Types of Athletic Mouthguards

Properly diagnosed, designed, and custom fabricated mouthguards are essential in the prevention of athletic oral/facial injuries.

In a 1995 study, it was found there was a 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. The various injuries ranged from simple contusions and lacerations, avulsions (teeth knocked out), concussions and broken jaws. Most often, the most common type of head injury is dental in nature. Loosing a tooth can be an expensive proposition - costs range from $10,000 to $15,000 per tooth in lifetime dental costs.

The American Dental Association estimates that mouthguards do prevent over 200,000 injuries each year in high school and collegiate football alone.

The term "mouthguard" is a rather generic term today, there are many different products that go by the same name. The "over the counter" ones that everyone is familiar with to very custom mouthguards delivered by a dentist. Almost all mouthguards worn today are from the variety that can be purchased "over the counter", only 10% are custom made by a dentist for the athlete.

If a mouthguard is to be made correctly, it must fulfill several different objectives.

Mouthguard Criteria List:

  • Fit well.
  • Be protective of the teeth.
  • Resistant to tearing or shredding.
  • Least bulky possible while still providing protection.
  • Comfortable.
  • Adequate thickness to prevent concussions.
  • Allow speaking with minimal interferences.
  • Remain in position (be retentive).

 

Types of mouthguards presently available:

 

1. Stock Mouthguard

These are found at the local sports store.  The cost is minimal but so is the protection they offer. There is no special preparation to wearing one of these guards - purchase the size closest to what is required - then put into the mouth.

If we refer to the "Criteria List" above, this type of mouthguard "attempts" (but falls short of) tooth protection and concussion prevention.  It does not fulfill at all the other items listed.

 

The fact that they are "stock" means most users cut and otherwise alter them as an attempt at reducing bulk and increasing comfort. These types of adjustments often render the guards even less protective.

As sports dentists and health professionals interested in injury prevention, we do not recommend this type of mouthguard to our patients and athletic teams.

 


Stock mouthguard after several weeks of use.

 

2. Mouth formed or Boil and Bite Mouthguard

These are the most common guard now used by athletes. The perceived advantage is that they will be more "custom". In fact, this supposed advantage is in most cases actually a large disadvantage. The procedure is to boil the thermoplastic guard, insert it into the mouth and then by using biting pressure - mould it into position. The problem occurs mostly from the fact that biting into the guard decreases the thickness dramatically - thus decreasing the tooth and concussion protection. Several studies have shown that mouthguards of this type decrease in thickness on average from 70%-95% - thus negating almost all protection for the athlete.

 

 

Most people (as with the "stock" variety) do trim and otherwise adjust these type of mouthguards as an attempt to make them more comfortable and easier to tolerate. These alterations further diminish the protection. One other major problem with these are that they inadequately cover the posterior teeth (back molars). This area of coverage is VERY important in concussion prevention.

 

 

Due to the fact that most mouthguards used are of   the "boil and bite" type, most of the public assumes that mouthguards in order to perform must be bulky, nonretentive, interfere with speech and breathing. This is not the case.

 

 

3. Custom-made Mouthguards  (single layer)

These type of guards take into consideration all the points from the "mouthguard criteria list" above.

 

Additional factors including the age of the athlete, allowances for erupting permanent teeth, type of sport being played, etc can all be taken into account when planning a custom guard. None of these are possible in the stock or boil-and-bite type guards.

 

This type of mouthguard is far superior to the stock and boil-and-bite type mouthguards.

 

Your dentist makes this type of guard. Most often an impression (mould) of the upper teeth is made and poured into stone.  A sheet of mouthguard material is then heated and vacuumed over the stone model. The excess material is trimmed and the guard is polished for delivery.

The vacuum machines used for this type of guard are very adequate for these single layer guards but now research is showing that multiple layered (pressure laminated) guards are preferred over these single-layer ones

4. Pressure Laminated Mouthguard (multiple-layered)

These custom mouthguards are made with the same mould taken for the single-layered except a special machine presses multiple layers of guard material over the models so as to build even more protection into the guard.  

 

The increased thickness is the most important aspect to these type guards. As the thickness increases, the materials will absorb greater forces and distribute them much more efficently. Also, this increased thickness does a great deal to decrease the incidence of concussion related injuries.

 

Another important point to make is that although these are markedly more thick than the single-layered guards, they are NOT uncomfortable to wear nor do they feel bulky.

Some dentists have the special machines to fabricate these in their offices. Most commonly the models are sent to a dental laboratory that will fabricate a pressure laminated mouthguard.

We highly recommend the custom made (multiple-layered) mouthguard type for the very best in oral/facial protection as well as concussion prevention.

Concussion Prevention and Athletic Mouthguards

Concussion is an alteration of consciousness, disturbance in vision and equilibrium caused by a direct blow to the head, rapid acceleration and/or deceleration of the head, or direct blow to the base of the skull from a vertical impact to the chin.

Levels of Concussion

  • Asymptomatic - No headache, dizziness or impaired orientation, concentration or memory during rest or exertion.
  • Mild (level 1) - No loss of consciousness  and Post traumatic amnesia (PTA) less than 30 minutes.
  • Moderate (level 2) - Loss of consciousness less than 5 minutes or PTA greater the 30 minutes.
  • Severe (level 3) - Loss of consciousness greater than 5 minutes or PTA greater than 24 hours.

 

Symptoms of Concussion

  • Headaches
  • Earaches
  • Facial pain
  • Dizziness
  • Impaired speech


This discussion is limited to direct blows to the chin.  When a heavy blow is delivered to the chin, the force goes up the lower jaw into the jaw joint, at this level the forces are transmitted to major nerves exiting the base of the brain, blood supplies to the brain, as well as the balance center located near the jaw joint. The end result is this force can leave the athlete with one of the concussive levels  and symptoms listed above.

Scientific studies and practical experience time and again have demonstrated the effectiveness of mouthguards in preventing facial and dental injuries and especially the prevention of concussion.

Custom mouthguards are prescribed and made by a dentist. They should be of uniform thickness and very importantly both separate the teeth (prevention of dental injuries) and separate the lower jaw from the base of the skull (prevention of concussion).

 

 

 

 

 

 

Without mouthguard the lower jaw in contact with the base of skull.

 

 

 

 

 

With mouthguard in place the lower jaw is separated from the base of skull. 

(Green arrow represents blow to chin)

Of all sports, it is especially important to wear a mouthguard while participating in football. Often it is the quarterback that wears a mouthguard the least because of interference with speech, as a result he usually receives the most concussions from blows to the chin

Sports Dentistry

Information about Dental/Facial Trauma and Concussion Prevention

Sports Dentistry is all about injury prevention. Mouthguards should be considered as essential as shin guards, helmets, elbow pads, thigh pads, shoulder pads and all the rest. Dental injuries are the most common type of oral facial injuries sustained during participation in sports. In the United States more that 5 million teeth are knocked out each year. Victims of tooth avulsions (teeth knocked out) who do not have the teeth properly preserved or replanted will face lifetime dental costs estimated from $10-15,000 per tooth, the inconvenience of hours spent in the dental chair and possibly other dental problems.

There are numerous considerations to made when designing a mouthguard such as the age, skill level, possible orthodontic therapy, erupting baby teeth, size of teeth etc. This is where the stock or boil-and-bite generic mouthguards that are available at most sporting good stores fall very short in their ability to adequately protect from injury. There are four types of mouthguards stock,  boil and bite, vacuum custom made, and pressure laminated custom made. (See Mouthguard Section).

In the traditional contact sports of football, hockey, boxing, and martial arts fitted mouthguards are considered essential. In other sports, traditionally classified as non contact - basketball, baseball, bicycle riding, roller blading, soccer, wrestling, racquetball, surfing and skateboarding also require properly fitted mouthguards, as dental injuries, are a negative aspect of participation in these sports as well.

Oral Cancer: Prevention and Detection

Background
Major Causes
Symptoms
Types of Lesions
Conclusion

Background:

About 31,000 new oral cancers will be diagnosed in the United States this year. Despite advances in surgery, radiation and chemotherapy, some 50 percent of these cancer patients will die of their malignancy.

Delay in diagnosis allows tumors to invade deep into local structures and spread to regional lymph nodes in the neck, resulting in this high mortality. When assessing survival, early staged cancers-those less than 4 cm in size and without regional lymph node involvement-are controlled in more than three quarters of the cases.

Routine oral examinations play an important role in controlling oral cancer. Exams can reveal mucosal changes that might be pre-malignant or malignant, thereby accelerating the diagnosis and initiation of early treatment. As carcinomas account for nine of 10 oral cancers, this indicates surface lesions that may be much easier to recognize.

Clinical dentists should think of prevention in two ways:

  • early detection to reduce morbidity and mortality; and
  • the opportunity to identify and treat pre-malignant lesions.

Major Causes:

Understanding causative factors also contributes to prevention and control of oral cancer. The most common related factor that may contribute to developing cancer is age. About 95 percent of all oral cancers occur in persons older than 40, and the average age at the time of diagnosis is about 60.

Tobacco use (both smoking and chewing) as well as alcohol consumption also contribute to the transformation of normal cells to cells exhibiting malignant behavior. Prevention programs must include measures to control these habits.

A dentist's dilemma in oral diagnosis stems from the multitude of ill-defined, variable appearing, controversial and poorly understood lesions that appear in the mouth. Most lesions are benign, but many present changes that may easily be confused with malignancy. Conversely, early malignancy may be mistaken for a benign change. Inescapably, such clinical uncertainty is involved in the early detection of malignancy as well as in the understanding and management of other lesions that may not always remain benign.

Both public and professional awareness of oral cancer is fundamental for minimizing the time from onset of signs or symptoms to diagnosis. In most instances, patients delay seeking consultation. In some cases, however, delayed diagnosis occurs because a clinician does not suspect a malignant lesion and treats it with inadequate procedures for cancer control. 

Symptoms:

Though some patients seek consultation only after developing severe and persistent pain, the most frequent symptom is a sore or irritation in the mouth. Early carcinomas may appear as small, apparently harmless areas of indurations or local changes (erosion, erythema, keratosis), frequently lulling the unsuspecting clinician into a false sense of security. In the pre-malignant and early cancerous stages, cellular proliferation may be slow. In some cases, this may obscure recognition of growth or tumor activity. All oral lesions that persist or do not respond to the usual therapeutic measures, therefore, must be considered malignant until proven otherwise.

Because of the variability of signs and symptoms, even good clinical judgment and experience do not preclude diagnostic errors. Biopsy is the only method to definitively diagnose a cancer.

Types of Lesions:

White and red lesions of the oral mucosa are the most common precancerous clinical lesions. Though premalignant mucosal changes don't always precede oral cancers, such changes warn of risk and present an opportunity for preventive measures. White changes (leukoplakia) are the most common pre-malignant lesions, but red changes (erythroplasia) or white changes with a red component (speckled leukoplakia, erythroleukoplakia) carry a greater risk.


Though tobacco use increases the risk for oral cancer, paradoxically, in patients with oral leukoplakia, non-smokers appear at higher risk. This finding is hard to explain, but we can speculate that in the absence of tobacco as a causative irritant, there may be a more lethal initiating or potentiating factor.

Some clinical leukoplakias show microscopic cellular changes that are developmentally abnormal (classification of dysplasia). Studies have documented the increased risk for malignant transformation of dysplastic leukoplakic lesions on an unpredictable basis.

There are no associated consistent or reliable clinical signs and symptoms that allow differentiation or prediction of a pre-malignant or early malignant change. Since the clinical appearance of oral leukoplakia-thick or scant, large or small-does not reliably indicate its biologic potential, dentists should suspect all white patches, and carefully evaluate and observe patients with such lesions.

Leukoplakia that clinically has an erythematous or red component (erythroleukoplakia, non-homogeneous) is far more likely to undergo dysplastic or malignant epithelial changes than other forms of leukoplakia. With this in mind, clinicians should biopsy specimens from erythematous areas, particularly if they must choose between red- and white-appearing mucosa.

Conclusion:

Patients with leukoplakia usually do not show symptoms. The lesion is often discovered during routine examination or when patients feel roughness in their mouth. Despite advances in treatment, five-year survival rates remain poor. Therefore, improving prevention and control of oral cancer is critically important. Regular dental examinations provide an excellent opportunity for early detection.

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