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SYSTEMATIC REVIEW
Year : 2022  |  Volume : 40  |  Issue : 1  |  Page : 3-8
 

Sports-related facial trauma in the Indian population - A systematic review


1 Department of Oral and Maxillofacial Surgery, KLE Academy of Higher Education and Research's, KLE Academy of higher Education and Research, V K Institute of Dental Sciences, Belagavi, Karnataka, India
2 Department of Community Medicine, KLE Academy of Higher Education and Research's, Jawaharlal Nehru Medical College, Nehru Nagar, Belagavi, Karnataka, India

Date of Submission27-Nov-2020
Date of Acceptance22-Sep-2021
Date of Web Publication13-Apr-2022

Correspondence Address:
Dr. Shridhar Damodar Baliga
Professor and Head, Department of Oral and Maxillofacial Surgery, KLE Academy of Higher Education and Research, V K Institute of Dental Sciences, Nehru Nagar, Belagavi 590 010, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jisppd.jisppd_505_20

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   Abstract 


Background: Sports injuries are a growing concern which requires immediate attention. Dental injuries are the most common type of orofacial injuries sustained during sports activities. Objectives: This study aims to review the prevalence of sports-related facial trauma in India, to identify the most common types of oro-facial injury incurred due to sports, and to assess the level of awareness regarding preventive measures used in sports. Methodology: The present review was performed in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines. All articles published from 2005 to 2019 on sports-related facial trauma were analyzed. PubMed, Google Scholar, and Cochrane reviews databases were searched using primary keywords. Results: A total of 24 articles published in the period of 2005–2019 were included. The prevalence of sports-related facial trauma was found to be the highest in the study conducted by Selva et al., in 2018, at a rate of 75%, whereas it was found to be minimal in the study conducted by Bali et al. in 2013. While the awareness of mouthguards was reported the highest in a study conducted by Ramagoni et al., in 2007. Conclusion: This study shows that there is a definite need to improve the awareness as well as the usage of protective gear, from the level of schooling, where children are introduced to sports. Prevention of sports-related facial trauma is essential to avoid the serious and lifelong consequences which could be the aftermath of such injuries.


Keywords: Facial trauma, oro-facial injuries, sports injuries, traumatic dental injuries


How to cite this article:
Shreya S, Baliga SD, Baliga SS. Sports-related facial trauma in the Indian population - A systematic review. J Indian Soc Pedod Prev Dent 2022;40:3-8

How to cite this URL:
Shreya S, Baliga SD, Baliga SS. Sports-related facial trauma in the Indian population - A systematic review. J Indian Soc Pedod Prev Dent [serial online] 2022 [cited 2022 May 21];40:3-8. Available from: https://www.jisppd.com/text.asp?2022/40/1/3/343020





   Introduction Top


Participation in sports is of paramount importance in order to maintain a physically as well as mentally healthy lifestyle. There is an ever-increasing percentage of participation in sports in all the age groups, especially children. One consequence of this is a higher proportion of sports-related injuries. The current prevalence of sports injuries is 19.2%–36% among children and adolescents.[1] Dental injuries are the most common type of orofacial injuries sustained during participation in sports.

The occurrence of such oro-facial trauma could have potentially serious consequences, some of which could remain to be a permanent effect. These injuries could have life-altering consequences for athletes, and it is essential that they understand the need for protective gear to be used during any form of sports activity. Many athletes are not aware of the health implications of a traumatic injury to the mouth or of the potential for incurring severe head and orofacial injuries while playing.[2]

The use of protective gear while participating in sports, especially high-risk contact sports, could significantly reduce the frequency of sustaining oro-facial injuries, as many of these injuries have lifelong consequences. Awareness and practices of school teachers, sports officials, parents, and players toward protective devices influence the usage of these protective devices.[3] The use of protective gear is not mandatory in India, which makes the chances of sustaining injuries quite significant.

After doing a thorough literature search, it was found that there was insufficient information regarding the prevalence of oro-facial injury in sports and the awareness of protective gear in India. Therefore, the present study was undertaken to review the prevalence of sports-related facial trauma in India, the most common types of oro-facial injury incurred due to sports, and the level of awareness regarding preventive measures used in sports.


   Methodology Top


Study design

Systematic review.

Data collection

Two reviewers performed the data collection independently. All articles published in the last 15 years (2005–2019) were analyzed. The following databases were used: PubMed, Google Scholar, Cochrane Reviews, using primary keywords such as “Sports injuries” AND “Facial trauma” AND “Oro-facial injuries” AND “India” AND “Mouthguards.” The full-text of all these articles were thoroughly examined and classified under the following inclusion and exclusion criteria.

Inclusion criteria

  1. Articles published during the period of 2005–2019
  2. Articles citing sports injuries causing oro-facial trauma
  3. Articles citing sports injuries which occurred within India.


Exclusion criteria

  1. Articles citing traumatic dental injuries of origin other than sports
  2. Articles whose full-text versions could not be obtained
  3. Narrative reviews where no studies were conducted
  4. Articles published in languages other than English.


Titles and abstracts were screened first, and then the full texts of relevant publications were obtained and reviewed independently. The risk of bias was analyzed using the Newcastle Ottawa Scale,[4] for cross-sectional studies, cohort studies, and case–control studies.

For every study, the following information was retrieved and analyzed; prevalence of sports-related facial trauma, most common orofacial injury caused, the level of awareness regarding preventive measures, and the usage of preventive measures. The present systematic review was performed according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines[5]–PRISMA, and the study protocol is registered with PROSPERO Register #CRD42020171424. The PECO question was used in this review, P (Patient Population of adults and children with orofacial injuries), E (Exposure—etiology of the orofacial injury), C (Comparison between different sites in India), and O (Outcomes, prevalence of trauma for each etiology).[6] Studies that met the inclusion criteria were selected for further analysis [[Figure 1]-PRISMA diagram of studies searched and selected. Duplicate articles were removed].
Figure 1: Preferred reporting items for systematic reviews and meta-analyses. Diagram of studies searched and selected

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Data analysis

Data were analyzed using statistical software R version 4.0.2 and Excel. To check the inter-rater reliability Kappa test was used, where the P < 0.05 was statistically significant. By Cohen's Kappa, it was observed that there was almost perfect agreement between the two investigators [Table 1].
Table 1: Inter-rater reliability Kappa test

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   Results Top


A total of 45 full-text articles and abstracts were identified and assessed for eligibility. Those not fulfilling the inclusion criteria and those with high risk of bias were not taken into consideration. A total of 24 articles published in the period of 2005–2019 were included in the review. The parameters evaluated were the prevalence of sports-related facial trauma in India, the most common types of oro-facial injury incurred due to sports, and the level of awareness regarding preventive measures used in sports.

The prevalence of sports-related facial trauma was found to be the highest in the study conducted by Selva et al., in 2018, at a rate of 75%, whereas it was found to be minimal in the study conducted by Bali et al. in 2013, at a rate of 2.80% [Table 2] and [Figure 2].[7],[8]
Table 2: Distribution of prevalence of trauma from sports

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Figure 2: Distribution of prevalence of trauma from sports[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18]

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Regarding the most common orofacial injury incurred, it was found that soft tissue injuries were the most common injuries reported, which was inclusive of contusion, lip and cheek lacerations, and any other form of facial bruising. The prevalence of soft tissue injuries was found to be as high as 88%, as reported in a study conducted by Selva et al., in 2018, and it was found to be least reported in a study conducted by Solanki et al., in 2016, where it was 15.1% [Table 3].[1],[7],[8],[9],[10],[11],[12],[13],[14],[15],[19],[20],[21],[22],[23] The most reported injury following soft tissue injuries was enamel fracture, which was the highest in a study conducted by Ain et al., in 2016, where it was reported to be 68.5%, and the study reporting the least occurrence of enamel fracture was 16%, as reported in a study conducted by Baldava and Anup, in 2009.[10],[11]
Table 3: Most common injured causes over different studies

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In the case of preventive measures, the awareness regarding mouthguards, and the prevalence of mouthguard usage were analyzed. While the awareness of mouthguards was reported the highest in a study conducted by Ramagoni et al., in 2007, at 79.3%, the same study reported the least usage of mouthguards, at a mere 0.4% in regular mouthguard use, and 1.1% in occasional use [Table 4].[1],[7],[9],[13],[20],[21],[22],[24],[25],[26],[27],[28],[29] The least usage of mouthguards was found to be in a study conducted by Monica, et al., in 2018, at a level of 14.9% [Table 4].[25]
Table 4: Summary of variables over studies

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   Discussion Top


Sports is a diverse field with multiple arenas of participation. It has been a field of utmost importance for decades, yet the most important aspect of it, i.e. protection to the players to prevent injuries is the most often overlooked part. In the present study, the highest reported prevalence of sports-related trauma was 75%, as seen in a study conducted by Selva et al., in 2016, which is an alarming number, as such a high rate clearly indicates that there is a lack in the instructions provided to the participants regarding the usage of protective gear while playing.[7] There are many injuries which could have life-altering consequences, and yet, it is still not given the attention it is required.

In this study, the most common orofacial injury was found to be soft tissue injuries, which is inclusive of intra-oral lip and cheek lacerations. This is followed by enamel fracture and avulsion. Other injuries which have been reported are contusion, tooth dislocation, and jaw fracture.[1],[19] This increased incidence of facial injuries could be attributed to lack of knowledge among the participants and/or their coaches regarding the availability of protective gear for the respective sport, as seen in a study conducted by Karande et al., in 2012.[29]

The third parameter analyzed in this study was the level of awareness regarding preventive measures and their usage amongst players. While the awareness of mouthguards was quite favorable in all the studies, their actual usage is quite low. The highest rate of mouthguard use reported is still <50%, as seen in a study conducted by Gupta et al., in 2016.[26] The major reason for this is that the usage of protective gear while participating in sports is not mandatory in India. Alternative reasons could be that the coaches may not encourage the usage of protective gear, as seen in a study conducted by Monica et al., in 2016, where only 14.9% of the coaches stated that they would advise the use of mouthguards.[25] Further reasons provided by the sports participants in various studies are discomfort on wearing protective gear, difficulty in breathing, etc., as reported in a study conducted by Sethi et al., in 2016.[27]

The impact of such injuries on the physical and mental health of a patient is an essential point of consideration, especially in children, as they are the most involved in sports. This is seen to be in agreement with a study conducted by Gupta et al., in 2018, where a predilection for mandibular fractures, especially the condylar and symphysis fractures was seen in children, and sports was found to be a common reason for the injuries.[18]


   Conclusion Top


The present study shows that even though there is quite a favorable outcome regarding the awareness of protective gear, there is a clear lack of the usage of the same. This shows that there is a definite need to improve the awareness as well as the usage of protective gear, from the level of schooling where children are introduced to sports.

The limitations of the study are that articles published in languages other than English were excluded, due to which their data could not be taken into account. The benefit of this study is that it contributes to the current level of knowledge regarding the prevalence and prevention of sports-related facial trauma in the Indian population, as there have been very few systematic reviews conducted with all of the parameters taken in this study into context.

Sports-related facial trauma is quite a serious issue as such injuries often lead to irreversible penalties, which can affect the individual not just physically but psychologically as well. There is a need for improvement in the measures taken to prevent such injuries. We recommend that every school and college could hire a sports counselor who will guide the coaches regarding preventive measures and the coaches need to make the usage of protective gear mandatory. Efforts should be made by all of the sports committees present in India to make the usage of protective gear mandatory, so that such injuries could be avoided.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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