Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018

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On Sep 2018

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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Year : 2023 | Month : November | Volume : 17 | Issue : 11 | Page : ZE01 - ZE06 Full Version

Sports Dentistry- A Review of Prevalence and Awareness of Sports Injuries, Dental Implications and Opportunities in Dentistry

Published: November 1, 2023 | DOI:
Sayem Anwarhussain Mulla, Fatima Sajid Munshi, Aarti S Bedia, Sumit Bedia, Laresh Mistry

1. Undergraduate Student, Dental College and Hospital, Bharati Vidyapeeth (Deemed to be University), Navi Mumbai, Maharashtra, India. 2. Undergraduate Student, Dental College and Hospital, Bharati Vidyapeeth (Deemed to be University), Navi Mumbai, Maharashtra, India. 3. Associate Professor, Department of Oral Medicine and Oral Radiology, Dental College and Hospital, Bharati Vidyapeeth (Deemed to be University), Navi Mumbai, Maharashtra, India. 4. Professor, Department of Prosthodontics and Crown and Bridge, Dental College and Hospital, Bharati Vidyapeeth (Deemed to be University), Navi Mumbai, Maharashtra, India. 5. Associate Professor, Department of Paediatric and Preventive Dentistry, Dental College and Hospital, Bharati Vidyapeeth (Deemed to be University), Navi Mumbai, Maharashtra, India.

Correspondence Address :
Sayem Anwarhussain Mulla,
Undergraduate Student, Dental College and Hospital, Bharati Vidyapeeth (Deemed to be University), Navi Mumbai-400614, Maharashtra, India.


Sports dentistry is a branch of oral sciences concerned with the treatment, management, and prevention of the trauma to the orofacial region sustained while participating in any sports activity. Sports have been frequently reported to be an important cause of overall oral trauma in children, as well as adults. There is an evident lack of knowledge in the general population regarding how sports injuries are to be prevented and dealt with. Dentists, if included in sports teams and schools, can help penetrate this knowledge and awareness barrier. Lifestyle, eating habits, stress, etc., have an impact on the performance of the athletes. Stress in athletes can lead to substance abuse, more precisely, tobacco abuse which can affect their performance. Like physiotherapists, even dentists can be made a part of a professional sports team where they can help prevent the complications arising due to facial traumas by the administration of various protective appliances and handle maxillofacial trauma. The present study aimed to evaluate and comprehend the current opportunities for dentists in the field of sports dentistry, whilst emphasising their significance in the professional sports system.


Dental trauma, Mouthguard, Oral health, Orofacial trauma

As stated by International Academy for Sports Dentistry-‘Sports dentistry is referred to as the sports medicine division that deals with the prevention and treatment of dental injury and related oral diseases associated with sports and exercise’ (1). To provide comprehensive care to patients, a dentist must be discerning and skilled in all areas of dentistry. All dentists should understand the concept of protecting and preserving the orofacial structures from trauma and injuries. They should be familiar with common emergencies, as well as, patient behaviour management. This is critical in cases of injuries related to trauma especially in the head, face and neck region. Dentists should be aware of the mechanisms behind the occurrence of traumatic injuries and their prevention (2). The International Olympic Committee has stated that athlete health is a priority, and international sporting bodies advocate a holistic approach in ensuring athlete well-being and performance (3),(4).

As the nation is progressing on multiple grounds such as commerce, economy, education, technology as well as sports, more and more people are finding their way onto the fields. Sports are a stress buster and play a crucial role in maintaining a healthy lifestyle. However, it also exposes one to muscle injuries, concussion, soft tissue laceration, and broken teeth. To summarise, athletes are at a higher risk of developing any sort of injury but most importantly, injuries to the oral and maxillofacial region can leave a lifelong psychological impact on the athletes. Fortunately, most of these are avoidable by understanding sports physiology, use of appropriate techniques and gears facilitated by the assistance provided by sports dentists. Such injuries can be addressed in two ways: one is to provide immediate treatment for any injury that may occur on the field and the other method is the use of preventive devices and measures to protect the athletes during the event. Immediate diagnosis and evaluation along with proper management of the injuries to athletes’ dentition as well as the entire maxillofacial region can result in saving or restoration of teeth and the treatment of the injury (if any) to the orofacial region (2). Preventive appliances come in the form of helmets, face shields, mouthguards, etc., Mouthguards are of many types like stock, mouth-formed, custom-made, etc.,

Prevalence of Orofacial Injuries during Contact Sports

Pasternack JS et al., concluded that 27% of baseball players were affected by orofacial injuries during contact sports (5). In 2008, Wenli M stated that, the prevalence of orofacial injuries in basketball players was 80.6% amongst professional players and 37.7% amongst semi-professionals (6). Caglar E et al., reported that 16.6% football athletes were affected (7). Handball affected 21.8% of the athletes, according to Galic T et al., (8). In the same year, with respect to hockey, Praveena J et al., showed that the prevalence rate was 33.8% (9).

Epidemiology of Orofacial Injuries

The host-agent environment can be amended to study the epidemiology of sports injuries (Table/Fig 1). Host factors like age, gender, skilled coaching and developmental stage of an individual, body proportion along with orthodontics of previous injuries affect the chances of occurrence of orofacial injuries in the athletes. Psychological status of the athlete as well as sports type also affects the performance (10).

Oral Health Related Quality of Life (OHRQoL) of Athletes

Oral Health Related Quality of Life (OHRQoL) has been described as a multifaceted concept that reflects (among other things) comfort of the people during certain activities such as eating, sleeping, and engaging in social interaction, their self-esteem, and their satisfaction with respect to their oral health (11). It can also affect their satisfaction levels of their oral health. Pain, discomfort, tooth discolouration and missing teeth, especially the anterior teeth are the sequelae of Traumatic Dental Injuries (TDI) common in contact sports, which results in a poor OHRQoL status amongst the athletes.

According to Needleman I et al., 33-66% of athletes who have faced physical trauma during sports activity, reported that it negatively impacted their oral health. Of this, 28-40% were bothered due to their oral health or reported of having an effect on their QoL. A 5-18% had an effect on their performance (13). Thus, oral health is considered to be one of the determinants of QoL (14). Some commonly used scales for the measurement of OHRQoL in athletes includes Beck’s Depression Inventory (BDI), Oral Health Impact Profile-14 (OHIP-14), etc.

A study done using OHIP-14 and BDI scale amongst elite athlete students in Kerman revealed low OHRQoL and high depression (15). Another study done using just the OHIP-14 scale, revealed that the most prevalent condition with respect to the oral cavity included dental erosion and malocclusion in Brazilians, which in combination with tooth sensitivity were most likely to impact or affect the OHRQoL of the athletes (16). A study focused on athletes with disabilities found that most affected domain was physical pain, followed by psychological discomfort along with periodontal disease, need for complete dentures and number of sound teeth, Decay-Missing-Filled Teeth (DMFT) index and its component. These clinical parameters are usually related to impaired OHRQoL (17).

Does Oral Health Affect the Performance of Athletes?

One of the determining factors of QoL is oral health (14). There is a myriad of literature present stating the effects of oral diseases such as caries (18), periodontal disease (19), and pericoronitis (20) on QoL. With pellucid psychosocial effects of oral health, it would be astonishing if physical training and performance in athletes with poor oral health were unaffected. Furthermore, in an environment where the ‘aggregation of marginal gains’ is condemning, subtle effects on training and performance could be extremely important. Oral diseases may have an impact on performance due to pain (21), increased systemic inflammation (22), and decreased confidence and socialisation (14). In conclusion, poor oral health may have a direct impact on performance through pain caused by disease conditions, but it may also have a more subtle impact through effects such as increased systemic inflammation and psychosocial effects that athletes may be unaware of.

According to a study done in 2018, 32% of athletes reported that the state of their oral health impacted their sports performance, while 5.8% admitted that performance was truly affected. According to the study, 29.9% of athletes experience oral pain, 9% have difficulty training/competing, and 3.8% have had to reduce their training sessions. Moreover, athletes reported difficulty eating (34.6%), smiling (17.2%), and relaxing (15.1%) as a result of their poor oral health (13).

Athletes and Dental Trauma during Sports

Despite accounting for 1% of the human body, injuries in the oral region account for 5% of total bodily injuries among all ages, according to a one-year longitudinal prospective Swedish survey (23). Traumatic forces are one of the four most common oral diseases. They can disrupt the supporting periodontal apparatus, including bone and peripheral soft tissues, as well as the tooth structure. Crown and/or root fractures involving or not involving the pulp are examples of TDI related to teeth (Table/Fig 2) [24-30]. Different degrees of periodontal support alteration, such as concussion, subluxation, luxation, and avulsion, can occur depending on the severity of the injury (31).

Athletes should be aware of the risks that are usually associated with participation in sports activities and pay close attention to the health of their oral environment, as changes in the oral health may have a negative impact on the athlete’s overall health and well-being, as well as physical performance (32). Trauma, joint disorders and alterations are associated with athletic performance and have a significant impact on athletes’ QoL.

Athletes and Salivary Factors

Intense physical training and exercise at the start of sports competitions as well as during the training hours can significantly reduce the salivary flow rate and secretory immunoglobulin A (s-IgA) load that can result in a decreased host defence response and increase the risk to specific pathologies such as Upper Respiratory Tract Infections (URTI) and, more specifically, pathologies of the oral cavity (33). Salivary cortisol levels as well as salivary Alpha-Amylase (sAA) are higher in athletes who experience more stress during the sports activity (34).

In a study where athletes were sampled in the middle of the season had longer Telomere Length (TL) on average than those sampled in the beginning of the season, possibly reflecting the physiological effects of different training contexts or regimes. Females had shorter TL than males, which could be attributed to hormonal differences or the presence of the female athlete Triad of Relative Energy Deficiency in Sport (RED-S). Female athletes in sports where weight and/or leanness are emphasised for performance or competition categories (e.g., wrestling or track and field for this study) are thought to be more vulnerable to the Triad, potentially influencing TL data (35),(36).

A study targeted towards kickboxing athletes found significant increases in indicators of lipid peroxidation activity and the concentration of lactic acid (4-fold); analysis of correlation matrices confirmed the absence of expressed changes. At the same time, there was a significant decrease in the levels of catalase (10-fold from 3.69 μkat/L to 0.39 μkat/L) and pyruvic acid (from 3.92 μL/l to 0.55 μL/l) (37).

Link between Athletes, Systemic Health and Oral Health

The oral environment is impacted by the athlete’s lifestyle, hygiene, and eating habits, as well as medications and sports participation. A review done to understand the relationship physical activity has with the athletes’ oral health revealed that the oral health is poor especially in athletes who partake in competitive activities, although it is reported to be significantly lower in a variety of sports individuals. Thus, types of sports an athlete plays has a major role in their poor oral health (13),(38).

Oral Pathologies Observed in Athletes

Sport activities, according to Needleman I et al., can be considered as a major cause for the onset of various oral pathologies such as dental caries, with an incidence rate ranging from 15% to 70% which includes dental erosion (36%), pericoronitis (5-39%), dental trauma (14-70%) and periodontal disease (upto 15%) (13).

Athletes and Wasting Diseases of the Oral Cavity

Dental erosion is a very common pathology encountered in athletes, and it has been linked to the increased consumption of food and soft drink by the young individuals and athletes. The internet and social media have promoted the widespread use of energy providing soft drinks which are primarily based on electrolytes and carbohydrates aimed to compensate for dehydration, mineral salt depletion, hypoglycaemia, and muscle glycogen depletion that are encountered in athletes during the physical activity. However, there is no valid scientific evidence to support the use of nutritional supplements, and a healthy diet does not necessitate the use of mineral supplements (39),(40),(41),(42).

Stress and Habit Formation in Athletes

Overtraining syndrome is an aggregation of training as well as/or non training stress that leads to a decrease in the long-run performance capacity of the athlete, which may or may not display signs and symptoms of physiological and psychological maladjustment, with recovery taking several weeks or months (43). Higher stress levels are associated with substance abuse in athletes, especially tobacco abuse (44). Tobacco is harmful for all. In athletes, it can exhibit immediate to long-term consequences. Carbon monoxide, a harmful chemical present in nicotine products disturbs the oxygen uptake of muscles, constricts the blood vessels, which can lead to easy fatigue in athletes leading to a significant decrease in their endurance. This can ultimately lead to an increased susceptibility to injuries (45).

When focusing on the oral cavity, it can increase the caries incidence. Since almost all athletes already suffer from hyposalivation and have a frequent carbohydrate rich diet and consume sports drinks, tobacco abuse can act as an adjuvant in the occurrence of dental decay, erosion, abrasion, gingival recession. It also hinders the maintenance of periodontal health which in turn can affect the systemic health (46).

Prevention of Orofacial Injuries

Wearing mouth guards and headgear is the most common method for avoiding orofacial injuries during sports.

i. Stock mouthguards: Stock mouthguards are easily available but in limited sizes. They are made from rubber, polyvinyl chloride, or a copolymer of polyvinyl acetate (47).

ii. M Mouth-formed protectors: These consist of two sub-types. The shell-liner and the other one being the thermoplastic mouthguard. The shell-liner type is created by placing freshly mixed ethyl methacrylate in a hard shell, which is then placed in the athlete’s oral cavity and moulded over the maxillary teeth and the associated soft tissues (48). The thermoplastic or preformed (also known as “boil and bite”) is immersed in boiling water for 40-45 seconds before being transferred to cold water and adapted to the teeth.

iii. Custom made mouth protectors: This is the most effective and best of the three options available. It is fabricated using a thermoplastic polymer and is built over a dentition model of the athlete designed by the dentist, and it perfectly fits the athlete’s mouth (49).

iv. H Helmet: Helmets are aimed to shield the skin on athletes’ scalp and ears from abrasions, contusions, and lacerations. They guard the head, face and neck region against skull fractures and protect the brain and Central Nervous System (CNS) from severe concussions, loss of consciousness, cerebral haemorrhage, paralysis, brain damage, and death (50).

v. Facemasks: It offers various degrees of horizontal defence to the maxillary bone and the region by including an extended finger, a closed fist followed by a forearm, or a helmet pointed at the zygomatic nasal pyramid or mandibular arch, respectively (51). One significant drawback of the facemasks is that they have a protruding object that an opponent can easily grab. During a fight, if an opponent pulls or twists the facemask, it could seriously hurt them physically and cause injury to their muscles, neck, or spinal column (52).

According to Pawar P et al., custom-fitted mouthguards are the best protective options for the athletes (53). A study done by Tjønndal A and Austmo Wågan F revealed that most of the athletes believed that headgear is the best option as it can save from severe injuries like concussion. However, very few of them reported wearing this protective headgear unless extremely necessary (54).

Sports Dentistry Awareness in India

A cross-sectional survey done on 2000 school children aged between 8-11 years comprising of male and female gender attending private schools in Ludhiana, Punjab, India revealed that the prevalence of the use of mouthguard was only 4.25%. A 78% of the children believed mouthguards can protect them from injuries (55). Similarly, a study done on athletes aged 6-18 years revealed that 86% of them were aware of the mouthguard device, however, only 27% of them ever used it (56). Tiwari V et al., in their study on athletes showed that the awareness pertaining to mouthguards was higher (67.5%) in athletes participating in contact sports than those who participated in non-contact sports (34.4%) (57). However, when combined, the awareness percentage is higher than children and adolescents. This projects the fact that there is a need to increase the awareness of mouthguards in younger population of India.

A study done exclusively on physical instructors in Sullia reported that only 58% of 50 included physical instructors were aware about the mouthguard appliances. This enlightens the fact that there is need for creating awareness not only amongst the athletes but also the instructors (58).

Four different PubMed searches conducted by the authors revealed a lack of awareness in the general population regarding sports dentistry, particularly in India. A PubMed search with the term “Sports” revealed a plethora of articles on sports and health (Table/Fig 3)a(59). This indicated that as time passed, people became more aware of the importance of conducting sports-related research. There are 705 PubMed-indexed articles in 2021 alone, followed by 698 articles in 2022. The second and third searches, which used the terms “Sports Dentistry” (Table/Fig 3)b (60) and “Sports Dentistry Awareness”, revealed that there is still an exponential growth in the literature, corresponding to the growing awareness globally (Table/Fig 3)c (61). However, the fourth and final search using “Sports Dentistry Awareness India” revealed that there is a severe lack of articles on Sports Dentistry in India (Table/Fig 3)d (62). There are no clinical trials on the subject. When compared to the rest of the world, India has a dearth of reviews, with only two systematic reviews on preventive measures in sports dentistry completed in 2021 and 2022 (59),(60). When the data is compared to the number of people who participate in sports each year from India, it becomes clear that Indians’ awareness of sports-related trauma is very low. As a result, it is critical to raise public awareness about the plethora of sports-related injuries and their prevention. Participation in Olympics events over the years has increased at both, international as well as national level (61). However, the number of dentists to suffice the oral health care needs of this population is still lagging.

Dentists as a Part of Sports Team

Physiotherapists, doctors and nutritionists have long been an integral part of sports teams, be it national or international. Cricket, a sport most familiar to the Indian community, has employed several physiotherapists, both Indian and International. For several decades now, the community has recognised the importance of professional support in the field of physiotherapy, with chiropractors being the most recent addition. Dentists, if in a similar way are made a part of the sports teams-whether amateur or professional, can use their knowledge and expertise to help provide the team members with a variety of aforementioned safety equipment. A study done by Goswami M et al., pointed out that of the 71.3% aware athletes, only 20.9% used mouthguards. The authors implied that the reason for this was lack of motivation and encouragement on the coaches’ end. Thus, a sports dentist will be able to encourage and motivate the athletes to wear, them pointing out the need and benefits of the same (62). Their presence will also ensure that any emergency will be taken care of immediately and in a professional way. This will ensure the athlete’s well-being both on and off the field, since the aesthetic appearance of one’s teeth plays a pivotal role in his or her confidence. The need for sports dentists has also been substantiated by winters in his study he emphasises their need in high schools and professional teams (63).

Studies show that of the 13-39% dental injuries, 11-18% are maxillofacial injuries related to sports accidents (64). A 10-year longitudinal study of mouth and jaw injuries found that approximately around 32% of facial trauma cases in children occurred during sports activities (65). Few other studies show that around 50% of children have their primary or permanent dentition affected by traumatic injuries during their school going years (66). The most frequently damaged tooth is the maxillary central incisor, which is traumatised twice as frequently in men as in women (67). Orofacial sports injuries include both soft tissue wounds like lacerations and hard tissue wounds like luxations, tooth intrusions, crown and/or root fractures, total avulsions, and/or dental-facial fractures. The athlete’s oral and maxillofacial health can be monitored long-term and managed by a sports dentist, which invariably has an impact on the athlete’s physical and mental health.

Opportunities for a Sports Dentist

The Academy of Sports Dentistry, USA has specified the qualification requirements for a Sports Team Dentist. However, there are no such specific requirements in India, apart from the obvious, i.e., a valid licence. Currently in India, only two institutes are offering Sports Dentistry programmes, i.e., the Indian Dental Association (IDA) which provides a fellowship in Sports Dentistry and the Institute of Sports Science and Technology, Pune (ISST, Pune) provides a Certificate Course in Sports Dentistry.

The fellowship offered by IDA is available in both classroom and online format. Minimum requirement is BDS or equivalent degree from a recognised institution in India or overseas. The certificate course offered by ISST, Pune is Distance Diploma in Sports Dentistry (DDSD), which was started in the year 2008 and is for six months duration. BDS degree from any recognised university in India is the minimum eligibility criteria. Candidates can enroll throughout the year by registering on the official website of the respective institutes. With the exponential increase in the nation’s population, and its ever-increasing demand for oral healthcare, it is imperative that more educational institutions offer specialisation in the field of dentistry to better cater to the community (Table/Fig 4).


To summarise, a sports dentist will be an excellent resource for both school and professional sports teams. They can assist athletes and students in recommending and prescribing safety clothing for their sporting activities. They will make certain that there is sufficient awareness of this topic in schools and sports teams. Due to a custom mouthguard’s triple function as a reservoir of substances protective for the oral ecology, protection against sports-related injuries, and enhancement of athletic performance, these risks can be avoided. Additionally, assessing the athletes’ risk status for contracting various diseases through clinical examination, salivary analysis, oral health promotion programmes, and monitoring their oral health may be possible. Similar to school and professional doctors, psychiatrists, and others, sports dentists can play a crucial role in the system that can enhance athletes’ oral health.


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DOI and Others

DOI: 10.7860/JCDR/2023/65057.18687

Date of Submission: Apr 29, 2023
Date of Peer Review: May 18, 2023
Date of Acceptance: Sep 15, 2023
Date of Publishing: Nov 01, 2023

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? NA
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: May 03, 2023
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