Mouthguard bites (Behavior, Impulsivity, Theory Evaluation Study): What drives mouthguard use among high school basketball and baseball/softball athletes

Background: Mouthguards are effective, inexpensive, easy to use, and readily available, yet this form of protective equipment has been underutilized for decades. This study's objective was to investigate the relationship between high school basketball, baseball, and softball players' mouthguard use, impulsive delay discounting, and the Precaution Adoption Process Model. Methods: 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 student athletes' demographic information, knowledge, attitudes and beliefs regarding mouthguard use, impulsive delay discounting, and Precaution Adoption Process Model stage. Results: Among the 1,636 students surveyed (55.9% male, 43.8% female, 0.3% unreported), only 12.3% reported using a mouthguard every time or sometimes during practice or competition. The top reasons for not wearing mouthguards were they were not required to (65.3%) and they could not breathe or talk while wearing a mouthguard (61.5%). Most athletes reported 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 gender. Conclusions: 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/or 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.