Background Concussion is the most common injury in youth ice hockey. Whether mouthguard use lowers the odds of concussion remains an unanswered question. Objective To determine the association between concussion and mouthguard use in youth ice hockey. Methods Nested case–control design. Cases and controls were identified from two prospective cohort studies using valid injury surveillance methods. Cases were players concussed during a game or practice; controls were players who sustained a non-concussion injury during a game or practice. The primary exposure was mouthguard use at time of injury; mouthguard type (dental custom fit or off the shelf) was a secondary exposure. Physician-diagnosed or therapist-suspected concussion was the primary outcome. Dental injury was a secondary outcome. Multilevel logistic regression with random effect at a team level was used to obtain ORs for the mouthguard effect, adjusted for level of play, age group, position, concussion history, mechanism of injury, cohort, session type and body checking policy. Results Among cases, 236/315 (75%) were wearing a mouthguard at time of injury, while 224/270 (83%) controls were wearing a mouthguard at time of injury. Any mouthguard use was associated with an adjusted OR for concussion of 0.36 (95% CI 0.17 to 0.73). Off-the-shelf mouthguards were associated with a 69% lower odds of concussion (adjusted OR: 0.31; 95% CI 0.14 to 0.65). Dental custom-fit mouthguards were associated with a non-significant 49% lower odds of concussion (adjusted OR: 0.51; 95% CI 0.22 to 1.10). No dental injuries were identified in either cohort. Conclusion Mouthguard use was associated with lower odds of concussion. Players should be required to wear mouthguards in youth ice hockey.

中文翻译：

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青少年冰球护齿器的使用与脑震荡风险：315 例嵌套病例对照研究

背景 脑震荡是青少年冰球运动中最常见的损伤。使用护齿器是否会降低脑震荡的几率仍然是一个悬而未决的问题。目的 确定青少年冰球中脑震荡和护齿器使用之间的关联。方法嵌套病例对照设计。病例和对照是从使用有效损伤监测方法的两项前瞻性队列研究中确定的。案例是球员在比赛或训练中受到脑震荡；对照组是在比赛或练习期间遭受非脑震荡伤害的球员。主要暴露是受伤时使用护齿套；护齿类型（牙科定制适合或现成的）是二次曝光。医生诊断或治疗师怀疑的脑震荡是主要结果。牙齿损伤是次要结果。使用具有团队级别随机效应的多级逻辑回归来获得护齿效应的 OR，并根据比赛水平、年龄组、位置、脑震荡史、受伤机制、队列、训练类型和身体检查政策进行调整。结果 在病例中，236/315 (75%) 在受伤时佩戴护齿，而 224/270 (83%) 对照组在受伤时佩戴护齿。任何护齿器的使用都与调整后的脑震荡 OR 为 0.36（95% CI 0.17 至 0.73）相关。现成的护齿与脑震荡的几率降低 69% 相关（调整后的 OR：0.31；95% CI 0.14 至 0.65）。牙科定制牙套与脑震荡几率降低 49%（调整后 OR：0.51；95% CI 0.22 至 1.10）相关，但不显着。两组均未发现牙齿损伤。结论 使用牙套与较低的脑震荡几率有关。青少年冰球比赛应要求运动员佩戴护齿器。