Athletic Mouthguard Types
Properly diagnosed, designed, and custom fabricated mouthguards are essential in the prevention of athletic oral/facial injuries.
In Dr. Raymond Flander’s 1995 study, he reported on the high incidence of injuries in sports other than football, in both male and female sporting activities. In football where mouthguards are worn, .07% of the injuries were orofacial. In basketball where mouthguards are not routinely worn, 34% of the injuries were orofacial. Various degrees of injury, from simple contusions and lacerations to avulsions and fractured jaws are being reported.
The National Youth Sports Foundation for the Prevention of Athletic Injuries, Inc. reports several interesting statistics. Dental injuries are the most common type or orofacial injury sustained during participation in sports. Victims of total tooth avulsions who do not have teeth properly preserved or replanted may face lifetime dental costs of $10,000 – $15,000 per tooth, hours in the dentist’s chair, and the possible development of other dental problems such as periodontal disease.
It is estimated by the American Dental Association that mouthguards prevent approximately 200,000 injuries each year in high school and collegiate football alone. A properly fitted mouthguard must be protective, comfortable, resilient, tear resistant, odorless, tasteless, not bulky, cause minimal interference to speaking and breathing, and (possibly the most important criteria) have excellent retention, fit, and sufficient thickness in critical areas.
Unfortunately, the word “mouthguard” is universal and generic, and includes a large range and variety of products, from “over the counter” models bought at the sporting goods stores to professionally manufactured and dentist prescribed custom made mouthguards.
Presently, over 90% of the mouthguards worn are of the variety bought at sporting good stores. The other 10% are of the custom made variety diagnosed and designed by a health professional (dentist and/or athletic trainer).
There are three types of mouthguards presently available. Each type will be discussed:
The stock mouthguard, available at most sporting good stores, come in limited sizes (usually small, medium, and large) and are the least expensive and least protective. The prices range approximately from, $3 to $25. These protectors are ready to be used without any further preparation; simply remove from the package and immediately place in the mouth. They are bulky and lack any retention, and therefore must be held in place by constantly biting down. This interferes with speech and breathing, making the stock mouthguard the least acceptable and least protective. This type of mouthguard is often altered and cut by the athlete in an attempt to make it more comfortable, further reducing the protective properties of the mouthguard. It has been suggested and advised in the medical/dental literature that these types of mouthguards not be worn due to their lack of retention and protective properties.
As sports dentists and health professionals interested in injury prevention, we do not recommend this type of mouthguard to our patients and athletic teams. See photo of Stock Mouthguard after use for several weeks.
Mouth formed or Boil and Bite Mouthguard:
Presently, this is the most commonly used mouthguard on the market. Most marketing and advertising in the past has been for this type mouthguard. Made from thermoplastic material, they are immersed in boiling water and formed in the mouth by using finger, tongue, and biting pressure. Available in limited sizes, these mouthguards often lack proper extensions and repeatedly do not cover all the posterior teeth. Dental mouth arch length studies have shown that most boil and bite mouthguards do not cover all posterior teeth in a majority of high school and collegiate athletes. Athletes also cut and alter these bulky and ill fitting boil and bite mouthguards due to their poor fit, poor retention, and gagging effects. This in turn further reduces the protective properties of these mouthguards. When the athlete cuts the posterior borders or bites through the mouthguard during forming, the athlete increases their chance of injury, especially concussion, from a blow to the chin. Some of these injuries, such as concussion, can cause life long effects. (See concussion section of Sports Dentistry On Line). Certain thicknesses and extensions are necessary for proper mouthguard protection.
Dr. Keith Hunter, Australian sports dentist, reported that mouthguards should be of certain thickness, without being bulky. He suggests a thickness of 3mm. It should be noted that each athlete should be evaluated individually for thickness and design as to promote comfort and sufficient protection.
Joon Park, PhD et al, at the First International Symposium on Biomaterials in August of 1993 reported that boil & bite mouthguards provide a false sense of protection due to the dramatic decrease in thickness occlusally during the molding and fabrication process. Dr. Park further stated that “Unless dramatic improvements are made, they (boil and bite mouthguards) should NOT be promoted to patients as they are now.”
Care should be taken by the public when bombarded with clever marketing schemes, claims, and promotions by stock and boil and bite mouthguard companies. The bottom line is that Stock and Boil and Bite Mouthguards do not provide the expected care and injury prevention that a properly diagnosed and fabricated custom made mouthguard does. Why is there a general belief that mouthguards are uncomfortable, do not fit, are bulky, and interfere with breathing and speaking? Could it be because 90% of today’s mouthguards worn are of the stock or boil and bite variety, and it is the perception by the public and coaches that these are the only available mouthguards? Indeed, most mouthguards today do not fit, are bulky, and do interfere with speaking and breathing because they are wearing stock or boil and bite mouthguards! The majority of athletes are not wearing properly made dentally diagnosed and designed custom made mouthguards provided by your sports dentist.
As sports dentists and health professionals interested in injury prevention, we do not recommend store bought boil and bite mouthguards to our patients and athletic teams. The public deserves the best quality of care in injury prevention and boil and bite mouthguards DO NOT provide this quality. See photo of Boil and Bite Mouthguard after use for several weeks.
Custom made mouthguards are supplied by your dentist. Custom mouthguards provide the dentist with the critical ability to address several important issues in the fitting of the mouthguard. Several questions must be answered before the custom mouthguard can be fabricated. These questions include those addressed at the preseason screening or dental examination. Is the mouthguard designed for the particular sport being played? Is the age of the athlete and the possibility of providing space for erupting teeth in mixed dentition (age 6-12) going to affect the mouthguard? Will the design of the mouthguard be appropriate for the level of competition being played? Does the patient have any history of previous dental injury or concussion, thus needing additional protection in any specific area? Is the athlete undergoing orthodontic treatment? Does the patient present with cavities and/or missing teeth? Is the athlete being helped by a dentist and/or athletic trainer or by a sporting good retailer not trained in medical/dental issues? These are important questions that the sporting good store retailer and the boil & bite mouthguard CANNOT begin to address.
The custom made mouthguards are designed by your dentist and are the most satisfactory of all types of mouth protectors. They fulfill all the criteria for adaptation, retention, comfort, and stability of material. They interfere the least with speaking and studies have shown that the custom made mouthguard has virtually no effect on breathing.
By acknowledging these significant differences in mouthguards, the public will be better informed and educated to seek their dentistry from dental health professionals and not from sporting good retailers.