Concussion and repetitive head impact exposure are significant media, clinical, and research topics. Long-term symptomatic outcomes of sub-injurious head impact exposure have become a topic of concern for professional and youth contact sport athletes alike. Vulnerable populations such as females and pediatric athletes deserve special attention but are understudied. It is known that females tend to be diagnosed with concussions more frequently and incur them at lower peak head kinematic values than their male counterparts. Sex-specific symptom presentation has been demonstrated, but little is known about the effect of athlete perception of head impact exposure or skill level on symptom reporting. Injury biomechanics research has begun to converge on using instrumented mouthguards to monitor head impact exposure in various sports. These devices offer six-degree-of-freedom head kinematic measurements and direct coupling to the measurement point of interest, the skull, by connecting to the upper dentition. However, published post-processing recommendations for these devices differ from one another and manufacturer practices. This lack of commonization makes cross-study comparison difficult. Additionally, the devices are plagued by relative motion artifacts that can leak into reported kinematic signals. The research presented in this dissertation aimed to first address a lack of common post-processing methods available for instrumented mouthguard measurements made with three linear accelerometers and three gyroscopes. We developed an optimal combination of cutoff frequencies for filters applied to these instruments by quantifying the minimal error from a transformation function. We then applied those same methods to instrumented mouthguards, minimizing error based on sport-specific impact duration. Next, mouthguard decoupling artifacts were described in a laboratory study. Decoupling increased kinematic error relative to ground truth measurements from an instrumented headform. We used these data to develop a classification algorithm that found signal features related to mouthguard decoupling while recording an acceleration event in an instrumented mouthguard. We proceeded to salvage impacts with decoupling artifacts. When decoupling was identified, the primary head acceleration signal could be salvaged by wavelet deconstruction. We removed high-frequency content that was representative of decoupling artifacts. We applied these optimized post-processing techniques to instrumented mouthguard data from a group of adolescent female ice hockey players. Their documented head impact exposure was correlated to symptom outcomes and ocular motor evaluation scores. Their sleep and menstrual cycle patterns were included as potential confounding factors. In this sample of athletes, sleep was more strongly associated with symptom presentation than head impact exposure. Ocular motor results showed a possible association with head acceleration exposure severity and menstrual cycle phase, but further study is warranted. Finally, a self-reported association between symptoms and head impact exposure appears to be individual- and skill-level specific, as we saw many variations between individuals of the same sex in what they called a "memorable" head impact. / Doctor of Philosophy / Concussion and repetitive head impact exposure are significant media, clinical, and research topics. Additionally, the long-term outcomes of sub-injurious head impact exposure have become a topic of concern for professional and youth contact sport athletes alike. Vulnerable populations such as females and pediatric athletes deserve special attention but are understudied. Sex-specific symptom presentation has been demonstrated, but little is known about the effect of athlete perception of head impact exposure or skill level on symptom reporting. Instrumented mouthguards are used to monitor head impact exposure in various sports. These devices measure linear and rotational head motion and couple directly to the measurement point of interest, the skull, by connecting to the upper dentition. However, published post-processing recommendations for these devices differ from one another and manufacturer practices. This lack of commonization makes cross-study comparison difficult. Additionally, the devices are plagued by relative motion (decoupling) artifacts that can leak into reported head motion signals. The research presented in this dissertation aimed to first address a lack of common post-processing methods available for instrumented mouthguard measurements made with three linear accelerometers and three gyroscopes. We developed an optimal combination of cutoff frequencies for filters applied to these instruments by quantifying the minimal error from a transformation function. We then applied those same methods to instrumented mouthguards, minimizing error based on sport-specific impact duration. Next, mouthguard decoupling artifacts were described in a laboratory study. Decoupling increased mouthguard error relative to ground truth measurements from an instrumented dummy headform and was direction dependent. We used these data to develop a classification algorithm that found signal features related to mouthguard decoupling while recording an acceleration event in an instrumented mouthguard. We proceeded to salvage impacts with decoupling artifacts through wavelet deconstruction. We applied these optimized post-processing techniques to instrumented mouthguard data from a group of adolescent female ice hockey players. Their documented head impact exposure was correlated to symptom outcomes and eye movement evaluation scores. In this sample of athletes, sleep was more strongly associated with symptom presentation than head impact exposure. Finally, a self-reported association between symptoms and head impact exposure appears to be individual- and skill-level specific, as we saw many variations between individuals of the same sex in what they called a "memorable" head impact.

No description available.

Aspectos como a prevalência e incidência de injúrias orofaciais ocorridas no esporte e a prevalência do uso de protetores bucais são temas que vem ganhando destaque na Odontologia do Esporte e na Odontologia do Trabalho, uma vez que grande parcela dos atletas pratica as modalidades profissionalmente. O objetivo do estudo foi avaliar a prevalência de injúrias orofaciais em esportistas profissionais e amadores. Foi realizado um levantamento epidemiológico com participantes dos Jogos Abertos do Interior, em 2009. Foram coletadas informações sobre prevalência de injúrias orofaciais e o uso de protetores bucais na prática esportiva de oito modalidades diferentes, fatores associados e qualidade de vida também foram investigados. Os dados foram analisados no pacote estatístico STATA e para verificar fatores associados foi realizada a Regressão Multivariada de Poisson, com nível de significância de 95%. O projeto foi aprovado pelo Comitê de Ética da FOUSP. Participaram do estudo 315 atletas, sendo 59,37% do gênero feminino e 50,90% amadores. Em relação às injúrias orofaciais na prática esportiva, 42,57% afirmaram já terem sofrido alguma injúria e dentre estes atletas 82,79% não utilizavam o protetor bucal no momento do acidente. Dentre os atletas que utilizavam o protetor bucal, 81,13% não apresentaram qualquer dificuldade. Em relação à qualidade de vida associada à condição de saúde bucal, a média do OHIP foi 2,98. A idade, gênero e condição sócio econômica não se mostraram associados à prevalência das injúrias. Podemos concluir que a experiência de injúria orofacial foi alta, a utilização de protetores bucais por atletas foi baixa e que os atletas participantes dos JAI 2009 têm uma ótima qualidade de vida em relação à saúde bucal. / Aspects such as the prevalence and incidence of orofacial injuries occurring in sport and the prevalence of use of the mouthguards are issues that have gained prominence in Sports Dentistry and Labour Dentistry, since that a big part of the athletes are practicing the modalities professionally. The aim of this study was to evaluate the prevalence of orofacial injuries in professional and amateur athletes. An epidemiological survey was realized with the participants of the Jogos Abertos do Interior 2009. Data on the prevalence of orofacial injuries and use of mouthguards in sports were collected in eight different modalities; associated factors and quality of life were also investigated. The data were analyzed with STATA software and to verify the associated factors it was realized the Multivariate Poisson Regression with a significance level of 95%. The project was approved by the Ethics Committee of FOUSP. Study participants were 315 athletes, 59.37% female and 50.90% amateurs. In relation to orofacial injuries in sports, 42.57% said they had suffered any injure and among these athletes 82.79% did not use a mouthguard at the time of the accident. Among the athletes who used the mouthguard, 81, 13% did not present any difficult. Regarding quality of life associated with oral health condition, the average in OHIP was 2.98. The age, gender and socio economic status were not associated with the prevalence of injuries. We can conclude that the experience of orofacial injury was high, the use of mouthguards for athletes was low and that athletes participating in the 2009 JAI have a superb quality of life in relation to oral health.

A consciência do corpo humano é pré-requisito para o desenvolvimento da mecânica corporal. A avaliação física do indivíduo é necessária para que se identifiquem condições que possam prejudicar a saúde e predispor o desenvolvimento de lesões e melhorar o desempenho físico dos atletas. Por esse motivo técnicos esportivos indicam, empiricamente, a utilização de placas oclusais para prática esportiva. Além disto, é sabido que o uso de dispositivos intra orais podem influenciar a postura e o equilíbrio corporal. O presente estudo teve como objetivo avaliar a influência do protetor bucal individualizado no equilíbrio, postura de cabeça, mandíbula e ombro de atletas que buscaram atendimento no Ambulatório de Odontologia do Esporte da FOUSP e relatar a percepção dos atletas quanto a possíveis alterações no equilíbrio, postura corporal e desempenho esportivo com o uso do dispositivo. Participaram da avaliação postural por fotogrametria 32 atletas. Para avaliação do equilíbrio participaram 33 atletas. 37 atletas retornaram o questionário de percepção do uso do protetor bucal. A utilização do protetor bucal individualizado teve influência significante na variável distância glabela mento (p=0,005) por aumentar a dimensão vertical de oclusão do indivíduo, porém teve efeito clínico considerado pequeno. Este aumento não resultou em alterações posturais da cabeça, sagitais da mandíbula e ombros. Na análise do equilíbrio, não ocorreram alterações significantes no deslocamento do centro de pressão e o efeito clínico da utilização do dispositivo foi considerado pequeno. Não foram percebidas alterações no equilíbrio e postura corporal pela maior parte dos atletas (75,68% e 70,28%, respectivamente). A utilização do protetor bucal individualizado causa nos indivíduos mais confiança e os atletas relataram sentir melhora do desempenho (70,28%) e facilidade em executar gestos esportivos (67,56%). Conclui-se que o uso de protetores bucais individualizados não altera a postura, não causa alterações importantes de equilíbrio corporal e que os atletas se sentem mais confiantes e com melhor desempenho esportivo. / The consciousness of the human body is a prerequisite to the development of mechanical body. The physical assessment of the individual is required for the identification of conditions that could harm the health and predispose the development of injuries and improve the performance of athletes. For this reason, sports technicians have, empirically, indicated the use of occlusal plates for sports. In addition, it is well known that using intraoral devices may influence the posture and body balance. This study aimed to evaluate the influence of the custom made mouthguard in balance, posture of head, jaw and shoulder of athletes who sought care at the Ambulatório de Odontologia do Esporte of FOUSP and report the perception of athletes for possible changes in balance, body posture and sports performance with the use of the equipment. Participated in the evaluation by postural photogrammetry 32 athletes. To evaluate the balance 33 athletes participated. 37 athletes returned the questionnaire of perception of the use of the custom made mouthguard. The use of this equipment cases had significant influence in the variable distance glabella (p = 0.005) to increase the vertical dimension of occlusion of the individual, but was considered to have a small clinical effect. This increase did not result in postural changes of head, jaw and shoulders. The analysis of the balance had no significant changes occurred in the shift of the center of pressure and the clinical effect of use of the device was considered small. Were not perceived changes in balance and body posture by most of athletes (75.68% and 70.28%, respectively). The use of custom made mouthguard cases in individuals more confidence and athletes reported feeling better performance (70.28%) and easily run sporting gestures (67.56%). It is concluded that the use of custommade mouthguard does not change the posture, does not cause important changes in body balance and that athletes feel more confident and better sports performance.

O uso de protetores bucais na prática de esportes tem ampliado espaço no contexto da prevenção de traumas bucais, bem como apresentado melhoria no desempenho ao longo de sua história. O objetivo deste trabalho foi avaliar o comportamento do complexo buco dento alveolar (lábio, dentes, osso alveolar e ligamento periodontal) por meio do método dos elementos finitos. A metodologia utilizada foi a partir de um modelo em formato esterolitográfico oriundo de uma tomografia computadorizada, o qual foi convertido para um modelo 3D pelo programa Rhinoceros® versão 4.0 sem protetor bucal (controle) e com protetor bucal de 4.0mm de espessura em EVA (copolímero de etileno e acetato de vinila), os quais receberam três cargas diferentes (500, 1000 e 1500N) no programa ANSYS® v12 em regime quaseestático, de caráter elástico linear. Pudemos observar que houve um padrão de comportamento das estruturas envolvidas quanto à dissipação das tensões geradas e ao se comparar o modelo controle com o modelo provido de protetor bucal houve uma absorção das tensões geradas em até 50%, permitindo confirmar a ação do protetor bucal em literatura e tornando o seu uso imperativo durante a prática de esportes, em especial as modalidades de maior contato. / The use of mouthguards in the practice of sports has expanded space in the prevention of oral trauma, and presented performance improvement over its history. The aim of this study was to evaluate the behavior of complex buco dental alveolar (lip, teeth, periodontal ligament and alveolar bone) through the finite element method. The methodology used was based on a sterelithographic model come from a CT scan, which was converted to a 3D model by the program Rhinoceros® version 4.0 without a mouthguard (control) and mouthguard 4.0mm-thick EVA (copolymerof ethylene and vinyl acetate), which received three different loads (500, 1000 and 1500N) in ANSYS® v12 under quasi-static, linear elastic character. We noticed that there was a pattern of behavior of the structures involved and the dissipation of the tensions generated and compare the model with the control model was fitted with a mouthguard absorbs stresses generated by 50%, allowing to confirm the action of the mouthguard in literature and making its use mandatory for participation in sports, in particular the modalities for greater contact.

A consciência do corpo humano é pré-requisito para o desenvolvimento da mecânica corporal. A avaliação física do indivíduo é necessária para que se identifiquem condições que possam prejudicar a saúde e predispor o desenvolvimento de lesões e melhorar o desempenho físico dos atletas. Por esse motivo técnicos esportivos indicam, empiricamente, a utilização de placas oclusais para prática esportiva. Além disto, é sabido que o uso de dispositivos intra orais podem influenciar a postura e o equilíbrio corporal. O presente estudo teve como objetivo avaliar a influência do protetor bucal individualizado no equilíbrio, postura de cabeça, mandíbula e ombro de atletas que buscaram atendimento no Ambulatório de Odontologia do Esporte da FOUSP e relatar a percepção dos atletas quanto a possíveis alterações no equilíbrio, postura corporal e desempenho esportivo com o uso do dispositivo. Participaram da avaliação postural por fotogrametria 32 atletas. Para avaliação do equilíbrio participaram 33 atletas. 37 atletas retornaram o questionário de percepção do uso do protetor bucal. A utilização do protetor bucal individualizado teve influência significante na variável distância glabela mento (p=0,005) por aumentar a dimensão vertical de oclusão do indivíduo, porém teve efeito clínico considerado pequeno. Este aumento não resultou em alterações posturais da cabeça, sagitais da mandíbula e ombros. Na análise do equilíbrio, não ocorreram alterações significantes no deslocamento do centro de pressão e o efeito clínico da utilização do dispositivo foi considerado pequeno. Não foram percebidas alterações no equilíbrio e postura corporal pela maior parte dos atletas (75,68% e 70,28%, respectivamente). A utilização do protetor bucal individualizado causa nos indivíduos mais confiança e os atletas relataram sentir melhora do desempenho (70,28%) e facilidade em executar gestos esportivos (67,56%). Conclui-se que o uso de protetores bucais individualizados não altera a postura, não causa alterações importantes de equilíbrio corporal e que os atletas se sentem mais confiantes e com melhor desempenho esportivo. / The consciousness of the human body is a prerequisite to the development of mechanical body. The physical assessment of the individual is required for the identification of conditions that could harm the health and predispose the development of injuries and improve the performance of athletes. For this reason, sports technicians have, empirically, indicated the use of occlusal plates for sports. In addition, it is well known that using intraoral devices may influence the posture and body balance. This study aimed to evaluate the influence of the custom made mouthguard in balance, posture of head, jaw and shoulder of athletes who sought care at the Ambulatório de Odontologia do Esporte of FOUSP and report the perception of athletes for possible changes in balance, body posture and sports performance with the use of the equipment. Participated in the evaluation by postural photogrammetry 32 athletes. To evaluate the balance 33 athletes participated. 37 athletes returned the questionnaire of perception of the use of the custom made mouthguard. The use of this equipment cases had significant influence in the variable distance glabella (p = 0.005) to increase the vertical dimension of occlusion of the individual, but was considered to have a small clinical effect. This increase did not result in postural changes of head, jaw and shoulders. The analysis of the balance had no significant changes occurred in the shift of the center of pressure and the clinical effect of use of the device was considered small. Were not perceived changes in balance and body posture by most of athletes (75.68% and 70.28%, respectively). The use of custom made mouthguard cases in individuals more confidence and athletes reported feeling better performance (70.28%) and easily run sporting gestures (67.56%). It is concluded that the use of custommade mouthguard does not change the posture, does not cause important changes in body balance and that athletes feel more confident and better sports performance.

O uso de protetores bucais na prática de esportes tem ampliado espaço no contexto da prevenção de traumas bucais, bem como apresentado melhoria no desempenho ao longo de sua história. O objetivo deste trabalho foi avaliar o comportamento do complexo buco dento alveolar (lábio, dentes, osso alveolar e ligamento periodontal) por meio do método dos elementos finitos. A metodologia utilizada foi a partir de um modelo em formato esterolitográfico oriundo de uma tomografia computadorizada, o qual foi convertido para um modelo 3D pelo programa Rhinoceros® versão 4.0 sem protetor bucal (controle) e com protetor bucal de 4.0mm de espessura em EVA (copolímero de etileno e acetato de vinila), os quais receberam três cargas diferentes (500, 1000 e 1500N) no programa ANSYS® v12 em regime quaseestático, de caráter elástico linear. Pudemos observar que houve um padrão de comportamento das estruturas envolvidas quanto à dissipação das tensões geradas e ao se comparar o modelo controle com o modelo provido de protetor bucal houve uma absorção das tensões geradas em até 50%, permitindo confirmar a ação do protetor bucal em literatura e tornando o seu uso imperativo durante a prática de esportes, em especial as modalidades de maior contato. / The use of mouthguards in the practice of sports has expanded space in the prevention of oral trauma, and presented performance improvement over its history. The aim of this study was to evaluate the behavior of complex buco dental alveolar (lip, teeth, periodontal ligament and alveolar bone) through the finite element method. The methodology used was based on a sterelithographic model come from a CT scan, which was converted to a 3D model by the program Rhinoceros® version 4.0 without a mouthguard (control) and mouthguard 4.0mm-thick EVA (copolymerof ethylene and vinyl acetate), which received three different loads (500, 1000 and 1500N) in ANSYS® v12 under quasi-static, linear elastic character. We noticed that there was a pattern of behavior of the structures involved and the dissipation of the tensions generated and compare the model with the control model was fitted with a mouthguard absorbs stresses generated by 50%, allowing to confirm the action of the mouthguard in literature and making its use mandatory for participation in sports, in particular the modalities for greater contact.

Aspectos como a prevalência e incidência de injúrias orofaciais ocorridas no esporte e a prevalência do uso de protetores bucais são temas que vem ganhando destaque na Odontologia do Esporte e na Odontologia do Trabalho, uma vez que grande parcela dos atletas pratica as modalidades profissionalmente. O objetivo do estudo foi avaliar a prevalência de injúrias orofaciais em esportistas profissionais e amadores. Foi realizado um levantamento epidemiológico com participantes dos Jogos Abertos do Interior, em 2009. Foram coletadas informações sobre prevalência de injúrias orofaciais e o uso de protetores bucais na prática esportiva de oito modalidades diferentes, fatores associados e qualidade de vida também foram investigados. Os dados foram analisados no pacote estatístico STATA e para verificar fatores associados foi realizada a Regressão Multivariada de Poisson, com nível de significância de 95%. O projeto foi aprovado pelo Comitê de Ética da FOUSP. Participaram do estudo 315 atletas, sendo 59,37% do gênero feminino e 50,90% amadores. Em relação às injúrias orofaciais na prática esportiva, 42,57% afirmaram já terem sofrido alguma injúria e dentre estes atletas 82,79% não utilizavam o protetor bucal no momento do acidente. Dentre os atletas que utilizavam o protetor bucal, 81,13% não apresentaram qualquer dificuldade. Em relação à qualidade de vida associada à condição de saúde bucal, a média do OHIP foi 2,98. A idade, gênero e condição sócio econômica não se mostraram associados à prevalência das injúrias. Podemos concluir que a experiência de injúria orofacial foi alta, a utilização de protetores bucais por atletas foi baixa e que os atletas participantes dos JAI 2009 têm uma ótima qualidade de vida em relação à saúde bucal. / Aspects such as the prevalence and incidence of orofacial injuries occurring in sport and the prevalence of use of the mouthguards are issues that have gained prominence in Sports Dentistry and Labour Dentistry, since that a big part of the athletes are practicing the modalities professionally. The aim of this study was to evaluate the prevalence of orofacial injuries in professional and amateur athletes. An epidemiological survey was realized with the participants of the Jogos Abertos do Interior 2009. Data on the prevalence of orofacial injuries and use of mouthguards in sports were collected in eight different modalities; associated factors and quality of life were also investigated. The data were analyzed with STATA software and to verify the associated factors it was realized the Multivariate Poisson Regression with a significance level of 95%. The project was approved by the Ethics Committee of FOUSP. Study participants were 315 athletes, 59.37% female and 50.90% amateurs. In relation to orofacial injuries in sports, 42.57% said they had suffered any injure and among these athletes 82.79% did not use a mouthguard at the time of the accident. Among the athletes who used the mouthguard, 81, 13% did not present any difficult. Regarding quality of life associated with oral health condition, the average in OHIP was 2.98. The age, gender and socio economic status were not associated with the prevalence of injuries. We can conclude that the experience of orofacial injury was high, the use of mouthguards for athletes was low and that athletes participating in the 2009 JAI have a superb quality of life in relation to oral health.

Background: Ice hockey is a fast-paced sport with a high possibility of acquiring dental damage and concussions which can be prevented by mouthguards (MG). Despite this, many athletes choose not to use MG due to drawbacks such as discomfort and restricted airways. Restricted airways provided by MG might be reduced by external nasal dilator strips (ENDS). ENDS could contribute to increased aerobic capacity, blood oxygen saturation and self-reported compliance of ENDS by elevating airflow through the nose. Therefore, ENDS could contribute to enhanced performance and recovery rate while reducing the discomfort of MG that could lead to an increased usage of MG among healthy young adult ice hockey players. Aim: The aim was to study aerobic capacity, and oxygen saturation using mouthguard with and without external nasal dilator strips during submaximal bicycle tests. A second aim was to study the compliance of external nasal dilator strips when using mouthguard in healthy young adult ice hockey players. Method: In this experimental study using a cross-over design 15 young adult ice hockey players were contacted to attend on two separate test occasions, with and without ENDS. Aerobic capacity was measured with a Ekblom-Bak submaximal bicycle test (VO2max) and a pulse oximeter was used to examine oxygen saturation (%SpO2). Post-testing, the participants stated self-reported compliance using ENDS based on the numeric rating scale (0-10, positive-negative attitude of usage). Data are presented as mean and standard deviation. Differences between groups were analyzed with the Wilcoxon- signed rank test based on median (Q1-Q3). Result: Nine participants, aged 18-19 completed both test occasions. This study found that ENDS provided no significant difference in estimated VO2max mean (±SD), with ENDS 63.3 (±5.5) and without ENDS 64.2 (±5.0), nor %SpO2 during standard load. A significant increase showed in %SpO2 for higher individual load by 3%, with ENDS 97.1 (±1.3) and without ENDS 94.1 (±4.5). The participants experienced the test as more strenuous with ENDS than without ENDS applied, without significant difference. Despite this, the participants had a positive attitude towards the usage of ENDS. Conclusion This study regarding healthy young adult ice hockey players showed that ENDS provided no significant difference in aerobic capacity. Oxygen saturation however resulted in a positive significant difference at the higher individual load. The majority of the participants in this study propose a positive compliance with ENDS. The results are interpreted with caution due to the small sample.