Oral Health Status, Preventive Behaviors, and Dental Injury Experience in Croatian Basketball Athletes

Abstract

Objectives: This cross-sectional study aimed to evaluate oral health knowledge, self-perceived oral status, hygiene behaviors, prevalence of dental injuries, and mouthguard use among Croatian basketball players and coaches. Materials and Methods: A total of 414 participants of both sexes, spanning various levels of basketball participation in Croatia, completed an anonymous online questionnaire assessing oral health knowledge, hygiene habits, trauma history, and preventive practices. Data was analyzed using descriptive statistics, Chi-square, Mann–Whitney, and Kruskal–Wallis tests. Results: Participants demonstrated generally poor oral health knowledge, with coaches scoring significantly higher than players (p < 0.05), and knowledge levels varying according to education and socioeconomic status (p ≤ 0.001). A majority reported no prior dental trauma (69.6%), and mouthguard use was notably low (20.8%). While regular toothbrushing was prevalent (87%), the use of dental floss was limited (39.9%). The most reported oral health problems included gingival bleeding (37.9%), dental calculus (35.0%), and tooth sensitivity (34.3%). Conclusions: Despite relatively good hygiene habits, Croatian basketball players demonstrated low oral health knowledge and insufficient preventive practices, particularly regarding mouthguard use. These findings indicate the need for targeted education and preventive strategies within the basketball community.

1. Introduction

Basketball is one of the most popular sports in the world, with over 400 million active players [1]. According to the National Sports Program from 2020, basketball, with 218 basketball clubs, ranks among the top five team sports in the Republic of Croatia, and the number of registered basketball player’s amounts to 32,050 [2]. Basketball is a contact sport involving complex movements such as jumps and sudden changes in direction, which increases the risk of various injuries, including those affecting the orofacial region and teeth. Dental injuries may occur due to contact with other players or the ball [3]. Given the strong national presence of basketball in Croatia and the physical demands of this contact sport, focusing on Croatian basketball provides a relevant and context specific framework for examining the occurrence of orofacial and dental injuries.

The World Health Organization defines oral health as being free from pain in the mouth and face, free from oral and throat cancer, oral infections and sores, periodontal diseases, tooth decay, tooth loss, and other diseases and disorders that limit biting, chewing, smiling, speaking, and psychosocial well-being [4]. Maintaining proper hygiene and regular dental visits are important for preventing dental problems. Poor oral health can negatively impact an athlete’s physical and mental health, leading to caries, gum disease, and tooth loss, as well as associated systemic diseases. In a sports setting, a concise focus on oral health highlights the importance of prevention, emphasizing that adequate hygiene and regular dental care reduce the risk of dental trauma and support optimal athletic performance [5].

Oral health among athletes—particularly basketball players—is influenced by several sport-specific factors, including high-intensity physical exertion, dietary routines, and an increased risk of dental trauma due to frequent contact during play [6,7,8]. These factors may significantly affect an athlete’s general health, as poor oral hygiene and inadequate protection of the oral cavity can lead to chronic conditions that impair sports performance and reduce quality of life [9,10,11]. Studies show that the prevalence of oral diseases such as caries, gingivitis, and erosion is higher in athletes compared to the general population, with reported caries rates ranging from 15% to 89%, gingivitis from 58% to 77%, and erosion from 42% to 59% [7]. Data from the 2019 Pan American Games revealed that 90.8% of participating athletes had at least one pre-existing oral pathology, most commonly periodontal disease (34%) and dental caries (29%) [8]. In addition, lifestyle and nutritional habits, including frequent consumption of sports drinks and energy supplements, further elevate the risk of oral disease [9,12]. While most athletes report brushing their teeth at least twice daily, the use of interdental cleaning devices and routine dental visits is still insufficient [9,13]. Basketball, as a contact sport, presents added risk for orofacial trauma, highlighting the importance of protective measures such as custom-fitted mouthguards. Proper oral hygiene practices and the consistent use of dental protection are therefore essential preventive strategies that may reduce the incidence of oral disease and trauma, ultimately contributing to better health and performance outcomes [10,11].

Dental injuries are common in basketball, accounting for approximately 10% of all sports-related injuries, most frequently affecting the upper maxillary incisors. The primary causes include elbow impacts, falls, and player collisions [14]. Although mouthguards are proven to be effective in preventing dental trauma [15,16], their use remains low. In Indonesia (2023), 30.1% of basketball players reported using mouthguards, while 30.4% experienced orofacial injuries [17]. In Istanbul (2017), although 95% of athletes believed mouthguards were protective, only 6.3% used them; discomfort (37.7%), difficulty breathing (7.3%), and impaired speech (6.4%) were cited as the main reasons for non-use [18]. In China, professional players showed a significantly higher incidence of orofacial injuries (80.6%) compared to semi-professionals (37.7%), despite high awareness (80.1%). Only one athlete used a custom-made mouthguard, and most information came from teammates and media rather than dental professionals [3]. In Brazil, the prevalence of orofacial injuries among basketball players was 27.26% in 2020 [19]. Earlier data from 2011 showed that dental trauma accounted for 69.7% of all orofacial injuries, with the lips being the most affected soft tissue (60.8%) [20]. In Croatia, research is limited, but a study involving 195 basketball players from Zagreb and the surrounding region reported soft tissue injuries in 84.4% of cases, temporomandibular joint injuries in 13.4%, and dental trauma in only 2.2%. Mouthguards were used by just 6.7% of athletes, with only 1% reporting regular use [21,22]. These findings highlight the need for improved preventive strategies, athlete education, and the promotion of custom-made protective devices.

Despite growing recognition of the link between oral and athletic health, limited research specifically addresses the oral health status and hygiene behaviors of basketball players. The aim of this study was to determine the prevalence of dental injuries and the use of mouthguards, as well as to assess the level of oral health knowledge, oral hygiene habits, and oral health status among basketball players in the Republic of Croatia. The specific objectives were to: (1) assess the level of knowledge about oral health; (2) evaluate oral hygiene habits; (3) assess the oral health status; and (4) determine the prevalence of dental injuries and the frequency of mouthguard use among basketball players. The hypotheses of this study were that basketball players would not demonstrate satisfactory knowledge of oral health, nor would they exhibit adequate oral hygiene practices or oral health status. The null hypothesis was that basketball players demonstrate satisfactory knowledge of oral health, adequate oral hygiene practices, and good oral health status, with no significant prevalence of dental injuries or inadequate mouthguard use.

2. Materials and Methods

This cross-sectional convenience sample study was conducted at the Department of Restorative Dental Medicine and Endodontics, University of Split School of Medicine, between 1 September and 30 October 2024. The study was approved by the Ethics Committee of the University of Split School of Medicine on 20 February 2024 (Class: 029-01/24-02/0001, Reg. No.: 2181-198-03-04-24-0019), in accordance with all applicable legal regulations and the Declaration of Helsinki. A self-structured questionnaire was used, and the design and reporting of the study followed the CHERRIES guidelines (Checklist for Reporting Results of Internet E-Surveys) [23].

Before participating, respondents received detailed information about the purpose of the study, including the number of questions, data storage and usage, duration, researcher identity, and contact information. They were informed that the collected data would be used for both a diploma thesis and scientific publication. On the first page of the online survey interface, participants were required to indicate written informed consent.

2.1. Survey Questionnaire

The questionnaire was designed by a specialist in endodontics and restorative dental medicine, together with a sixth-year dental student, based on similar studies from relevant literature [3,9,15,17,18,19,20,21,22,24,25,26,27,28,29,30,31,32]. The survey, hosted via Google Forms, was distributed through WhatsApp, Facebook, and Instagram. A pilot study was conducted on a sample of 15 participants meeting the inclusion criteria. The pilot respondents assessed usability and technical functionality. Their responses were excluded from the final sample as they provided feedback used to revise the survey and refine the survey. Based on the feedback from the pilot testing and participants, the questionnaire underwent additional content validation by a Doctor of Dental Medicine with relevant clinical experience, who was not involved in the initial design. This expert assessed the clarity, relevance, and comprehensiveness of the items, and their suggestions were incorporated through two rounds of adjustments. The estimated time to complete the survey was approximately 15 min.

The questionnaire consisted of 83 questions divided into eight sections. Most questions were closed-ended, except for five open-ended items (age, height, weight, basketball experience, and weekly training hours). Questions were presented over multiple pages corresponding to the eight sections. One reminder was sent four weeks after the initial invitation, and snowball sampling was encouraged. To ensure the validity of this approach, participants were instructed not to share their assessments of the instrument with acquaintances, and the referral process was monitored to confirm that each new participant met the inclusion criteria and contributed independently.

Section one included six questions on demographic and social data (Q1–Q6). Section two comprised five questions on respondents’ sports background (Q7–Q11). Section three assessed general knowledge of oral health through 18 items (Q12–Q29), each scored as “Yes,” “No,” or “I don’t know,” with correct answers earning one point. Based on Bloom’s taxonomy, knowledge levels were categorized as good (80–100%, 14.4–18.0 points), moderate (60–79%, 10.8–14.3), and poor (<60%, <10.7) [33]. Section four included six questions (Q30–Q35) on oral hygiene practices. Section five (Q36–Q56) examined self-assessed oral health status. Section six (Q57–Q64) addressed the incidence of dental injuries. Section seven (Q65–Q73) evaluated the frequency of mouthguard use and related knowledge. Section eight (Q74–Q83) examined attitudes and self-assessed oral health status.

2.2. Respondents

A non-probabilistic convenience sample was used in this cross-sectional observational study, conducted on active basketball players (professionals, amateurs, recreational players, and coaches) in Croatia. This classification was based on self-reported information provided by the participants in the study questionnaire. Participants were adult males and females with at least one year of basketball experience. Only players registered in official Croatian basketball clubs were included in the study, and their residency status was confirmed through club records and self-reported information to ensure that all participants were active Croatian residents. Participants were aged between 18 and 30 years, ensuring inclusion of adult basketball players within a comparable age range. All participants were volunteers. Individuals who did not complete the questionnaire or who were underage or not Croatian residents were excluded. Missing data were handled using listwise deletion, excluding participants with incomplete responses from the relevant analyses. Potential confounding variables, including age, education level, and years of basketball practice, were controlled for in the statistical models to ensure that the observed associations were not influenced by these factors.

The minimum required sample size (N = 379) was calculated based on the total number of registered basketball players in Croatia (N = 32,050) from the 2020 National Sports Program, using a 95% confidence level, a 5% margin of error, and an expected response distribution of 50%, as calculated via the Raosoft sample size calculator [34].

2.3. Statistical Analysis

Data was analyzed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA), with the significance level set at p < 0.05. Normality was tested using the Kolmogorov–Smirnov test. Since the data were not normally distributed, descriptive analysis included means and standard deviations (M ± SD) for continuous variables and frequencies and percentages for categorical variables. Group differences (amateurs, recreational players, professionals, coaches) were tested using chi-square or Fisher’s exact test. The dependent variable was the level of oral health knowledge (total knowledge score). Independent variables included sex, age, height, weight, socioeconomic status, education level, years of basketball experience, weekly training hours, and type of sports engagement. The Mann–Whitney U test was used to compare two groups, and the Kruskal–Wallis test with post hoc analysis was used for comparisons among more than two groups.

3. Results

Table 1. Sociodemographic Characteristics of the Respondents.

Characteristic		Total N = 414	Sport Involvement				p
			Recreational N = 172	Amateur N = 130	Professional N = 74	Coach N = 38
Age	18–24	201 (48.6)	67 (38.9)	74 (56.9)	53 (71.6)	7 (18.4)	≤0.001 *
	25–30	213 (51.4)	105 (61.0)	56 (43.0)	21 (28.4)	31 (81.6)
Sex	Male	308 (74.4)	126 (73.3)	91 (70.0)	60 (81.1)	31 (81.6)	0.240
	Female	106 (25.6)	46 (26.7)	39 (30.0)	14 (18.9)	7 (18.4)
Education level	Elementary school	10 (2.4)	2 (1.2)	2 (1.5)	4 (5.4)	2 (5.2)	≤0.001 *
	High school	215 (51.9)	91 (52.9)	75 (57.7)	47 (63.5)	2 (5.2)
	University	189 (45.7)	79 (41.8)	53 (28.0)	23 (12.2)	34 (89.5)
Socioeconomic status	Below average	10 (2.4)	3 (1.7)	3 (2.3)	2 (2.7)	2 (5.2)	0.010 *
	Average	315 (76.1)	137 (79.6)	104 (80.0)	55 (74.3)	19 (44.7)
	Above average	89 (21.5)	32 (18.6)	23 (17.7)	17 (22.9)	17 (44.7)
Height (cm)	<170	48 (11.6)	19 (11.1)	20 (15.4)	4 (5.4)	5 (13.2)	≤0.001 *
	171–199	311 (75.1)	143 (83.1)	92 (70.8)	50 (67.6)	26 (68.4)
	>200	55 (13.3)	10 (5.8)	18 (13.8)	20 (27.0)	7 (18.4)
Weight (kg)	<70	93 (22.5)	42 (24.4)	31 (23.8)	14 (18.9)	6 (15.8)	0.212
	71–99	239 (57.7)	95 (55.2)	80 (61.5)	45 (60.8)	19 (0.5)
	>100	82 (19.8)	35 (20.3)	19 (14.6)	15 (20.3)	13 (34.2)
Body Mass Index	Underweight	11 (2.6)	5 (2.9)	5 (3.8)	1 (1.3)	0 (0)	0.121
	Normal weight	256 (61.8)	94 (54.6)	86 (66.1)	55 (74.3)	21 (55.2)
	Overweight	117 (27.5)	57 (33.1)	31 (23.8)	16 (21.6)	13 (34.2)
	Obese	30 (8.1)	16 (9.4)	8 (6.3)	2 (2.8)	4 (10.6)

Data are presented as numbers (percentages). χ²—chi-square test or Fisher’s exact test, * p < 0.05.

displays the sociodemographic characteristics of the 414 participants, predominantly male (74.4%). The sample size met and exceeded the required minimum (N = 414 > 379), ensuring adequate statistical power for the study. Participants were categorized by sport involvement: recreational (41.5%), amateur (31.4%), professional (17.9%), and coaches (9.2%). The mean age was 28.51 ± 11.41 years, height 186.14 ± 11.37 cm, and weight 85.28 ± 18.20 kg. The mean oral health knowledge score was 10.48 ± 5.56. Coaches demonstrated the highest scores (12.66 ± 5.22), followed by professionals (10.76 ± 5.30), recreational athletes (10.26 ± 5.42), and amateurs (9.96 ± 5.87), with significant differences between groups (p = 0.037). Coaches scored significantly higher than professionals (p = 0.042), amateurs (p = 0.009), and recreational athletes (p = 0.006), while differences among the latter three were not significant (p > 0.05). No significant differences were observed by sex (p = 0.919) or age group (p = 0.620). Knowledge scores varied significantly by education level (p ≤ 0.001) and socioeconomic status (p = 0.001).

Table 2. Professional Characteristics of Respondents.

Characteristic			Sport Involvement				p
		Total N = 414	Recreational N = 172	Amateur N = 130	Professional N = 74	Coach N = 38
Position	Point guard	99 (23.9)	43 (25.0)	27 (20.7)	21 (28.4)	8 (21.1)	0.948
	Shooting guard	101 (24.4)	45 (26.2)	32 (24.6)	17 (22.9)	7 (18.4)
	Small forward	79 (19.1)	31 (18.1)	27 (20.8)	14 (18.9)	7 (18.4)
	Power forward	73 (17.6)	26 (15.0)	24 (18.5)	13 (17.6)	10 (26.3)
	Center	62 (15.0)	27 (15.7)	20 (15.4)	9 (12.2)	6 (15.8)
Years of Practicing	˂10	237 (57.2)	100 (58.1)	91 (0.7)	39 (52.7)	7 (18.4)	≤0.001 *
	10–15	87 (21.0)	33 (19.2)	21 (16.1)	26 (35.1)	7 (18.4)
	>15	90 (21.7)	39 (22.7)	18 (13.8)	9 (12.2)	24 (63.2)
Hours of practicing per week	˂10	327 (79.0)	156 (90.7)	114 (87.7)	32 (43.2)	25 (65.8)	≤0.001 *
	10–15	44 (10.6)	9 (5.2)	9 (6.9)	21 (28.4)	5 (13.3)
	>15	43 (10.4)	7 (4.1)	7 (5.4)	21 (28.4)	8 (21.0)

Data are presented as numbers (percentages). χ²—chi-square test or Fisher’s exact test, * p < 0.05.

shows that most participants played as shooting guards (24.4%) or point guards (23.9%), followed by small forwards (19.1%) and power forwards (17.6%), with the fewest playing as centers (15.0%). Most had trained for less than 10 years (57.2%), while 21.7% trained for over 15 years and 21.0% between 10 and 15 years. Weekly training hours were predominantly under 10 (79.0%), with 10.6% training 10–15 h and 10.4% over 15 h. A statistically significant association was found between basketball training duration and weekly training hours, but not with playing position. The average training duration was 11.56 ± 8.40 years, and the average weekly training time was 6.85 ± 6.36 h. Coaches had the longest training history (19.26 ± 9.49 years), followed by professionals (11.58 ± 6.35), recreational athletes (11.59 ± 8.54), and amateurs (9.27 ± 7.60). In terms of weekly hours, professionals trained the most (12.18 ± 5.68), followed by coaches (10.34 ± 9.47), amateurs (6.22 ± 5.59), and recreational athletes (4.25 ± 4.34).

Table 3. Oral Health Knowledge among Respondents.

Question		Sport Involvement				p
	Total N = 414	Recreational N = 172	Amateur N = 130	Professional N = 74	Coach N = 38
Oral health is closely linked to an individual’s overall health	327 (79.0)	141 (81.9)	91 (27.8)	62 (83.8)	33 (86.8)	0.021 *
Oral health is closely related to an individual’s quality of life	316 (76.3)	136 (79.1)	93 (29.4)	58 (78.4)	29 (76.3)	0.468
The most common oral diseases are dental caries, periodontitis, and oral cancer	262 (63.3)	113 (65.7)	75 (28.6)	49 (66.2)	25 (65.8)	0.465
Poor oral hygiene can lead to the development of caries and periodontitis	328 (79.2)	139 (80.8)	95 (29.0)	61 (82.4)	33 (86.8)	0.168
Diet influences the development of caries, periodontitis, and oral cancer	301 (72.7)	125 (72.7)	89 (29.6%)	53 (71.6)	34 (89.5)	0.086
Smoking is associated with oral cancer and periodontal diseases	299 (72.2)	129 (75.0)	86 (28.8)	54 (72.9)	30 (78.9)	0.270
High alcohol consumption is associated with an increased risk of developing oral cancer, periodontitis, and dental caries	254 (61.4)	104 (60.5)	76 (29.9)	45 (60.8)	29 (76.3)	0.250
Sports drinks and energy beverages can damage the tooth surface and cause erosion	233 (56.3)	96 (55.8)	67 (28.8)	40 (54.0)	30 (78.9)	0.026 *
Mouthguards are an effective method for preventing dental injuries during sports activities	298 (72.0)	119 (69.2)	90 (30.2)	58 (78.4)	31 (81.6)	0.222
An avulsed tooth is one that has been completely displaced from its socket and out of the oral cavity	173 (41.8)	65 (37.8)	56 (32.4)	29 (39.2)	23 (60.5)	0.075
Permanent teeth avulsed due to trauma can be replanted into the oral cavity	138 (33.3)	51 (29.3)	46 (33.3)	23 (31.1)	18 (47.4)	0.184
The emergency management of a tooth completely avulsed from its socket and contaminated with debris involves rinsing the tooth under running water and repositioning it into the oral socket	131 (31.6)	47 (27.0)	44 (33.6)	23 (31.1)	17 (44.7)	0.187
When repositioning and handling an avulsed tooth, it should be held by the crown	123 (29.7)	44 (25.3)	37 (30.1)	24 (32.4)	18 (47.4)	0.059
If immediate replantation at the injury site is not possible, the tooth should be stored in a moist medium (such as milk or specialized tooth preservation solutions) until reaching a dentist	141 (34.1)	48 (27.6)	48 (34.0)	24 (32.4)	21 (55.2)	0.011 *
The ideal time to seek professional help after tooth avulsion is immediately, within 30 min of the injury	183 (44.2)	67 (38.5)	55 (30.1)	38 (51.4)	23 (60.5)	0.051
The upper anterior teeth are most affected by injuries	262 (63.3)	100 (57.5)	79 (30.2)	53 (71.6)	30 (78.9)	0.036 *
Teeth should be brushed twice daily for at least two minutes using fluoride toothpaste	295 (71.3)	124 (71.2)	86 (29.2)	55 (74.3)	30 (78.9)	0.369
Fluorides play a protective role in preventing caries by inhibiting tooth surface damage, aiding remineralization, and preventing bacterial growth.	273 (65.9)	117 (67.2)	82 (30.0)	47 (63.3)	27 (71.1)	0.695

Data are presented as numbers (percentages). χ²—chi-square test or Fisher’s exact test, * p < 0.05.

shows that most participants recognized the strong link between oral and general health (79.0%) and quality of life (76.3%) and were also aware of the most common oral diseases (63.3%). The majority knew that poor oral hygiene leads to caries and periodontitis (79.2%) and that diet plays a role in their development (72.7%). Most participants also identified smoking (72.2%), alcohol (61.4%), and energy drinks (56.3%) as harmful to oral health. A high proportion knew that mouthguards are effective in preventing dental injuries during sports (72.0%) and that maxillary anterior teeth are most affected (63.3%). Furthermore, 71.3% understood proper toothbrushing technique, and 65.9% recognized the importance of fluoride. Conversely, fewer participants demonstrated knowledge of dental avulsion: 41.8% correctly identified an avulsed tooth, 33.3% knew it could be replanted, and 31.6% were aware of the emergency management protocol. Only 29.7% knew how to handle the tooth by the crown, and 34.1% understood the need to store it in a moist medium if immediate replantation is not possible. Less than half (44.2%) knew that seeking help within 30 min is critical.

Data presented in

Table 4. Self-assessed Oral Hygiene Habits of Respondents.

Characteristic	Sport Involvement					p
	Total N = 414	Recreational N = 172	Amateur N = 130	Professional N = 74	Coach N = 38
Brushing teeth two or more times a day for at least two minutes	360 (87.0)	151 (87.8)	110 (84.6)	66 (89.2)	33 (86.8)	0.787
Use of fluoride toothpaste	313 (75.6)	138 (80.2)	91 (70.0)	60 (81.1)	24 (63.2)	0.035 *
Replacing toothbrush every three months	313 (75.6)	134 (77.9)	95 (73.1)	55 (74.3)	29 (76.3)	0.796
Use of dental floss or an interdental brush	165 (39.9)	69 (40.1)	54 (41.5)	26 (35.1)	16 (42.1)	0.819
Regular dental visits (every 6 months)	234 (56.5)	94 (54.6)	74 (56.9)	43 (58.1)	23 (60.5)	0.902
Regular tongue scraping	246 (59.4)	95 (55.2)	76 (58.5)	55 (74.3)	20 (52.6)	0.031 *

Data are presented as numbers (percentages). χ²—chi-square test or Fisher’s exact test, * p < 0.05.

suggest that most participants brush their teeth twice or more daily for at least two minutes (87.0%), use fluoride toothpaste (75.6%), and replace their toothbrush every three months (75.6%). The majority also attend regular dental check-ups every six months (56.5%) and clean their tongue daily (59.4%). However, less than half reported using dental floss or interdental brushes (39.9%).

Results presented in

Table 5. Oral Health Issues among Respondents.

Characteristic	Sport Involvement						p
		Total N = 414	Recreational N = 172	Amateur N = 130	Professional N = 74	Coach N = 38
Dental pain	Yes	122 (29.5)	40 (23.3)	47 (36.1)	23 (31.1)	12 (31.6)	0.104
Tooth sensitivity	Yes	142 (34.3)	58 (33.7)	50 (38.5)	20 (27.0)	14 (36.8)	0.412
Gum bleeding	Yes	157 (37.9)	67 (38.9)	50 (38.5)	26 (35.1)	14 (36.8)	0.949
Damaged or painful gingiva	Yes	91 (22.0)	35 (20.3)	37 (28.5)	9 (12.2)	10 (26.3)	0.045 *
Bad breath	Yes	92 (22.2)	39 (22.6)	33 (25.4)	12 (16.2)	8 (21.1)	0.504
Burning or stinging sensations	Yes	43 (10.4)	15 (8.7)	19 (14.6)	5 (6.8)	4 (10.5)	0.255
Dry mouth	Yes	130 (31.4)	46 (26.7)	51 (39.2)	23 (31.1)	10 (26.3)	0.117
Swelling	Yes	46 (11.1)	11 (6.4)	25 (19.2)	6 (8.1)	4 (10.5)	0.004 *
Tooth mobility	Yes	50 (12.1)	12 (6.9)	25 (19.2)	11 (14.8)	2 (5.3)	0.005 *
Chewing and eating difficulties	Yes	63 (15.2)	19 (11.1)	29 (22.3)	11 (14.8)	4 (10.5)	0.045 *
Fractured or avulsed tooth	Yes	56 (13.5)	17 (9.8)	25 (19.2)	11 (14.8)	3 (7.9)	0.082
TMJ pain	Yes	42 (10.1)	9 (5.2)	21 (16.2)	8 (10.8)	4 (10.5)	0.021 *
Tooth decay	Yes	129 (31.2)	47 (27.3)	48 (36.9)	23 (31.1)	11 (28.9)	0.351
Tartar	Yes	145 (35.0)	67 (38.9)	43 (33.1)	20 (27.0)	15 (39.5)	0.285
Dental filling	Yes	119 (28.7)	46 (26.7)	42 (32.3)	20 (27.0)	11 (28.9)	0.741
Endodontic treatment	Yes	47 (11.4)	11 (6.4)	26 (20.0)	6 (8.1)	4 (10.5)	0.002 *
Tooth extraction	Yes	53 (12.8)	21 (12.2)	22 (16.9)	6 (8.1)	4 (10.5)	0.300
Orthodontic treatment	Yes	63 (15.2)	23 (13.4)	24 (18.5)	11 (14.8)	5 (13.2)	0.649
Dental crowns or veneers	Yes	51 (12.3)	17 (9.8)	21 (16.2)	9 (12.2)	4 (10.5)	0.419
Dental implant	Yes	50 (12.1)	17 (9.8)	21 (16.2)	8 (10.8)	4 (10.5)	0.390

Data are presented as numbers (percentages). χ²—chi-square test or Fisher’s exact test, * p < 0.05.

indicate that most participants reported no oral health issues. Among those who did, the most reported problems were gingival bleeding (37.9%), calculus (35.0%), tooth sensitivity (34.3%), dry mouth (31.4%), dental caries (31.2%), toothache (29.5%), and the presence of fillings (28.7%). Less frequently reported issues included temporomandibular joint pain (10.1%), burning sensations (10.4%), swelling (11.1%), and endodontic treatment (11.4%).

Table 6. Prevalence of Dental and Jaw Injuries During Basketball Participation.

Characteristics		Sport Involvement					p
		Total N = 414	Recreational N = 172	Amateur N = 130	Professional N = 74	Coach N = 38
Experience of injury in the maxillofacial region	Yes	170 (41.1)	62 (36.0)	50 (38.5)	40 (54.1)	18 (47.4)	0.047 *
	No	244 (58.9)	110 (64.0)	80 (61.5)	34 (45.9)	20 (52.6)
Experience of dental trauma	Yes	126 (30.4)	50 (29.1)	40 (30.8)	21 (28.4)	15 (39.5)	0.621
	No	288 (69.6)	122 (70.9)	90 (69.2)	53 (71.6)	23 (60.5)
Number of dental traumas	One	46 (11.2)	16 (9.3)	20 (15.4)	5 (6.8)	5 (13.2)	0.640
	Two	44 (10.6)	19 (11.0)	13 (10.0)	7 (9.5)	5 (13.2)
	Three	15 (3.6)	6 (3.5)	3 (2.3)	3 (4.0)	3 (7.9)
	Four and more	21 (5.1)	10 (5.8)	4 (3.1)	5 (6.8)	2 (5.3)
Time of dental trauma	During match	70 (16.9)	24 (14.0)	20 (15.4)	15 (20.2)	11 (28.9)	0.248
	During practice	56 (13.5)	26 (15.1)	20 (15.4)	6 (8.1)	4 (10.5)
Reason of trauma (multiple choice)	Fall	43 (10.3)	19 (11.0)	11 (8.5)	10 (13.5)	3 (7.9)	0.653
	Slipping	24 (5.8)	9 (5.2)	13 (10.0)	0 (0.0)	2 (5.3)	0.031 *
	Collision with another person	87 (21.1)	35 (20.3)	25 (19.2)	14 (18.9)	13 (34.2)	0.214
	Impact with an object (ball)	32 (7.8)	14 (8.1)	6 (4.6)	5 (6.8)	7 (18.4)	0.046 *
	Other	7 (1.6)	3 (1.8)	3 (2.3)	1 (1.4)	0 (0.0)	0.800
Type of trauma (multiple choice)	Avulsion	32 (7.7)	9 (5.2)	13 (10.0)	6 (8.1)	4 (10.5)	0.411
	Crown fracture	54 (13.0)	29 (16.9)	14 (10.8)	6 (8.1)	5 (13.2)	0.222
	Luxation	28 (6.8)	9 (5.2)	16 (12.3)	1 (1.4)	2 (5.3)	0.114
	Other	44 (10.6)	18 (10.5)	16 (12.3)	8 (10.8)	2 (5.3)	0.672
Teeth affected by trauma	Upper front teeth	100 (24.2)	39 (22.7)	30 (23.1)	15 (20.2)	16 (42.1)	0.056
	Lower front teeth	22 (5.3)	4 (2.3)	13 (10.0)	4 (5.4)	1 (2.6)	0.026 *
	Other	23 (5.6)	5 (2.9)	9 (6.9)	6 (8.1)	3 (7.9)	0.253
Dental visit after trauma	Yes	92 (22.2)	27 (15.7)	34 (26.2)	16 (21.6)	15 (39.5)
	No	34 (8.2)	9 (5.2)	14 (10.1)	6 (8.1)	5 (13.2)

Data are presented as numbers (percentages). χ²—chi-square test or Fisher’s exact test, * p < 0.05.

shows that most participants had no experience of maxillofacial injury during basketball (N = 244, 58.9%) and no experience of dental injury either (N = 288, 69.6%). Among those who did sustain an injury, the majority experienced it once (N = 45, 10.9%) or twice (N = 44, 10.6%), while fewer participants reported three (N = 15, 3.6%) or four or more injuries (N = 21, 5.1%). More injuries occurred during games (N = 70, 16.9%) than during training sessions (N = 56, 13.5%). The most common cause of injury was collision with another person (N = 87, 21.1%), followed by falling (N = 43, 10.3%), impact with an object such as the ball (N = 32, 7.8%), and slipping (N = 24, 5.8%). The most frequent type of dental injury among basketball players was crown fracture (N = 54, 13%), followed by tooth avulsion (N = 32, 7.7%) and tooth displacement (N = 28, 6.8%). Regarding the affected teeth, upper anterior teeth were most injured (N = 100, 24.2%), while lower anterior teeth (N = 22, 5.3%) and other teeth (N = 23, 5.6%) were less frequently affected. Among participants who sustained a dental injury, most sought dental treatment (N = 105, 25.4%).

Table 7. Frequency of Use and Knowledge of Mouthguards among Participants.

Characteristics		Sport Involvement					p
		Total N = 414	Recreational N = 172	Amateur N = 130	Professional N = 74	Coach N = 38
Knowledge of the existence of mouthguards	Yes	363 (87.7)	154 (89.5)	108 (83.1)	68 (91.9)	33 (86.8)	0.227
	No	51 (12.3)	18 (10.5)	22 (16.9)	6 (8.1)	5 (13.2)
Usage of mouthguard	Yes	86 (20.8)	27 (15.7)	24 (18.5)	26 (35.1)	9 (23.7)	0.006 *
	No	328 (79.2)	145 (84.3)	106 (81.5)	48 (64.9)	29 (76.3)
Type of mouthguard (multiple choice)	Stock	21 (5.1)	7 (4.1)	7 (5.4)	6 (8.1)	1 (2.6)	0.001 *
	Semi-custom	31 (7.5)	9 (5.2)	14 (10.8)	5 (6.8)	3 (7.9)
	Custom	45 (10.9)	9 (5.2)	11 (8.5)	15 (20.3)	10 (26.3)
Recommendation for use (multiple choice)	Dentist	67 (16.2)	12 (7.0)	23 (17.7)	17 (23.0)	15 (39.5)	≤0.001 *
	Coach	23 (5.6)	10 (5.8)	6 (4.6)	5 (6.8)	2 (5.3)	0.930
	Media	23 (5.6)	9 (5.2)	8 (6.1)	4 (5.4)	2 (5.3)	0.988
	Coplayers	27 (6.5)	4 (2.3)	9 (6.9)	9 (12.2)	5 (13.2)	0.009 *
	Other	15 (3.6)	7 (4.1)	4 (3.1)	2 (2.7)	2 (5.3)	0.878
Reason for not using mouthguard (multiple choice)	Discomfort	110 (26.6)	43 (25.0)	39 (30.0)	19 (25.7)	9 (23.7)	0.755
	Uselessness	19 (4.6)	6 (3.5)	8 (6.1)	3 (4.1)	2 (5.3)	0.731
	Unavailability of purchase	58 (14.0)	23 (13.4)	25 (19.2)	6 (8.1)	4 (10.5)	0.137
	Perceived unnecessity in basketball	49 (11.8)	20 (11.6)	17 (13.1)	7 (9.5)	5 (13.2)	0.882
	Price	22 (5.3)	13 (7.6)	7 (5.4)	0 (0.0)	2 (5.3)	0.118
	Other	154 (37.2)	73 (42.4)	44 (33.9)	22 (29.7)	15 (39.5)	0.212

Data are presented as numbers (percentages). χ²—chi-square test or Fisher’s exact test, * p < 0.05.

shows that most participants do not use a mouthguard while playing basketball (N = 328, 79.2%). Among those who do use one (N = 86, 20.8%), custom-made mouthguards are the most common (N = 45), followed by semi-custom (N = 31), while stock mouthguards are used less frequently (N = 21). The majority of recommendations for mouthguard use come from dentists (N = 67, 16.2%), followed by teammates (N = 27, 6.5%), while recommendations from coaches (N = 23, 5.6%) and media (N = 23, 5.6%) are less frequent. The most cited reason for not using a mouthguard falls under the category “other” (N = 154, 37.2%). Some participants reported not knowing where to obtain a mouthguard (N = 58, 14.0%), while others considered it unnecessary in basketball (N = 49, 11.84%). Regarding knowledge about the existence of protective mouthguards, most participants were aware of them (N = 363, 87.7%).

According to the results shown in

Table 8. Attitudes and Self-assessment of Oral Health among Participants.

Characteristics	Sport Involvement						p
		Total N = 414	Recreational N = 172	Amateur N = 130	Professional N = 74	Coach N = 38
Educated on how to assist a person who has experienced a dental trauma	Yes	66 (15.9)	22 (12.8)	19 (14.6)	8 (10.8)	17 (44.7)	≤0.001 *
	No	348 (84.1)	150 (87.2)	111 (75.4)	66 (79.2)	21 (55.3)
Perceived adequacy of education to provide first aid for dental trauma	Yes	67 (16.2)	24 (13.9)	19 (14.6)	10 (13.5)	14 (36.8)	0.004 *
	No	347 (83.8)	148 (86.0)	111 (75.4)	64 (86.5)	24 (63.2)
Perceived knowledge of dental trauma	Excellent	36 (8.7)	13 (7.6)	9 (7.0)	6 (8.1)	8 (21.1)	0.006 *
	Moderate	134 (32.4)	45 (26.2)	49 (37.7)	23 (31.1)	17 (44.7)
	Low	244 (58.9)	114 (66.3)	72 (55.4)	45 (60.8)	13 (34.2)
Perceived importance of knowledge about traumatic dental injuries and emergency management during playing/training	Unimportant	47 (11.4)	17 (9.9)	22 (17.0)	7 (9.5)	1 (2.6)	0.123
	Moderately important	197 (47.6)	82 (47.7)	60 (46.2)	39 (52.7)	16 (42.1)
	Extremely important	170 (41.1)	73 (42.4)	48 (36.9)	28 (37.8)	21 (55.3)
Willingness to improve knowledge of dental traumas, their emergency management, and oral health	Yes	175 (42.3)	70 (40.7)	51 (59.2)	33 (44.6)	21 (55.3)	0.326
	No	239 (57.7)	102 (59.3)	79 (60.8)	41 (55.4)	17 (44.7)
Ways to improve knowledge of first aid procedures for dental trauma (multiple choice)	Online instructions	159 (38.4)	64 (37.2)	49 (37.7)	30 (40.5)	16 (42.1)	0.920
	Dentist instructions	111 (26.8)	44 (25.6)	33 (25.4)	19 (25.7)	15 (39.5)	0.331
	Informative posters/brochures	116 (28.0)	45 (26.2)	36 (27.7)	18 (24.3)	17 (44.7)	0.108
	No need to improve knowledge	101 (24.4)	46 (26.7)	30 (23.1)	17 (22.9)	8 (21.1)	0.814
Oral health information source	Dentist	212 (51.2)	87 (50.5)	55 (42.3)	44 (59.5)	26 (68.4)	0.014 *
	Friends and family	152 (36.7)	68 (39.5)	43 (33.1)	31 (41.9)	10 (26.3)	0.267
	School	102 (24.6)	44 (25.6)	38 (36.9)	10 (13.5)	10 (26.3)	0.088
	Media	83 (20.0)	43 (25.0)	25 (19.2)	7 (9.5)	8 (21.1)	0.048 *
Self-assessed oral health knowledge	Excellent	56 (13.5)	22 (12.8)	15 (11.5)	10 (13.5)	9 (23.7)	0.171
	Moderate	292 (70.5)	117 (68.0)	94 (72.3)	53 (71.6)	28 (73.4)
	Low	66 (15.9)	33 (19.2)	21 (16.2)	11 (14.9)	1 (2.6)

Data are presented as numbers (percentages). χ²—chi-square test or Fisher’s exact test, * p < 0.05.

, most participants had not received education on how to assist a person who experienced a dental trauma (N = 348, 84.1%), and a similar proportion reported that they do not consider themselves sufficiently educated for such situations (N = 347, 83.8%). Regarding self-assessment of knowledge about traumatic dental injuries, the largest number of participants rated their knowledge as poor or very poor (N = 244, 58.9%). One-third of participants considered their knowledge satisfactory (N = 134, 32.4%), while only a few believed they possessed very good or excellent knowledge (N = 36, 8.7%). Most participants considered knowledge about dental trauma moderately important (N = 197, 47.6%), while 170 (41.1%) rated it as important or extremely important. A smaller number regarded it as unimportant or completely unimportant (N = 47, 11.4%). Despite this, most participants did not wish to further improve their knowledge in this area (N = 239, 57.7%). Among those interested in further education, the preferred learning methods were online instructions (N = 159, 38.4%), followed by informative posters and brochures (N = 116, 28.0%), and lectures by dental professionals (N = 111, 26.8%). The main source of information on oral health for most participants was the dentist (N = 212, 51.2%), while fewer obtained information from family and friends (N = 152, 36.7%), school (N = 102, 24.6%), and media (N = 83, 20.0%).

4. Discussion

This study aimed to assess the prevalence of dental injuries and the use of mouthguards, evaluate oral hygiene habits, and determine the overall level of oral health knowledge and status among basketball players in Croatia. The null hypothesis was rejected, as the results showed that basketball players demonstrated generally poor oral health knowledge, inadequate oral hygiene practices, and suboptimal oral health status, with low mouthguard use and varying knowledge levels according to education and socioeconomic status. Results revealed insufficient knowledge across all groups, thereby supporting the study’s null hypothesis. Coaches demonstrated the highest level of knowledge, while amateur athletes scored the lowest. Other groups, including professional and recreational athletes, also exhibited lower levels of oral health literacy compared to coaches. Similar findings have been reported in a 2023 study conducted in Croatia among 114 professional water polo players, which found limited awareness about oral health and dental trauma, with an average knowledge score of 6.4 ± 2.6 out of 12 [13].

In this study, coaches achieved a moderate knowledge level, significantly higher than that of professional, amateur, and recreational athletes. This likely reflects their educational background and their responsibility for the athletes’ well-being [18]. No significant differences were found with respect to sex or age; however, socioeconomic status had a notable impact. These results are consistent with a study from India, which concluded that oral health knowledge is more closely associated with education and access to information than with sex or body composition [24]. Sex differences in oral health and sports-related dental injuries have been reported in previous studies, with women generally showing different oral health outcomes compared to men and men being at higher risk for dental injuries during sport [35,36]. The data in this study also indicate that participants with above-average socioeconomic status had the highest knowledge levels, followed by those with average status, while individuals with below-average socioeconomic backgrounds had the lowest scores. These findings align with previous research highlighting the role of sociodemographic factors in shaping oral health knowledge. For instance, a 2018 UK study showed a positive correlation between higher education, favorable socioeconomic status, and improved oral health behaviors in athletes [9]. Additionally, the level of education significantly influenced oral health knowledge, with the highest scores among those with university degrees. A study conducted in 2015 in the United Kingdom among elite athletes showed that they often have poor oral health, which is associated with a lack of knowledge and inadequate preventive habits [32].

Basic awareness about the link between oral and general health was relatively high. The highest correct response rates were for items such as “Poor oral hygiene can lead to caries and periodontitis” (79.2%), “Oral health is closely related to overall health” (79.0%), and “Oral health affects quality of life” (76.3%). These results are consistent with similar findings among Croatian water polo players [13]. Conversely, knowledge of dental trauma and emergency procedures was lacking. For example, only 29.7% correctly identified that a knocked-out tooth should be handled by the crown, and 33.3% knew that avulsed permanent teeth can be replanted. These findings are concerning, given that athletes are frequently exposed to the risk of dental injuries [37]. Similar results have been reported in other studies [13,18,22]. A study conducted among military athletes in the United States showed that knowledge of proper management following dental trauma was unsatisfactory [26], while less than 30% of young athletes in the United Kingdom knew how to correctly handle an avulsed tooth [25]. A comparable lack of knowledge was also observed in a 2019 study from Jordan, where young amateur football players demonstrated low awareness regarding the prevention and management of traumatic dental injuries [38].

Despite 87.0% of respondents reporting that they brush their teeth twice daily for at least two minutes and 75.6% using fluoride toothpaste, knowledge gaps persist. Only 39.9% regularly use interdental aids. Similar trends were observed among the Croatian general population, where daily brushing was common, but only 32% used interdental brushes or floss [39]. However, although athletes often report regular toothbrushing, research shows that this does not guarantee optimal oral health. For example, a study conducted among elite athletes in the United Kingdom found that, despite 94% of participants brushing their teeth at least twice daily, the prevalence of caries was 49.1%, while 77% showed signs of gingivitis or calculus deposits [11]. Additionally, 75.6% of respondents reported using fluoride toothpaste, which is a positive finding, though somewhat lower than in developed countries where usage reaches up to 90% [40]. In this study, 39.9% of participants reported regular use of interdental brushes or dental floss, reflecting a moderate level of awareness of the importance of interdental hygiene among athletes. A similar pattern was observed in a study of Croatian water polo players, where more than 80% reported brushing daily, but only 32% used interdental aids [13]. On an international level, a study conducted among elite athletes in the United Kingdom showed that only 16.2% used interdental cleaning devices at baseline; however, after an educational intervention, this figure increased to 75.0%, demonstrating the importance of education in promoting oral hygiene practices [25].

A considerable proportion of athletes, regardless of professional status, reported various symptoms and signs of compromised oral health. The most common complaints were gingival bleeding (37.9%), tooth sensitivity (34.3%), dental caries (31.2%), and toothache (29.5%). Gingival bleeding, as the most prevalent symptom, points to the possible presence of gingivitis and periodontal problems. This finding is concerning, particularly in light of a 2018 study from the United Kingdom, which showed that even Olympic athletes had a high prevalence of gingivitis despite regular toothbrushing [9]. Similarly, a 2011 study in Spain among professional football players found that more than 40% showed signs of periodontal disease, which can negatively impact both sports performance and general health [6]. Toothache (29.5%) and caries (31.2%) were reported by nearly one-third of participants, underscoring the importance of preventive dental examinations, which appear to be insufficient in this population. These results align with a 2023 Croatian study among water polo players, which recorded a similar prevalence of self-reported caries [13].

Significant differences related to the level of sports engagement were observed for several items, including swollen and painful gums, tooth mobility, difficulty chewing, temporomandibular joint pain, and history of endodontic treatment. These issues were most frequently reported by amateur athletes, which may reflect reduced access to education and dental care in this group compared to professionals, who potentially have greater support from club medical staff. Notably, as many as 13.5% of respondents reported having suffered a fractured or avulsed tooth, a finding particularly relevant for contact sports such as basketball. A Croatian study on orofacial injuries among basketball players in 2011 showed that more than half of the players had experienced some form of dental trauma during their careers [21]. Problems such as dry mouth (31.4%) and halitosis (22.2%) were also commonly reported. Xerostomia may result from dehydration or frequent consumption of sports drinks with high sugar and acid content, which are well documented in the literature as risk factors for caries and enamel erosion [9,13].

Alarmingly, 41.1% of respondents had experienced orofacial trauma while playing basketball, with higher rates among amateurs and recreational players. Similar trends were noted in a 2011 Croatian study, where over half of basketball players reported dental injuries [21]. Concerning dental injuries, 30.4% of respondents reported experiencing them, and although differences between groups were not statistically significant, the highest prevalence was again recorded among recreational (39.7%) and amateur athletes (31.7%). The most common injuries involved the upper anterior teeth (24.2%), which are expected given their exposure to impact [37]. In addition, injuries to the lower anterior teeth were significantly more frequent among amateur athletes, further emphasizing the need for education and prevention in this group [13]. While 87.7% were aware of mouthguards, actual usage was low at 20.8%. This gap between awareness and application mirrors findings in Spain and the UK, where mouthguard usage remains low despite high awareness [6,15,18]. Only 15.9% of athletes had been educated on responding to dental trauma. Furthermore, only 8.7% rated their trauma management knowledge as good or excellent. These results echo other Croatian and Turkish studies, indicating a widespread educational gap among athletes and coaches alike [15,18]. While 88.6% recognized dental trauma education as important, and 42.3% expressed interest in further learning, the primary source of information remained dentists (41%), followed by unverified sources like media and peers. Studies confirm that dental professionals play a crucial role in raising awareness and promoting preventive measures, including custom-fitted mouthguards [26].

Basketball is a dynamic contact sport that involves rapid changes in direction, jumping, player collisions, and frequent falls, all of which increase the risk of orofacial injuries, particularly dental trauma [1,20,21]. Despite this risk, the use of mouthguards in basketball is not mandatory, and their adoption among players remains low [3,17,18]. Numerous studies emphasize the effectiveness of mouthguards in preventing dental injuries, yet poor awareness and lack of habit often result in their limited use [15,26,41]. Encouragingly, as many as 87.7% of respondents reported being aware of mouthguards, but this knowledge does not translate into actual use. A study conducted in Spain in 2011 concluded that without mandatory regulation and education, awareness alone is insufficient to reduce the incidence of dental trauma [6]. In the present study, only 20.8% of respondents reported using a mouthguard, although nearly all were aware of their existence. This discrepancy between knowledge and practice has also been confirmed in other studies. For example, research conducted in Spain in 2011 demonstrated that despite a high level of awareness (over 80%), the prevalence of mouthguard use was below 15% [6]. A statistically significant difference was observed in relation to the level of sports engagement: mouthguard use was highest among professional athletes (30.2%) and coaches (10.5%), while recreational athletes—although numerically the largest group—reported only 31.4% usage. These findings suggest that a more serious approach to sport increases the likelihood of using protective equipment, which is further supported by Croatian studies among professional handball and water polo players, showing that professionals are more likely to use protective gear [13,21]. When examining the type of mouthguards used, custom-made devices were the most common, followed by semi-custom options, while stock mouthguards were the least represented. This aligns with dental recommendations, as custom-made mouthguards are considered the most effective due to their superior fit and comfort [39]. Interestingly, dentists were reported as the most frequent source of recommendations for mouthguard use. This highlights the crucial role of dentists in educating athletes, although their involvement is neither systematic nor widespread. This was confirmed in a 2023 Croatian study, where many athletes reported never having received advice from their dentist about mouthguards [13]. The most frequently cited reasons for not wearing a mouthguard included discomfort and lack of knowledge regarding how and where to obtain one. Importantly, cost was not identified as a primary barrier. These reasons reflect a lack of education and personal motivation, consistent with international research findings [15,18,26,41].

The results indicate an alarmingly low level of knowledge and education regarding dental trauma among basketball players across all levels of participation. Only 15.9% of respondents reported having been educated on how to assist a person with dental trauma during sports activities. Although this education was most frequently reported among recreational athletes (33.3%), as many as 84.1% of all participants lacked such knowledge, highlighting a serious educational deficit. Similarly, only 16.2% of respondents considered themselves sufficiently educated to provide first aid in the case of dental trauma. Self-assessment of knowledge was also low, with only 8.7% rating their knowledge as very good or excellent, while 58.9% assessed it as poor or very poor. These findings are consistent with previous research. A 2023 study conducted in Croatia among football players also revealed very low levels of knowledge about managing dental trauma, with most athletes reporting they had never received any education on the subject [15]. Similarly, a 2017 study from Turkey found that most basketball players and their coaches were not familiar with the correct procedures for handling an avulsed tooth [18]. Nevertheless, it is encouraging that most of the respondents (88.6%) considered knowledge about dental trauma at least moderately important, while 41.1% rated it as very or extremely important. This attitude reflects awareness of the topic’s relevance and suggests strong potential for implementing targeted educational interventions. When it comes to willingness to improve knowledge, 42.3% of participants expressed interest in further education. Dentists were identified as the most common source of information on oral health (41%), which is a positive finding; however, it is concerning that media and friends were also frequently reported sources, given their lack of professional validation. A 2014 study from Turkey confirmed that direct education by dentists plays a crucial role in improving knowledge and encouraging the use of preventive measures such as mouthguards [26].

The main limitation of this study lies in its reliance on self-reported data collected through an online questionnaire, which may introduce subjective bias such as socially desirable responses and selective recall. Some participants may have shown reduced attention due to the length of the questionnaire. Furthermore, the cross-sectional design does not allow for the establishment of causal relationships or the monitoring of behavioral changes over time. The absence of objective clinical indicators (e.g., dental examinations) further complicates the validation of self-reported oral health status. Future research should therefore incorporate a more diverse sample of athletes from different sports and regions to enhance the generalizability of results, as well as combine quantitative and qualitative methods for a deeper understanding of attitudes, habits, and barriers [42]. The inclusion of clinical assessments, validation of self-reports, and longitudinal approaches would strengthen data reliability and enable the evaluation of educational and preventive interventions over time, providing a foundation for the development of national guidelines on the prevention of sports-related dental injuries [35,43]. Also, the absence of a multiple regression analysis, which was not feasible given the available sample size and data structure, represents a limitation of this study. Future research with larger samples should include multivariable analyses to better explore these associations.

Despite these limitations, the study provides valuable insights into athletes’ knowledge, attitudes, and practices regarding oral health, which have not previously been systematically investigated in the Croatian context. The findings can serve as a basis for targeted preventive measures, such as mandatory oral health education in sports federations—particularly in contact sports like basketball—as well as the integration of dental examinations into routine medical check-ups [16]. Special emphasis should be placed on encouraging the use of custom-made mouthguards, especially among younger athletes, with the possibility of financial support for their fabrication. To further inform athletes and coaches, the distribution of educational materials (brochures, posters, digital content) with clear instructions for managing dental trauma is recommended. Evidence shows that structured educational programs can significantly improve awareness of oral hygiene and the use of protective equipment, ultimately reducing the risk of dental injuries. Additionally, our findings highlight the need for implementing preventive strategies tailored to the observed deficiencies. These include regular dental checkups to monitor oral health, targeted education to enhance knowledge and hygiene practices, and the promotion of customized mouthguards to mitigate dental trauma, thereby supporting both oral health and athletic performance.

5. Conclusions

This study revealed that basketball players in Croatia demonstrated inadequate knowledge of oral health, with amateur athletes showing the lowest levels of understanding. Higher educational attainment and socioeconomic status were positively associated with better knowledge, whereas sex and age did not appear to have a significant effect. Oral hygiene habits were generally satisfactory, although the use of interdental cleaning aids remained limited. Approximately one-third of respondents reported oral health problems such as gingival bleeding and toothache, and a similar proportion experienced dental injuries, which were most common among recreational and amateur athletes. Despite widespread awareness of mouthguards, only one in five participants reported using them, with professional athletes being the most frequent users. Overall, education regarding the management of dental injuries was insufficient, and most participants evaluated their knowledge as unsatisfactory. These findings highlight the need for targeted educational interventions aimed at improving oral health knowledge and preventive practices, particularly among athletes. Specific recommendations include implementing mandatory oral health education programs within sports federations, integrating dental examinations into routine athlete medical checkups, promoting the use of customized mouthguards, and distributing educational materials to athletes and coaches. Such initiatives can enhance oral hygiene practices, increase awareness of dental trauma prevention, and ultimately support both oral health and athletic performance.