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

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]