# Introduction he cause of traumatic dental injuries are usually the result of an external impact on a tooth and its surrounding tissues. (Soares et al., 2016) Dental trauma is thus a public health problem that affects a large number of people, leading in certain cases to irreversible tooth loss, not only during the accident but also during or after treatment. In athletes, trauma often occurs in youth and contact sports, representing an important group in the etiology of dental trauma. (Ferrari & Medeiros, 2002) Contact sports are those in which practitioners are in direct physical contact with other players or objects, which leads to a higher likelihood of trauma and injury. (Fernandes et al., 2019) Despite efforts to reduce the number of dental injuries, the incidence is relatively high in children and young people. (Sigurdsson, A., 2013) Mouthguards are a viable option for the prevention of traumatic injuries of the oral cavity during sports practice, and their use is more relevant in contact sports, despite their low frequency. (Collins et al., 2016) The practitioners of Hockey should use mouthguards to prevent the occurrence of oral trauma, since Hockey is a high-risk collective sport in which physical contact is marked (Galic et al., 2018) Understand the importance of use the mouthguard by young people who practice a collective contact sport and its relationship with the orofacial trauma suffered by them is the aim of this study. # II. # Materials and Methods This is an observational cross-sectional study with a sample of 117 athletes between 13 and 19 years old practicing a collective contact sport. It was conducted a study at the Sporting Clube de Portugal, Sport Lisboa e Benfica, Clube Desportivo de Paço de Arcos e Parede Futebol Clube, in their respective sports halls. Observation and personal and direct interview with the athletes and father/mother/legal guardian were used to collect the following data: gender; age; occurrence of orofacial trauma; circumstances of the fact of orofacial lesion (outside sports, during sports or both); injury location (dental and/or soft tissue); in case of dental trauma, what type of wound occurred in concrete; if a dentist was report after the harm occurred; if you went to a dentist, how long did it take to do so; in case of avulsion of a tooth, is it aware of the possibility of its reimplantation and, if so, how long do you think is proper to do that intervention; and in which transport medium do you think is The observation was made with the individual sitting, facing the observer, with the parent/legal guardian next to him/her and in the place/sports hall/room where the training took place, with the aid of artificial light. Occlusion and risk factors were evaluated, as well as the presence of traumatic injuries and orthodontic appliances not previously mentioned by the guardians, as well as the DMFT index. Descriptive statistics were performed for the final sample (absolute and relative frequencies), analyzing universal and independent variables. The binomial test was used to compare two proportions. The data collected were statistically analyzed # Results For this research, we considered a final sample of 117 young people between 13-and 19-years old roller hockey practitioners, who're mean, and mode age was 15.3 years and 13 years, respectively. Regarding gender, only 0,9% (n=1) was female. As for sports clubs, 23,1% (n=27) were athletes from Sporting Clube de Portugal, 22,2% (n=26) from Sport Lisboa e Benfica, 32,5% (n=38) from Clube Desportivo de Paço de Arcos and 22,2% (n=26) of Parede Futebol Clube. Overall, 38,5% (n=45) of the athletes suffered orofacial trauma at least once (Figure 1), which specifically affected the teeth in 71,1% (n=32) of the cases (Figure 2). Of these, 68,8% (n=22), the affected dentition was the definitive one (most often the definitive maxillary incisors), 25% (n=8) affected the deciduous dentition (most often the deciduous maxillary incisors) and 6,3% (n=2) both dentitions. Regarding the type of injuries suffered, 62,5% (n=20) of them were coronary fractures, 9,4% (n=3) subluxations, 6,3% (n=2) intrusions, 12,5% (n=4) avulsions and 9,4% (n=3) of another type unknown. It was observed, regarding the type of impact that led to trauma, that 71,9% (n=23) occurred due to impact with some equipment and 28,1% (n=9) due to impact with another athlete (Figure 3). Facing the knowledge about the function of the mouthguard, 90,6% (n=106) of the athletes reported knowing their role, and 9,4% (n=11) reported not knowing his paper (Figure 4). reported no recommendation, 6,0% (n=7) related that it exists and 3,4% (n=4) describes not knowing/not responding. The opinion about the use of a mouthguard is variable, 60,7% (n=71) indicated that it could be used, but it is their choice, 37,6% (n=44) that should be used and 1,7% (n=2) indicated not knowing/not answering (Figure 5). Regarding the 52,6% (n=10) of individuals currently using Type II mouthguard, 31,6% (n=6) had no orofacial lesion in the past, 5,3% (n=1) had orofacial wound in the past, but already used mouthguard at the time and 15,8% (n=3) suffered orofacial trauma in the past, but has not suffered any more injurysince they began using mouthguard. Relatively to the 47,3% (n=9) of individuals currently using Type III mouthguard, 36,8% (n=7) had no orofacial trauma in the past, 5,3% (n=1) had damage in the past, but already used mouthguard and 5,3% (n=1) suffered orofacial harm in the past, but not since they began using oral mouthguard. # IV. # Discussion Regarding the athletes' knowledge about the mouthguard, in the study sample, it was concluded that 106 athletes (90,6%) knew the mouthguard and its function. In Portugal, the values range between 41,8% and 100%, similar to those in other countries where the values range between 51,6% and 97,3%. ( Thus, it was essential to understand the prevalence of mouthguard use. It was found in the sample of 117 young roller hockey practitioners under study, that 19 (16,2%) used a mouthguard in their sports practice. Of these 19, 10 (52,6%) used Type II mouthguard, and 9 (47,4%) used Type III mouthguard. There are several studies on this subject, both national and foreign. In Portugal, the values range between 0,8% and 18%, and abroad the values range between 4,25% and 91,3%. However, differences between studies should be taken in consideration because of the different age groups and modalities. It was also recorded the prevalence of orofacial injuries. In the study sample of 117 athletes, 45 of them (38,5%) reported having suffered orofacial trauma at least once, and 18 of them (15,4%) suffered trauma for more than once. Of the 45 (38,5%), 32 (71,1%) suffered a dental trauma, 4 of them (12,5%) reported using a mouthguard during the incident, 1 of which Type I (25%), 2 Type II (50%) and 1 Type III (25%). In Portugal, the values range between 3,9% and 90%, while abroad, the oscillation between 10,7% and 57,9% is smaller. ( It was also under analysis which type of dental injury was the most prevalent, verifying that it was the dental fracture, because of the 32 athletes who suffered a dental trauma, 20 (62,5%) suffered a coronary fracture. In similar studies conducted both in Portugal and abroad, the results were in line with ours with dental fracture as the most prevalent dental injury. (Figueroa, 2018;Galic et Regarding the type of tooth most affected, it was found that the maxillary incisors were the most injured tooth type in both dentitions, both deciduous with seven individuals (6%) reporting trauma to these teeth, and the definitive one in which 18 individuals (15,4%) stated the same. In studies carried out in Portugal, the results were identical to ours, with the upper incisors being the target of trauma more frequently, as in outside studies. (Juneja et It was found several kinds of impacts during sports that may be responsible for orofacial trauma, of the 32 of injuries sustained during sports, 23 (71,9%) occurred due to impact with some equipment, and 9 (28,1%) due to impact with another athlete, with no injury due to impact with the ground. As for other studies conducted abroad the results vary: (Lahti et al., 2002) reported that 48,9% of athletes suffered impact-related orofacial trauma with sports equipment, specifically with the stick, (Collins et al., 2016 ) reported that 61,3% of dental injuries were due to contact with another athlete, 31,5% to impact with some equipment, 4,1% to impact with the playing surface and 3,2% for another or unknown and (Vucic et al., 2016) reported that the main cause of orofacial trauma was impacted with the ball (57%), followed by impact with the stick (39%) One of the objectives of this study was to verify whether there is a correlation between increased overjet and orofacial trauma. We then observed that of the 32 athletes who suffered a dental trauma, 6 (18,7%) had an overjet greater than 3mm, unlike the remaining 26 (81,3%) who had an overjet less than 3mm. Comparing with similar studies, the results obtained were quite different. We have (Traebert et al., 2004) who reported that children with overjet larger than 5mm suffered more dental trauma (15,3%) than children with overjet up to 5mm (9,9%), (Martins et al., 2013 ) who mentioned that the prevalence of overjet children over 3mm was 21,6%, not being statistically significant in relation to dental trauma and also (Juneja et al., 2018) who found that among children with overjet than 3mm 13,4% suffered traumatic dental injury. Among children with an overjet smaller than 3mm, 9,6% suffered traumatic dental injury. Finally, our main objective was to understand if the mouthguard use decreased the prevalence of orofacial trauma. Orofacial injuries occurred to only four athletes using mouthguard, which 2 (6,3%) only once, and 2 (6,3%) more than once. So, the distribution was as follows: 1 athlete (25,0%) used Type I, 2 (50,0%) used Type II, and 1 (25,0%) used Type III mouthguard. We also observed that of the 19 athletes currently using mouthguard, 6 (31,6%) had already suffered orofacial trauma during past roller hockey practice, and 2 (10,5%) had orofacial trauma in the past, but already used mouthguard and 4 (21,1%) suffered orofacial trauma in the past, but not since they began using mouthguard. Thus, the remaining 13 (68,4%) had never suffered orofacial trauma in the past. Regarding the type of mouthguard currently used by these 19 athletes, there was the following distribution: 10 athletes currently use Type II mouthguard, and 6 (31,6%) did not suffer orofacial trauma in the past, 1 (5,3%) had orofacial trauma in the past, but already used mouthguard and 3 (15,8%) had orofacial trauma in the past, but not since they started using mouthguard. Regarding the Type III mouthguard, 9 athletes currently use it, and 7 (36,8%) did not suffer orofacial trauma in the past, 1 (5,3%) had orofacial trauma in the past, but already used mouthguard and 1 (5,3%) has suffered orofacial trauma in the past, but not since they started using mouthguard. In Portugal, Silva (2013) concluded mouthguard would be effective. In studies abroad, (Lieger & Von Arx, 2006) and (Tiwari et al., 2014) had satisfactory results relatively the reduction of trauma by the mouthguard, unlike (Kroon et al., 2016) who found that 135 athletes used mouthguard at the time of injury and 131 did not, thus registering a higher occurrence of injuries among athletes using mouthguard. V. # Conclusion The mouthguard should be increasingly used by all roller hockey athletes, and they must be sensitized and advised to use it to avoid orofacial injuries and whose consequences may be manifestly negative. ![using the Statistical Package for Social Sciences (SPSS) version 22.0 software program for Windows and synthesized in figures in the Microsoft Office Excel 2019 software program. III.](image-2.png "") 1![Figure 1: Sample distribution regarding the occurrence of orofacial trauma](image-3.png "Figure 1 :") 2![Figure 2: Distribution of the orofacial trauma sample by location](image-4.png "Figure 2 :") 3![Figure 3: Distribution of the sample that suffered orofacial trauma during sports related to the type of impact](image-5.png "Figure 3 :") 4![Figure 4: Total sample distribution regarding knowledge of mouthguard function Considering the counseling on the use a mouthguard in the respective sports club, 90,6%reported no recommendation, 6,0% (n=7) related that it exists and 3,4% (n=4) describes not knowing/not responding.](image-6.png "Figure 4 :") 5![Figure 5: Sample distribution regarding opinion about the use of a mouthguardOf all athletes, only 16,2% (n=19) used mouthguard, 52,6% (n=10) Type II and 47,4% (n=9) Type III (Figure6and Figure7).](image-7.png "Figure 5 :") ![Must be used It can be used, but it is one's option Doesn't know/Doesn't answer](image-8.png "") 6![Figure 6: Total sample distribution regarding the use of a mouthguard](image-9.png "Figure 6 :") 7![Figure 7: Distribution of the sample that uses a mouthguard about to the type used](image-10.png "Figure 7 :") 8910![Figure 8: Distribution of the sample that currently uses mouthguard regarding the occurrence of orofacial trauma during sports practice in the past At the time of the injury, only four athletes used a mouthguard, which 25% (n=1) used Type I, 50% (n=2) Type II and 25% (n=1) Type III (Figure 9 and Figure 10)](image-11.png "Figure 8 :JFigure 9 :Figure 10 :") ![(Al-arfaj et al., 2016; Antunes et al., 2016; Çaglar et al., 2005; Collins et al., 2015; Ferrari & Ferreira De Medeiros, 2002; Figueroa, 2018; Galic et al., 2018; Goswami et al., 2017; Hersberger et al., 2012; Kroon et al., 2016; Lahti et al., 2002; Lieger & Von Arx, 2006; Lopes, 2014; Matos, 2011; Pacheco, 2012; Sethi et al., 2016; Silva, 2013; Tiwari et al., 2014; Vucic, Drost, Wijk et al., 2016)](image-12.png "") 1![Al-arfaj, I., Al-shammari, A., Al-subai, T., Al-absi, G., Aljaffari, M., Al-kadi, A.,? Al-ansari, A. (2016). The knowledge, attitude and practices of male sports Year 2019](image-13.png "Bibliography 1 .") type of occlusion; presence of risk factors (increasedoverjet and high caries index); knowledge about what isand what is the function of a mouthguard; frequency ofmouthguard use; type of mouthguard; frequency ofmouthguard replacement; existence in the clubconcerned of any advice regarding the use ofmouthguards; opinion regarding the relevance of themouthguard; what are the reasons for not using it. © 2019 Global Journals ( )J © 2019 Global Journals 1 * to sports-related dental trauma in Khobar and Dammam, Saudi Arabia -A pilot survey 10.1016/j.sdentj.2016.02.001 The Saudi Dental Journal 28 3 * Trauma dental e protetor bucal: conhecimento e atitudes em estudantes de graduação em Educação Física LA AAntunes HM RSouza PH P QGonçalves MACrespo LSAntunes 10.1590/1807-55092016000200287 Revista Brasileira de Educação Física e Esporte 30 2 2016 * Dental trauma and mouthguard usage among ice hockey players in Turkey premier league EÇaglar BKargul ITanboga 10.1111/j.1600-9657.2004.00271.x Dental Traumatology 21 1 2005 * Dental injuries sustained by high school athletes in the United States CLCollins LBMckenzie AKFerketich RAndridge HXiang RDComstock 10.1111/edt.12228 Dental Traumatology 32 2 2016. 2008/2009 through 2013/2014 academic years * The use of mouthguards and prevalence of dento-alveolar trauma among athletes: A systematic review and meta-analysis LMFernandes JCordeiro LNThiago BMSantiago YWCavalcanti DAlmeida BMarcela 10.1111/edt.12441 Dental Traumatology 35 1 2019 * Dental trauma and level of information: Mouthguard use in different contact sports CHFerrari JMFerreira De Medeiros 10.1034/j.1600-9657.2002.00017.x Dental Traumatology 18 3 2002 * Traumatismos orofaciais e a prática desportiva de hóquei em patins: desenvolvimento e implementação de protetores bucais GFFigueroa 2018 Dissertação de Mestrado, Faculdade de Medicina Dentária da Universidade do Porto * Knowledge and attitudes about sports-related dental injuries and mouthguard use in young athletes in four different contact sports-water polo, karate, taekwondo and handball TGalic DKuncic TPPericic IGalic FMihanovic JBozic MHerceg 10.1111/edt.12394 Dental Traumatology 34 3 2018 * Evaluation of Knowledge, Awareness, and Occurrence of Dental Injuries in Participant Children during Sports in New Delhi: A Pilot Study MGoswami PKumar UBhushan 10.5005/jp-journals-10005-1468 International Journal of Clinical Pediatric Dentistry 10 4 2017 * Dental injuries in water polo, a survey of players in Switzerland SHersberger GKrastl SKühl AFilippi 10.1111/j.1600-9657.2011.01083.x Dental Traumatology 28 4 2012 * Prevalence of Traumatic Dental Injuries and their relation with predisposing factors among 8-15 years old school children of Indore city PJuneja SKulkarni SRaje 10.15386/cjmed-898 India. Medicine and Pharmacy Reports 91 3 2018 * Mouthguard use and awareness of junior rugby league players in the gold coast, Australia: A need for more education JKroon JACox JEKnight PNNevins WWKong 10.1097/JSM.0000000000000206 Clinical Journal of Sport Medicine 26 2 2016 * Dental injuries in ice hockey games and training HLahti JSane PYlipaavalniemi 10.1097/00005768-200203000-00003 Medicine and Science in Sports and Exercise 34 3 2002 * Orofacial/cerebral injuries and the use of mouthguards by professional athletes in Switzerland OLieger TVon Arx 10.1111/j.1600-9657.2006.00328.x Dental Traumatology 22 1 2006 * Uso de goteiras durante a atividade desportiva -estudo piloto LF FLopes 2014 Dissertação de Mestrado, Universidade Católica Portuguesa * Disponível * ACMartins RMarinho MConceição Manso VColares DJCasimiro De Andrade 2013 * Medicina Dentária e Cirurgia Maxilofacial Prevalência de traumatismo dentário e fatores associados em adolescentes no concelho do Porto 10.1016/j.rpemd.2013.07.004 Medicina Dentária e Cirurgia Maxilofacial 54 43 Revista Portuguesa de Estomatologia * Traumatologia oral numa população de atletas infanto-juvenis abordagem epidemiológica e preventiva CR CMatos 2011 Dissertação de Mestrado, Faculdade de Medicina da Universidade de Coimbra * Traumatismos orais em atletas: prevenção e conhecimentos SP FPacheco 2012 Dissertação de Mestrado, Faculdade de Medicina Dentária da Universidade do Porto * QKHex5Cq8QFjAAegQIAhAC&url=https%3A%2%2 Fsigarra.up.pt%2Fffup%2Fpt%2Fpub_geral.show_fil e%3Fpi_doc_id%3D6842&usg=AOvVaw2Kfqw1Om bDkJnLCOHOoK50 * Oral injuries related to Ice Hockey in the province of Alberta, Canada: Trends over the last 15 years JRattai LLevin 10.1111/edt.12387 Dental Traumatology 34 2 2018 * Trauma in Permanent Teeth: Factors Associated with Adverse Outcomes in a University Pediatric Dental Clinic AHRozi JMScott ALSeminario Journal of Dentistry for Children 84 1 2017 * Traumatismos dentoalveolares num hospital central de Lisboa -estudo retrospectivo AS RSantos 2013 Instituto Superior de Ciências da Saúde Egas Moniz Dissertação de Mestrado * Disponível * Attitude toward mouthguard utilization among North Indian school children HSethi GKaur SMangat AGupta ISingh DMunjal 10.4103/2231-0762.175417 Journal of International Society of Preventive and Community Dentistry 2016 6 * Evidence-based review of prevention of dental injuries ASigurdsson 10.1016/j.joen.2012.11.035 Journal of Endodontics 39 3 2013 * Avaliação das consequências do trauma na ATM e a sua relação com uso de Protetores Bucais INSilva 2013 Dissertação de Mestrado, Faculdade de Medicina Dentária da Universidade de Lisboa * Is caries a risk factor for dental trauma? A systematic review and meta-analysis TR CSoares TK SFidalgo ASQuirino DM T PFerreira TKChianca PARisso LCMaia Doi: 10.1111/ edt.12295 Dental Traumatology 33 1 2016 * Traumatic Dental Injuries Resulting from Sports Activities ; Immediate Treatment and Five Years Follow-Up : An Observational ESpinas AMameli LGiannetti 10.2174/1874210601812010001 The Open Dentistry Journal 12 2018 * Dental trauma and mouthguard awareness and use among contact and noncontact athletes in central India VTiwari VSaxena UTiwari ASingh MJain SGoud 10.2334/josnusd.56.239 Journal of Oral Science 56 4 2014 * Prevalência, necessidade de de idade JTraebert IC SAlmeida CGarghetti WMarcenes 2004 20 * Patterns of orodental injury and mouthguard use in Dutch field hockey SVucic RWDrost AJVan Wijk PRWesselink EBWolvius 10.1136/bjsports-2015-095677 British Journal of Sports Medicine 50 11 2016 * Risk of orofacial injuries and mouthguard use in water polo players CZamora-Olave EWillaert AMontero-Blesa NRiera-Punet JMartinez-Gomis 10.1111/edt.12434 Dental Traumatology 2018