Mouth Guards in Sports

by Dr. Frenda Williams, DDS

Each year more than 5 million teeth are either avulsed or displaced due to a sports injury. In many cases the loss or damage to teeth can be attributed to the absence of a mouth guard or to a poorly fabricated or ill-fitting one. Research in the area of orofacial injury has shown that any trauma that occurs to the base of the skull which causes the condyles to be pushed upward into the glenoid fossa will result in a concussion. This bit of information may come as a surprise, because most people attribute athletic mouth guards to just protecting teeth. However, empirical evidence shows that an athletic mouth guard not only protects teeth, but also protects the head against a blow to the jaw that can result in a concussion and/or loss of consciousness.

Functions of a Mouth Guard

According to the National Youth Sports Foundation for Safety, a young athlete is 60x more likely to sustain damage to the mouth and teeth when not wearing an athletic mouth guard. In the book Text and Color Atlas of Traumatic Injuries to the Teeth, the authors list 8 functions of a mouth guard:

    1. Prevention of lacerations and bruising during impact by acting as a buffer between soft tissue and the teeth
    2. Prevent tooth fractures or dislocation by cushioning the teeth from direct frontal blows while redistributing the forces of the impact
    3. Opposing teeth are protected from seismic contact with each other
    4. The mandible is afforded elastic recuperative support that can prevent fracture or damage to the unsupported angle of the lower jaw
    5. Reduce neurologic injury by acting as a shock absorber between upper/lower jaws. Without a mouth guard, the trauma of the jaws violently jarring together can distribute the impact from the condyles for the mandible against the base of the skull resulting in a concussion
    6. Provide positive reinforcement in the prevention of neck injuries
    7. Provide psychologic benefit to athletes. Findings suggest athletes feel more confident and aggressive when having proper protection
    8. Fill edentulous spaces and help support adjacent teeth. This allows removable prostheses to be taken out during athletic competitions

Indications for a Mouth Guard

When thinking about what sports a mouth guard should be worn, the immediate answer is contact sports. Well that answer is correct. However, when you think about it a bit more, you will come to the conclusion that all sports are associated with injuries and those injuries can also include damage to the teeth, mouth and surround/supporting soft tissue. Keeping that in mind, the ADA and other sports organizations have begun to include in their list of sports that they recommend an athlete should wear a mouth guard to included non-contact sports. This means that mouth guards need to be fabricated based upon the sport that an athlete is playing. Clearly the mouth guard that football player would wear doesn’t look or fit like one worn by an equestrian or mountain climber. But, where injury can occur to the head and neck area, a specialized athletic guard is indicated.

Types of Mouth Guards

There are three basic types of mouth guards available.

1. Stock Mouth guard

A stock mouth guard is a sports guard that is available in sporting goods stores. These guards are the least expensive, the least effective and least desirable when it comes to protecting the mouth. Because the stock guards come in limited sizes, an athlete is more apt to modify the guard in order to obtain a more comfortable fit. In doing so, the effectiveness of the guard has been reduced. In addition, because the guard is not ‘custom’ fit to the athlete, the guard may dislodge during contact and if the athlete is unconscious could become an airway obstruction.

2. Boil-and-Bite

The boil-and-bite mouth guards are the most commonly used guards. The guards are made of thermoplastic material that when immersed in hot water is made pliable and can be molded to the mouth using the athlete’s lips, cheeks, tongue and pressure from biting. Because the guard must be molded to the mouth, the thermoplastic material is thinner and therefore does not provide the proper thickness needed to protect the posterior teeth, support the jaw or protect against concussions.

3. Custom Made Mouth Guards

Custom mouth guards are designed by qualified dentists and sent to a dental laboratory for fabrication. This type of mouth guard provides the necessary thickness, custom fit, comfort and protection that is needed to reduce injury to teeth and soft tissue as well as protect the jaw during contact that may cause a concussion. Custom mouth guards are designed to meet the needs of the athlete. For example, a basketball player may have a mouth guard that requires only one to two thin layers of ethylene vinyl acetate (EVA) because it is less of a direct contact sport than football. But in playing basketball, elbows to the face and bodies falling to the ground are a real concern and can cause injury to the mouth and soft tissue.

The way of thinking about sports mouth guards and their use has evolved. With athletes becoming more competitive and more specialized, the gear that is meant to protect them must also become more adaptable and more customizable. Research has shown that if an athlete knows that are prone to less injury because they are equipped with the best gear, they are more likely to go all out and perform their best. Sports mouth guards should no longer be associated with only heavy contact sports but should be seen as a necessity for keeping all of our athletes safe no matter sport they are competing in.

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