Abstract
Although mouthguards are effective, inexpensive, easy to use, and readily available, this form of protective equipment has been underutilized. “Impulsive delay discounting” (an index of impulsive behavior) among high school athletes may help explain their decision making regarding use of protective equipment such as mouthguards. We investigated the relationship between high school baseball, softball, and basketball players’ mouthguard use, impulsive delay discounting, and the precaution adoption process model (a behavior change theory). A convenience sample of boys’ and girls’ basketball and baseball/softball players at 21 high schools in the Greater Columbus, Ohio, metro area completed a self-administered survey that captured their demographic information, knowledge, attitudes, and beliefs regarding mouthguard use, impulsive delay discounting, and precaution adoption process model stage. We surveyed a total of 1636 students (55.9 % male, 43.8 % female, 0.3 % unknown). Only 12.3 % reported using a mouthguard either every time or sometimes during practice or competition. The primary reasons reported for not wearing mouthguards were they were not required to (65.3 %) and that the athletes could not breathe or talk while wearing one (61.5 %). These reasons were consistent across sex and sport. Most athletes reported that their coaches (87.3 %) and parents (64.5 %) had never talked to them about wearing a mouthguard. Lower precaution adoption process model stage was significantly associated with higher impulsivity (p < 0.001) and higher delayed discounting (p = 0.016) after adjusting for school, sport, and sex. Voluntary mouthguard use among high school athletes playing basketball and baseball/softball remains low despite the risk of dental injury in these sports. Effective, evidence-based, targeted, and tailored interventions to improve adolescent athletes’ use of mouthguards to prevent sports-related dental injuries should be based on the specific behavioral and social factors influencing each athlete’s decision making regarding use of mouthguards.
Similar content being viewed by others
References
ADA Council on Access & ADA Council on Scientific Affairs. (2006). Using mouthguards to reduce the incidence and severity of sports-related oral injuries. Journal of the American Dental Association, 137(12), 1712–1720.
Ainslie, G. (1975). Specious reward: A behavioral theory of impulsiveness and impulse control. Psychological Bulletin, 82(4), 463–496.
American Academy of Pediatrics. (2012). Family life: Daughters. http://www.healthychildren.org/English/family-life/family-dynamics/pages/Daughters.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token. Accessed February 26, 2015.
Beachy, G. (2004). Dental injuries in intermediate and high school athletes: A 15-year study at Punahou School. Journal of Athletic Training, 39(4), 310–315.
Berg, R., Berkey, D. B., Tang, J. M., Altman, D. S., & Londeree, K. A. (1998). Knowledge and attitudes of Arizona high-school coaches regarding oral-facial injuries and mouthguard use among athletes. The Journal of the American Dental Association, 129(10), 1425–1432.
Berry, D. C., Miller, M. G., & Leow, W. (2005). Attitudes of Central Collegiate Hockey Association ice hockey players toward athletic mouthguard usage. Journal of Theory and Practice of Dental Public Health, 65(2), 71–75.
Borssen, E., & Holm, A. K. (1997). Traumatic dental injuries in a cohort of 16-year-olds in northern Sweden. Endodontics & Dental Traumatology, 13(6), 276–280.
Bourdin, M., Brunet-Patru, I., Hager, P. E., Allard, Y., Hager, J. P., Lacour, J. R., et al. (2006). Influence of maxillary mouthguards on physiological parameters. Medicine and Science in Sports and Exercise, 38(8), 1500–1504.
Collins, C. L., & Comstock, R. D. (2008). Epidemiological features of high school baseball injuries in the United States, 2005–2007. Pediatrics, 121(6), 1181–1187.
da Matta, A., Gonçalves, F. L., & Bizarro, L. (2012). Delay discounting: Concepts and measures. Psychology & Neuroscience, 5(2), 135–146.
DeYoung, A. K., Robinson, E., & Godwin, W. C. (1994). Comparing comfort and wearability: Custom-made vs. self-adapted mouthguards. The Journal of the American Dental Association, 125(8), 1112–1118.
Diab, N., & Mourino, A. P. (1997). Parental attitudes toward mouthguards. Pediatric Dentistry, 19(8), 455–460.
Fakhruddin, K. S., Lawrence, H. P., Kenny, D. J., & Locker, D. (2008). Impact of treated and untreated dental injuries on the quality of life of Ontario school children. Dental Traumatology, 24(3), 309–313.
Ferrari, C. H., & Ferreria de Mederios, J. M. (2002). Dental trauma and level of information: Mouthguard use in different contact sports. Dental Traumatology, 18(3), 144–147.
Finch, C., Braham, R., McIntosh, A., McCrory, P., & Wolfe, R. (2005). Should football players wear custom fitted mouthguards? Results from a group randomized controlled trial. Injury Prevention, 11(4), 242–246.
Gardiner, D. M., & Ranalli, D. N. (2000). Attitudinal factors influencing mouthguard utilization. Dental Clinics of North America, 44(1), 53–65.
Hawn, K. L., Visser, M. F., & Sexton, P. J. (2002). Enforcement of mouthguard use and athlete compliance in National Collegiate Athletic Association men’s collegiate ice hockey competition. Journal of Athletic Training, 37(2), 204–208.
Herrnstein, R. J. (1981). Self-control as response strength. In C. M. Bradshaw, E. Szabadi, & C. F. Lowe (Eds.), Quantification of steady-state operant behavior (pp. 3–20). Amsterdam: Elsevier.
Huffman, E. A., Yard, E. E., Fields, S. K., Collins, C. L., & Comstock, R. D. (2008). Epidemiology of rare injuries and conditions among United States high school athletes during the 2005–2006 and 2006–2007 school years. Journal of Athletic Training, 43(6), 624–630.
Kirby, K. N., & Herrnstein, R. J. (1995). Preference reversals due to myopic discounting of delayed reward. Psychological Science, 6(2), 83–89.
Knapik, J. J., Marshall, S. W., Lee, R. B., Darakjy, S. S., Jones, S. B., Mitchener, T. A., et al. (2007). Mouthguards in sport activities: History, physical properties and injury prevention effectiveness. Sports Medicine, 37(2), 117–144.
Kvittem, B., Hardie, N. A., Roettger, M., & Conry, J. (1998). Incidence of orofacial injuries in high school sports. Journal of Theory and Practice of Dental Public Health, 58(4), 288–293.
Lancaster, D. M., & Ranalli, D. N. (1993). Comparative evaluation of college football officials’ attitudes toward NCAA mouthguard regulations and player compliance. Pediatric Dentistry, 15(6), 398–402.
Lephart, S. M., & Fu, F. H. (1991). Emergency treatment of athletic injuries. Dental Clinics of North America, 35(4), 707–717.
Logue, A. (1988). Research on self-control: An integrating framework. Behavioral and Brain Science, 11, 665–679.
Maestrello-deMoya, M. G., & Primosch, R. E. (1989). Orofacial trauma and mouth-protector wear among high school varsity basketball players. Journal of Dentistry for Children, 56(1), 36–39.
Morrongiello, B. A., & Hogg, K. (2004). Mothers’ reactions to children misbehaving in ways that could lead to injury: Implications for gender differences in children’s risk taking and injuries. Sex Roles, 50(1–2), 103–120.
Morton, J. G., & Burton, J. F. (1979). An evaluation of the effectiveness of mouthguards in high-school rugby players. The New Zealand Dental Journal, 75(341), 151–153.
Newsome, P. R. H., Tran, D. C., & Cooke, M. S. (2001). The role of the mouthguard in the prevention of sports-related dental injuries: A review. International Journal of Paediatric Dentistry, 11, 396–404.
Nowjack-Raymer, R. E., & Gift, H. C. (1996). Use of mouthguards and headgear in organized sports by school-aged children. Public Health Reports, 111(1), 82–86.
Patrick, D. G., van Noort, R., & Found, M. S. (2005). Scale of protection and the various types of sports mouthguard. British Journal of Sports Medicine, 39, 278–281.
Patton, J. H., Stanford, M. S., & Barratt, E. S. (1995). Factor structure of the Barratt impulsiveness scale. Journal of Clinical Psychology, 51(6), 768–774.
Perunski, S., Lang, B., Pohl, Y., & Filippi, A. (2005). Level of information concerning dental injuries and their prevention in Swiss basketball—A survey among players and coaches. Traumatology, 21(4), 195–200.
Pribble, J. M., Maio, R. F., & Freed, G. L. (2004). Parental perceptions regarding mandatory mouthguard use in competitive youth soccer. Injury Prevention, 10(3), 159–162.
Rachlin, H., & Green, L. (1972). Commitment, choice and self-control. Journal of the Experimental Analysis of Behavior, 17(1), 15–22.
Ranalli, D. N., & Lancaster, D. M. (1995). Attitudes of college football coaches regarding NCAA mouthguard regulations and player compliance. Journal of Public Health Dentistry, 55(3), 139–142.
Rodd, H. D., & Chesham, D. J. (1997). Sports-related oral injury and mouthguard use among Sheffield school children. Community Dental Health, 14, 25–30.
Stanford, M. S., Mathias, C. W., Dougherty, D. M., Lake, S. L., Anderson, N. E., & Patton, J. H. (2009). Fifty years of the Barratt Implusiveness Scale: An update and review. Personality and Individual Differences, 47, 385–395.
United States Department of Health and Human Services. (2000). Oral health in America: A report of the Surgeon General. Rockville: US Department of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research.
Uslu, M., Uslu, R., Eksioglu, F., & Ozen, N. E. (2007). Children with fractures show higher levels of impulsive–hyperactive behavior. Clinical Orthopaedics and Related Research, 460, 192–195.
von Arx, T., Flury, R., Tschan, J., Buergin, W., & Geiser, T. (2008). Exercise capacity in athletes with mouthguards. Internal Journal of Sports Medicine, 29(5), 435–438.
Walker, J., Jakobsen, J., & Brown, S. (2002). Attitudes concerning mouthguard use in 7- to 8-year-old children. Journal of Dentistry for Children, 69(2), 207–211.
Weinstein, N. D., Lyon, J. E., Sandman, P. M., & Cuite, C. L. (1998). Experimental evidence for stages of health behavior change: The precaution adoption process model applied to home radon testing. Health Psychology, 17(5), 445–453.
Weinstein, N. D., & Sandman, P. M. (1992). A model of the precaution adoption process: Evidence from home radon testing. Health Psychology, 11(3), 170–180.
Acknowledgments
This study was funded by a grant from the National Institutes of Health, National Institute of Dental and Craniofacial Research. Grant Number: 1RO3DE019176-01A1.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have no conflicts of interest to disclose.
Rights and permissions
About this article
Cite this article
Collins, C.L., McKenzie, L.B., Roberts, K.J. et al. Mouthguard BITES (Behavior, Impulsivity, Theory Evaluation Study): What Drives Mouthguard Use Among High School Basketball and Baseball/Softball Athletes. J Primary Prevent 36, 323–334 (2015). https://doi.org/10.1007/s10935-015-0402-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10935-015-0402-7