Muay Thai, a rapidly growing combat sport, involves significant risk of head and facial injuries, with dental trauma being a major concern. Previous research has shown high rates of maxillofacial injuries in Muay Thai, emphasizing the need for protective measures like mouthguards. Three main types of mouthguards exist: prefabricated, mouth-formed ('boil and bite'), and custom-made. While mouthguards are recommended, their use isn't always mandatory in Muay Thai gyms. This study aimed to understand Muay Thai participants' attitudes toward mouthguard use and their experiences of dental trauma to inform strategies for injury prevention. The high prevalence of dental trauma in combat sports necessitates an investigation into the attitudes and practices surrounding mouthguard use within the Muay Thai community. Understanding these factors is critical for developing effective injury prevention strategies and promoting safer participation in this popular and physically demanding sport.

Prior research on Muay Thai injuries has largely overlooked dental trauma, although some studies have highlighted the substantial prevalence of dental and jaw injuries among participants. One study in Thailand reported a 23.5% rate of dental and jaw injuries, while another in Iran found that 44% of combat sports participants (including Muay Thai) experienced dental injuries. These studies underscore the significant risk of dental trauma in Muay Thai and emphasize the need for more focused research in this area. Existing literature highlights the different injury profiles across various combat sports, with professional athletes often experiencing higher rates of maxillofacial injuries compared to amateurs. This further underscores the importance of protective measures like mouthguards in mitigating the risk of dental trauma.

This cross-sectional study utilized an anonymous online questionnaire distributed via the Facebook page of a Muay Thai gym in Newcastle upon Tyne, UK, and through snowball sampling. The questionnaire, developed according to established guidelines and reviewed by participant groups, included sections on demographics, Muay Thai participation, mouthguard use, and dental health. Data was collected electronically and analyzed using SPSS. The questionnaire included both quantitative (multiple choice, Likert scale) and qualitative (open-ended) questions to assess participants' experiences, opinions, and perceptions regarding mouthguard use and dental injuries. The questionnaire addressed various aspects, including the importance of different factors in choosing mouthguards, comfort levels during various activities (warm-up, sparring, fighting), and the impact of mouthguard use on performance. Ethical approval was obtained before study commencement. The study aimed for approximately 100 participants to ensure meaningful data for this exploratory study. Two follow-up reminders were sent over the first two weeks, and the survey closed after four weeks. A total of 92 completed questionnaires were received, allowing for frequency distributions, cross-tabulations, and chi-squared tests to analyze associations between responses. Qualitative data from open-ended questions were analyzed descriptively.

Ninety-two participants (66 males, 26 females) completed the survey. The sample included a high proportion of advanced and professional fighters. Only 3.3% had never worn a mouthguard, while 88% used mouthguards during sparring. However, only 60.9% reported wearing them during fights. Younger participants (18-29 years) were significantly more likely to wear mouthguards during fights (73%) than older participants (50%). Mouth-formed mouthguards were the most common type (59.8% of users), followed by custom-made (31.5%). The majority of respondents found mouthguards extremely or very comfortable during sparring (70.7%) and fighting (73.2%), but less so during warm-up. Protection, breathing, fit, and comfort were considered highly important factors in choosing a mouthguard. 14% (13 respondents) reported dental injuries, most frequently chipped/broken teeth. Eight respondents reported that their dental injuries definitely changed their mouthguard usage, while three reported some change. Most participants (75.6%) perceived no performance impact during warm-up, while a majority reported better performance with mouthguards during sparring (53.6%) and fighting (51.2%). A significant number of participants (22.2% for sparring and 20.9% for fighting) believed that mouthguards increased dental risk. However, no statistically significant differences were found when comparing these participants with those who held the opposite opinion based on age, gender, skill level, or mouthguard type. 57% definitely recommend using a custom-made mouthguard from a dentist. 84% agreed that mouthguards should be mandatory for children, and 62% felt participants should primarily be responsible for using them.

This study reveals a concerning discrepancy between the perceived benefits of mouthguards and their actual use during fights, particularly among older participants. While a significant majority finds mouthguards comfortable and beneficial for protection, a substantial portion still doesn't use them consistently during fights. The lower rate of reported dental injuries compared to some previous studies may be partly attributed to mouthguard use, but the fact that 14% still experienced injuries warrants intervention. The significant difference in mouthguard use between younger and older participants highlights the need for targeted educational strategies focusing on risk perception and the potential influence of past experience with dental injuries. The relatively high percentage of participants believing that mouthguards increase risk might stem from issues like discomfort or ill-fitting mouthguards, highlighting the importance of ensuring proper fit and encouraging the use of custom-made mouthguards.

Despite the perceived benefits and relatively low reported dental injury rate, significant improvements are needed in mouthguard usage among Muay Thai participants, particularly during fights. Targeted educational interventions, perhaps involving those who have experienced dental trauma, could be influential. Dentists should proactively recommend mouthguards, especially custom-fitted ones, to those involved in this contact sport. Further research should investigate reasons for the perceived increased risk associated with mouthguard use during intense activity.

The study's limitations include a higher-than-expected proportion of experienced participants, potentially biasing the results. The sample size, while sufficient for descriptive analysis, was slightly below the target, limiting the power for some comparisons. The online questionnaire, primarily targeting one gym, might introduce bias. Future studies could employ purposive sampling to ensure a more representative sample and explore reasons for not wearing mouthguards through more in-depth qualitative methods.