Sports related facial injuries are most prevalent amongst young men aged 16–30 yrs, with male to female injury ratios as high as 19:1. The most common site of injury is the mandible followed by the mid-face. The severity of injury can have a detrimental effect on health and return to sport. Differences in facial structure and strength may be a key element to the success or failure of protective equipment in relation to these injuries. Twenty six healthy male adults (14 Caucasian (C), 12 African Caribbean (AC); mean age (21 ± 1.7 y)) were matched for height (1.79 ± 0.08 cm) and mass (84 ± 16.4 kg). All participants had bone mineral density (BMD) measurements obtained by a Discovery QDR DXA scanner (Hologic Inc, USA). Measurements were taken at the lumbar spine (LS), femoral neck (FN) and facial sites; mandibular ramus (R) and body (Mb). Multivariate statistical analysis was conducted on both groups. Mean BMD for R were 0.65 ± 0.28 g/cm2 for C and 0.92 ± 0.25 g/cm2 for AC, Mb were 1.40 ± 0.34 g/cm2 for C and 1.45 ± 0.36 g/cm2 for AC. A significant (F = 3.752, p < 0.05) ethnicity affect was detected across all BMD sites with the highest significance at the ramus (p < 0.0125). Correlations between BMD for the two facial sites were not statistically significant for the C group (r = 0.323, p > 0.05), but was for the AC group (r = 0.636, p < 0.05). Whole body analyses showed no significant correlations (p > 0.05) between facial sites and FN or LS BMD for either cohort. Mean R and Mb was higher in the AC than C group but both demonstrated high and low values. Mandibular BMD has previously been assessed in osteoporosis and implant design studies. Thus, individuals with lower BMD could be more susceptible to facial injury, particularly if they do not wear facial protection or compete in sports where weight maintenance is important. Our findings highlight that some individuals may be more susceptible to facial injury and therefore, facial protection in sport should be worn and more customised to the individual.

Orofacial traumas account for a third from all injuries sustained during contact sports. Wearing a mouthguard (MG) could reduce the risk of such injuries. Yet, there is an underlying belief amongst many players that the device could cause impedances with comfort, breathing and speech. This might be due to the type of MG or athletes knowledge of which one is best. For example, custom-made MGs were found to provide superior protection and fit compared to ‘boil-and-bite’ or stock MGs. The aim of the present study was to examine the current attitudes and awareness of MGs in the UK via online questionnaire. An online survey was distributed to 308 participants via email and social media, which consisted of 18 questions, addressing the usage of mouth protection in different levels of sport (e.g. national/international), rate of dental injuries and common issues previously raised within the literature. The results showed that 23% of the 308 respondents competed at national level, 15% at international and 10% were part of a club. The majority were rugby union players (57%) and the rest participated in sports such as ice hockey (17%), martial arts (5%) and other team sports. It was found that 40% currently wore a customised MG, however many of them had experienced problems with discomfort and breathing. Almost half of the respondents highlighted that they had stopped wearing a MG due to the device being uncomfortable. These factors are raised quite considerably throughout the literature and within this study; it is therefore a recommendation that these issues need to be addressed. More education about why customised MGs should be worn is required to improve usage and compliance as well as improving manufacturing techniques to reduce the highlighted issues.