• Sports Mouth Guard: Dentist fabricated vs. Boil and Bite

    by Catherine Koo, DDS and Victoria Burfield, RDA
    on Jun 2nd, 2016

1. The protective qualities of a proper sports mouthguard are well documented.

2. The decision making process regarding mouthguards from a coach and parent perspective.

3. Understanding the type of sports mouthguard that will actually deliver the expected protection.


Pictured: Patient Jalen Shelley 8 YO

I. The protective qualities of a sports mouthguard are well documented.

From American high school football athletes to Germany’s elite athletes, the data prove that when wearing a sports mouthguard that is fabricated to specifications for protection there are less concussions, traumatic brain injury and less oral and facial injuries such as fractured teeth or teeth knocked out after a sports related impact. A 1989 study of mouthguards in relation to sport injuries gathered data from 2, 470 interviews taken from players across 21 junior and senior high schools over a three year period. The athletes played primarily football. This is a broad study and therefore a good canvass of how injuries breakdown in this demographic strata. Over that 3 year period, there were 222 injuries noted with 9% of all players suffering some kind of oral injury while participating in a sport and 3% (or 64 players) reporting a loss of consciousness while participating in a sport. Of the total players reporting injuries, 75% of the time the player was not wearing a mouthguard. There were significantly fewer concussions while wearing mouthguards. Also, lower was the prevalence of both soft and hard tissue injuries while wearing mouthguards. In this study, American high school football athletes not wearing a mouthguard were almost 60 times more likely to sustain hard tissue trauma.(4)

A 2000 survey of 303 of Germany’s top athletes studied the athletes use and experience with sports mouthguards. A larger number of these German athletes as compared to the preceding study’s high school athletes reported getting injured when playing. Almost a third or 32% of these top German athletes reported suffering orofacial injury at some point in their sports career. For those athletes not wearing a mouthguard, the incidence of fracture of an upper front tooth was at 7% and having one of those teeth completely knocked out at 14%. For those elite German athletes wearing mouthguards, only one fractured tooth was reported.

Of the German athletes, 62% reported wearing a sports mouthguard at some time in their career. Furthermore, this broke down into 50% of those mouthguards being made by dentists and 50% were shop bought boil and bites. The German elite athletes complained that boil and bites were more problematic in terms of fit than custom made mouthguards. (3)

The knowledge that a properly made mouthguard protects when playing impact sports is unquestioned at this point in time. The mechanism of protection is that when separating teeth from the rest of the mouth and the soft tissues, lacerations and bruising are prevented. Also, in a direct frontal blow that may otherwise cause fracture or dislocation of anterior teeth, the mouthguard works by cushioning and distributing that force. (4 McNutt) But, to obtain this protection, a properly made mouthguard needs to be used. As the prevalence of orofacial injuries in contact sports is high, all athletes should be advised that custom made sports mouthguards offer the greatest comfort, fit, durability and protection. (3) Details on this type of custom mouthguard will be elucidated in the last third of this article.

II. Decision making processes regarding mouthguards from a coach and parent perspective.

Coaches and parents universally agree that sports mouthguards are protective but there is a breakdown when it comes to obtaining the benefit of it. One study showed that 95% of sports coaches surveyed feel mouthguards prevent oral injuries. However, the main criteria for their selection of a mouthguard was the cost of the appliance. The coaches surveyed identified convenience and the quality and degree of oral protection as their remaining concerns regarding selection of a sports mouthguard. (4) Now, focusing on cost and convenience will likely lead to a boil and bite mouthguard which is not very protective.

In a study by Dr. Andrew Greasley, the boil and bite mouthguard was found to provide only slightly more protection than no mouthguard at all. Some problems with boil and bite mouthguards are poor fit and poor retention. Also, certain thickness and extensions are necessary for proper mouthguard protection which a boil and bite mouthguard, in studies, is found not to have. (5) A proper mouthguard needs to be fabricated to established specifications to be protective.
One article identified 90% of all mouthguards in use as being boil and bite types with only 10% of mouthguards used being custom made. This point brings to attention that understanding and selecting the proper quality of the mouthguard is necessary in order to afford the protection.

There is also an issue with dentists and physicians not educating parents on the topic. One survey probed parents perceptions regarding sports mouthguards for their kids that played competitive soccer with ages ranging from 8-14YO. 92% of parents surveyed believed mouthguards were effective in reducing orofacial injuries but only half thought that mouthguards should be mandatory. Only 30% of parents reported that their dentist or physician recommended mouthguards for competitive youth soccer. (2) Many sports organizations, such as football at all levels, have requirements for mouthguard protection. Some sports highly recommend them such as martial arts studios and basketball. Really, any sport would benefit such as basketball, rugby, squash, etc. This highlights the need for health professionals to draw attention to the protection afforded from a dentist fabricated sports mouthguard. This would serve to reinforce guidelines from sports organizations and also to provide more insight into what kind of sports mouthguard should be acquired.


III. The pressure-vacuum fabricated sports mouthguard that can actually deliver the expected protection.

One study found 44% of football players wearing a mouth protector at the time of injury suffered soft tissue laceration that could have been avoided or been reduced if the mouthguard had increased protection or extra coverage of lip and cheeks. (4) This points to the need for standards in a sports mouthguard.
To start the discussion about a properly made sports mouthguard, it should be understood that among dentist fabricated mouthguards there are different types- mouthguards may be made using a 1. Vacuum +heat machine or a 2. Vacuum +heat +pressure machine. (6) Labs using a vacuum +heat only machine will not be able to sustain a 3mm thickness of material and subsequently, protection is greatly undermined. To be protective, a sports mouthguard should have 3mm of material occlusally, 3mm of material labially and 2 mm of material palatally. This fabrication requires equipment that supplies enough heat+ pressure on the necessary amount of material. It is a feat that conventional machines without pressure can’t do but unfortunately, most dental labs use. (5) This requirement has become a standard following data that suggest that the mouthguard be 3mm in thickness occlusally to statistically reduce the incidence of mild traumatic brain injury and concussion in high school football athletes. (1) It has become the standard that 3mm of material occlusally and facially be present to ensure proper absorption of impact energy. Boil and bites mouthguards are often thin and easily chewed through and torn. Moreover, a properly fabricated mouthguard should be delivered to the patient and adjusted to achieve a balanced occlusion without losing the required thickness of material. (6)

Custom mouthguards are more likely to be worn due to being tight fitting, nonbulky and comfortable and (6)they should meet all the criteria for adaptation, retention, thickness, comfort, and stability of material. (5) The truth is, boil and bite mouthguards simply do not have the internal adaptation that will enable the appliance to fit well and therefore, they do not stay in well and there are so many other problems with these. Only a properly made dentist fabricated mouthguard has the protective capabilities we expect for our athletes wearing them.


References:


1. Winters J, DeMont R. The Role of Mouthguards in Sports-Related Head Injuries. “Role of Mouthguards in Reducing Mild Traumatic Brain Injury/Concussion Incidence in High School Football Athletes.” General Dentistry, 2014; 62:34-38.

2. JM Pribble, RF Maio, GL Freed. “Parental perceptions regarding mandatory mouthguard use in competitive youth soccer”. Injury Prevention 2004; 10:159-162

3. Bemelmanns, P, Pfeiffer P. “Incidence of dental, mouth and jaw injuries and the efficacy of mouthguards in top ranking athletes.” Sportverletz Sportschaden. 2000 Dec; 14(4):139-43.

4. Tim McNutt, DDS, Sory W. Shannon, Jr., DMD, J.Timothy Wright, DDS, MS, Ronald A. Feinstein, MD. “Oral Trauma in adolescent athletes; a study of mouth protectors”. Pediatric Dentistry 1989, by The American Academy of Pediatric Dentistry Volume 11, Number 3.

5. Sports Dentistry Online review of Dr. Raymond Flander’s 1995 study on mouthguards and “Types of Athletic Mouthguards.”

6. Ray R. Padilla, DDS. “A Technique for Fabricating Modern Athletic Mouthguards”. May 2005. Vol. 33. No. 5. CDA. Journal.

Author Catherine Koo, DDS and Victoria Burfield, RDA

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