was found to be poor.
- Dentists to play an active role in educating the public in the use of protective equipment for the prevention of orofacial injuries during sporting activities
- Reinforcement of preventive practices in sports practitioners by conducting orientation program repeated once a year for reinforcement
- Mandating the use of properly-fitted mouthguards in other organized sporting activities that carry risk of orofacial injury
- Coaches/administrators of organized sports to consult a dentist with expertise in orofacial injuries before initiating practices for a sporting season
- Recommendations for immediate management of sports-related injuries (e.g., avulsed teeth)
- Continuation of research in the development of a comfortable, efficacious, and cost-effective sports mouthguard to facilitate more widespread use of this proven protective device
- Dentists of all specialties, including pediatric and general dentists, to provide education to parents and patients regarding the prevention of orofacial injuries as part of the anticipatory guidance discussed during dental visits
- Third-party payers to realize the benefits of mouthguards for the prevention and protection from orofacial sports-related injuries and furthermore, encourages them to improve access to these services
- Dentists and child health professionals, school administrators, legislators, andcommunity sports organizations to promote the broader use of mouthguards.
We hereby thank the Principal, Bapuji Dental College, and Hospital, Davangere for allowing permission to conduct the survey. We would like to thank the directors of all the sports academy and all the participants who voluntarily participated in our survey.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kruk J. Physical activity in the prevention of the most frequent chronic diseases: An analysis of the recent evidence. Asian Pac J Cancer Prev 2007;8:325-38.
Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: The evidence. CMAJ 2006;174:801-9.
Keçeci AD, Eroglu E, Baydar ML. Dental trauma incidence and mouthguard use in elite athletes in Turkey. Dent Traumatol 2005;21:76-9.
Kumamoto DP, Maeda Y. A literature review of sports-related orofacial trauma. Gen Dent 2004;52:270-80.
Fos PJ, Pinkham JR, Ranalli DN. Prediction of sports-related dental traumatic injuries. Dent Clin North Am 2000;44:19-33, v.
O'Malley M, Evans DS, Hewson A, Owens J. Mouthguard use and dental injury in sport: A questionnaire study of national school children in the west of Ireland. J Ir Dent Assoc 2012;58:205-11.
Rodd HD, Chesham DJ. Sports-related oral injury and mouthguard use among Sheffield school children. Community Dent Health 1997;14:25-30.
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;56:239-43.
ADA Council on Access, Prevention and Interprofessional Relations, ADA Council on Scientific Affairs. Using mouthguards to reduce the incidence and severity of sports-related oral injuries. J Am Dent Assoc 2006;137:1712-20.
Knapik JJ, Marshall SW, Lee RB, Darakjy SS, Jones SB, Mitchener TA, et al
. Mouthguards in sport activities: History, physical properties and injury prevention effectiveness. Sports Med 2007;37:117-44.
Persic R, Pohl Y, Filippi A. Dental squash injuries – A survey among players and coaches in Switzerland, Germany and France. Dent Traumatol 2006;22:231-6.
Takahashi M, Koide K, Mizuhashi F. Differences in the thickness of mouthguards fabricated from ethylene vinyl acetate copolymer sheets with differently arranged v-shaped grooves: Part 2 – Effect of shape on the working model. Dent Traumatol 2014;30:472-6.
Rouhani A, Ghoddusi J, Rahmandost M, Akbari M. Prevalence of traumatic dental injuries among contact sport practitioners in Northeast of Iran in 2012. J Dent Mater Tech 2016;5:82-5.
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;21:195-200.
Antunes LA, Souza HM, Gonçalves PH, Crespo MA, Antunes LS. Dental trauma and mouthguard: Knowledge and attitudes in physical education undergraduates. Rev Bras Educ Fís Esporte 2016;30:287-94.
Aljohani YR, Alfaifi KH, Redwan SK, Sabbahi DA, Zahran MH. Dental injuries in taekwondo athletes practicing in Saudi Arabia. Saudi Med J 2017;38:1143-7.
Ozbay G, Bakkal M, Abbasoglu Z, Demirel S, Kargul B, Welbury R. Incidence and prevention of traumatic injuries in paediatric handball players in Istanbul, Turkey. Eur Arch Paediatr Dent 2013; 14: 41-5.
Ferrari CH, Ferreria de Mederios JM. Dental trauma and level of information: mouthguard use in different contact sports. Dent Traumatol 2002;18:144-7.
Andreasen JO, Andreasen FM. Dental trauma. In: Pine C, editor. Community oral health. London: Elsevier Sci Ltd; 2002.