Mouthguards and their use in sports: Report of the 1st International Sports Dentistry Workshop, 2016

There appears to be much confusion or misinformation worldwide regarding mouthguards and their use in sports. In an effort to clarify where the international dental community stands on mouthguards and mouthguard research, the workshop looked at some important questions. The goal was to one day formulate consensus statements related to these questions, which will be based on current scientific evidence‐based research, to motivate the international community of the importance of dentally fitted laminated mouthguards and the wearing of them by athletes of all sports. There are only five sports in the United States that require the use of mouthguards. If, through workshops such as this, the importance of wearing dentally fitted laminated mouthguards can be demonstrated, then more sports may require their athletes to wear them.     

A new technique for the custom fabrication of mouthguards with photopolymerized urethane diacrylate.

The use of protective mouthguards in athletes has proven to be an effective and inexpensive means of preventing traumatic injuries to the teeth and supporting structures. Of the three general types of mouthguards available currently, the custom-fabricated type is considered superior to stock and mouth-formed protectors. A new technique is introduced for the fabrication of custom-made mouthguards with light-curing urethane diacrylate material.     

Oral injury and mouthguard usage by athletes in Japan

Abstract— The use of mouthguards in contact sports effectively prevents oral injury and preserves oral structures. We investigated oral injuries and awareness concerning mouthguards ainong Japanese high school soccer and rugby players. Athletes were asked a series of questions concerning their history of oral injury while participating in sports, and their pattern of mouthguard use was determined. The data were evaluated statistically using chi-square analysis. The incidence of oral injuries was 32.3% for soccer athletes and 56.5% for rugby athletes, with 0.8% and 24.1% of the respective groups having mouthguards. There were sigmficant differences between the soccer and rugby groups (p<0.001). Although 81.8% of soccer athletes thought mouthguards were unnecessary, only 26.2% of rugby athletes shared this opinion and there was a sigmficant difference between the soccer and rugby groups. Many soccer ath-letes had insufficient knowledge about mouthguards and were not concerned about preventing oral injury, although it was in fact a common problem in their sport. Athletes as well as coaches must be made aware of the high risk of oral injury when playing soccer, rugby, and other contact sports.     

A comparison of the attitudes and beliefs of professional rugby players from one club and parents of children playing rugby at an adjacent amateur club to the wearing of mouthguards.

OBJECTIVE: To assess the knowledge that professional rugby players have with regard to the benefits of wearing an oral mouthguard and the importance that they give to wearing the appliance during play, then to compare these views with those of the parents of children who are beginning to play the sport. DESIGN: Questionnaires and covering letters were sent to the parents of children who played rugby at Malton & Norton Rugby Union Football Club (RUFC), which has teams for all age groups from under 7-8 years to adult. Similar questionnaires were sent to the first team squad of Leeds Tykes, a Zurich Premiership rugby union club. The questionnaires asked a series of questions on the use of mouthguards and knowledge of their importance in the prevention of injuries. RESULTS: The overall response rate was 76%. Seventy-four of the 100 questionnaires sent to the parents and 25 of the 30 sent to the professional players were completed and returned. Both the professional rugby players and parents felt that mouthguards were essential when playing rugby. The professionals seemed to have a much greater understanding of the benefits that mouthguards provided. Although parents agreed that children should begin to wear mouthguards as soon as possible, very few actually did. The barriers to providing mouth protection were mainly financial combined with the difficulties of taking the child to the dentist. CONCLUSIONS: If the results from this small study are representative of the current situation, with regard to the wearing of mouthguards by professional players and children, it appears that there is a need for all those involved to ensure that rugby-playing children wear mouthguards. Rugby clubs could consider the appointment of honorary dental advisers and devise systems to ensure that cost is not a factor in preventing children from wearing mouthguards.     

Influence of different types of mouthguards on strength and performance of collegiate athletes: a controlled-randomized trial

Abstract – Background: Prevention of traumatic dental injuries relies on the identification of etiologic factors and the use of protective devices during contact sports. Mouthguards are considered to be an effective and cost‐efficient device aimed at buffering the impacts or blows that might otherwise cause moderate to severe dental and maxillofacial injuries. Interestingly, besides their role in preventing injury, some authors claim that mouthguards can enhance athletic performance. Thus, the purpose of this controlled randomized trial was to evaluate and compare the effect of two different types of mouthguards on the athletic performance and strength of collegiate athletes. Materials and methods: Eighteen college athletes ranging from 19 to 23 years participated in this study. Devices tested in this study included an over‐the‐counter boil‐and‐bite mouthguard (O‐Flow? Max Under Armour^®) (UA) and a custom‐made mouthguard (CM). Physical tests were carefully selected by the head athletic trainer and aimed at evaluating the strength and performance. The following sequence was carried out on each test day: (i) 3‐stroke maximum power ergometer test, (ii) 1‐min ergometer test, and (iii) a 1600‐m run. A random assignment was developed to test all three experimental groups on each test day. Following the tests, each athlete completed a brief anonymous survey aimed at evaluating the athletes’ overall satisfaction with each type of mouthguard. Results: Custom‐made mouthguards had no detrimental effect on athletic strength and performance and were reported by the athletes as being comfortable and not causing difficulty in breathing. In contrast, boil‐and‐bite mouthguards did not perform as well and were reported as being uncomfortable and causing breathing difficulties. Conclusions: Based on the results of this study, the use of custom‐made mouthguards should be encouraged in contact sports as a protective measure, without concern for any negative effect on the athletic performance of the athletes.     

Prevention of craniofacial injuries in football.

The evolution of rules and regulations governing the development and use of protective football equipment for the prevention of craniofacial and intraoral traumatic injuries to football players have reduced substantially the occurrence of these injuries. Protective football equipment such as helmets, facemasks, and intraoral mouthguards have undergone numerous developmental changes to improve their effectiveness in preventing traumatic injuries to the head, face, and mouth of participants in football during practice sessions as well as in game situations. Unfortunately, however, some of these types of injuries do continue to occur. Various regulatory agencies and football governing bodies have established quality performance standards for equipment and have enacted rulings for their proper use. Penalties have been assessed for rule infractions to aid in curtailing the misuse of such equipment, as occurs for example, when the helmet is used to spear tackle an opponent or when the facemask is grasped, pulled, or twisted by an opposing player. Dentists can contribute significantly to the overall well-being of their patients who participate in football by providing information and advice regarding the proper use of protective football equipment to prevent craniofacial and intraoral traumatic football-related injuries, by fabricating properly fitted mouthguards as one aspect of their total practice of dentistry, and by providing high-quality and expeditious emergency and long-term treatment subsequent to football-related intraoral traumatic injuries. In addition, dentists can contribute on a larger scale to the overall well-being of football athletes by participating in community service activities such as mouthguard days, as consultants to football teams, as team dentists, or as advisors to those interested in research and development to improve protective football equipment, and to those responsible for sponsoring more stringent regulations for player safety in football.     

Nigerian dentists' knowledge and attitudes towards mouthguard protection

Abstract –  The objective of this study was to assess the knowledge and attitudes of Nigerian dentists towards mouthguard protection. A pre-tested 15-item, one-page questionnaire was distributed to 185 dentists practising in different parts of the country with government hospitals or private establishments, by 'hand-delivery' system. Filled and returned forms were 170 (response rate of 92%). The period of the survey was between April and August 2003. Dental graduates from the different dental schools in the country responded to this survey. About 49% of the respondents indicated having only classroom lectures on mouthguards during their undergraduate trainings, 11% said they had some laboratory sessions in addition while no form of education on mouthguards was received by 40%. About 82% had never recommended mouthguard protection for athletic patients, and the major reason was no formal training in the subject. Only 58.5% were familiar with the different types of mouthguards, 75.9% would not be able to supervise or fabricate mouthguards and 50.6% would prefer custom-made mouthguard for their athletic patients. About 84% felt the current training on mouthguards in Nigerian dental schools is inadequate. Over 98% agreed that mouthguard usage in contact sports should be encouraged with the involvement of the dentists. The knowledge and attitudes of the respondents towards mouthguard protection did not vary significantly across years of postqualification from dental schools as well as the professional status of the dentists ( P  > 0.05). Although Nigerian dentists support mouthguard protection in contact sports and want to be involved in the provision of mouthguards for athletes, their knowledge of the protective device is inadequate. There is need for attention to be given to this subject in the undergraduate curricula of our dental schools.     

The prevalence of orofacial injuries and use of mouthguards in Rugby Union

A bstract — Mouthguards are important for those involved in contact sports and their use in such sports is recommended by authorities as they provide considerable protection for the orofacial structures. The use of mouthguards in contact sports in part reflects the success of community awareness programmes designed to encourage such practice. A comprehensive study of 116 Rugby Union footballers was undertaken in 1984 to study the prevalence of orofacial injuries and the use of mouthguards in that sport and the results are presented in this paper. The grades ranged from club level through to international level of competition. Overall the usage of mouthguards was high and ranged from 79–96 per cent in the various teams. This study is the most complete ever recorded in Rugby Union.     

Paired maxillary and smaller mandibular mouthguard for rugby player with malalignment

A rugby player who had frequently experienced soft tissue injuries while playing rugby and wearing a conventional custom‐made mouthguard came to the hospital clinic. The patient had suffered traumatic soft tissue injuries such as lip lacerations and bite trauma. Severe crowding due to ectopic maxillary and mandibular canines was observed. In response to the patient's request for better protection, a set of maxillary and mandibular mouthguards was designed: one covering the entire maxillary dentition and the other the mandibular front teeth only. The mouthguards were to be worn simultaneously. In this paper, we describe how these mouthguards were fabricated and discuss the results. The patient has experienced no injury to the stomatognathic system, including the lips, for five seasons since he began wearing this set of mouthguards. This new pairing of mouthguards appears to offer sufficient protection against injury, despite severe malalignment. We believe that this new type of paired maxillary and mandibular mouthguards has the potential to reduce sports‐related dental injuries.     

Rugby athletes' awareness and compliance in the use of mouthguards in the North West of Italy

Abstract – Background: The prevention of dental injuries during full‐contact sports such as rugby is extremely important. Wearing a mouthguard can significantly reduce the frequency and severity of orofacial injuries, but it is not always used as athletes find it difficult to tolerate. The purpose of the present study was to determine the awareness and the extent of mouthguard use in a sample of young rugby athletes in the North West of Italy. Material and Methods: The athletes of four amateurs rugby teams based in the Province of Turin, Italy completed a questionnaire about playing history, current use and type of mouthguards, disturbs associated with mouthguard use, and general attitudes towards mouthguards. Results: Only 53.85% of the subjects reported wearing their mouthguard all the time both during training and games. The most commonly reported problem associated with using a mouthguard was the discomfort on speech, followed by difficulty in closing lips, adversely affected breathing, adversely affected swallowing and slipping sensation. A statistically significant association between patients <22 years and non‐use of mouthguards was observed. Conclusion: Limited knowledge about oral injury prevention and limited use of mouthguards were observed. The present study suggests that educational courses for rugby players and coaches to promote the use of mouthguards would be extremely important to reduce common complaints about these devices and increase their usage.     

Mouthguards in dentistry: Current recommendations for dentists

Properly fitted mouthguards reduce the risk and severity of orofacial injury, to both hard and soft tissues, preventing thousands of dollars of trauma management. In this review, findings from recent research will be evaluated to discuss the strengths and limitations of the different types of mouthguards, including their indications by sport. Design, ideal dimensions, and other characteristics will also be explored. Additionally, patient education and motivation will be examined, with a focus on the dentist’s role in this regard. Finally, in addition to proper oral hygiene, the importance of proper mouthguard maintenance and evaluation will be discussed. This review will therefore be able to act as a guide for dentists looking to provide patients of all ages with personal protective equipment and stay up-to-date on recent developments in this branch of the sports dentistry field.     

The effect of wearing custom-made mouthguards on the aeroacoustic properties of Japanese sibilant /s/

Abstract – Background/Aim: There have been many reports on the discomfort of speech when wearing oral appliances. Fricatives articulated in an oral cavity can be difficult to pronounce when oral appliances are worn, because the oral cavity is partially changed by their installation. Sibilant /s/, one fricative, is especially difficult to pronounce when wearing oral appliances. This study investigates the effect of the difference in the setting positions of the palatal margin of custom-made mouthguards on the aeroacoustic characteristics of sibilant /s/.Materials and methods: Eighteen subjects (11 women and seven men) participated. The palatal margin of mouthguards was set at the gingival line for nine subjects and 4 mm from the line for another nine subjects. Acoustical analyses examined the difference of the palatal margins of the mouthguards on the autocorrelation coefficient, the zero crossing count, and the spectral peaks of sibilant /s/.Results: The results showed that the zero crossing count of the waveforms and the spectral peaks of sibilant /s/ were significantly broadened and shifted toward the low-frequency range with the mouthguard whose palatal margin extended 4 mm from the gingival line than the mouthguard whose palatal margin was set at the gingival line.Conclusion: We believe that a more appropriate palatal mouthguard design for custom-made mouthguards can be made by considering the aeroacoustical effects. Our study supported the mouthguard whose palatal margin was set at the gingival line by considering the influence on pronouncing sibilant /s/. We believe that a more appropriate palatal mouthguard design for custom-made mouthguards can be made based on the balance of aeroacoustical effects and mechanical requirements.     

Attitudinal factors influencing mouthguard utilization

From the introduction of a protective mouthpiece in the sport of boxing, the evidence for the importance of this piece of athletic equipment in injury prevention has grown. Yet, despite this knowledge, only five amateur sports and one professional sport have regulations requiring the use of mouthguards. Even in the sports that require their use, compliance is not universal. Attitudes of coaches, officials, parents, and players about wearing mouthguards all influence their usage. Studies of the attitudes of these groups reveal that coaches are perceived as the individuals with the most impact on whether or not players wear mouthguards. There is reluctance among college football officials to enforce mouthguard violations that they believe are inappropriate. Parents see themselves as having responsibility in determining mouthguard use; however, their views about when and for whom mouthguards are necessary reveal a lack of complete understanding of the benefits. Resistance on the part of players stems from the physical characteristics of the mouthguard, interference with breathing and speech, and the effect on the players' image. Education on the effectiveness of properly fitted mouthguards for injury prevention, information on the risk for injury, availability of more comfortable and appealing mouthguards, and development of an approach for expanding regulations are all tools that can lead to the development of more positive attitudes and increased usage.     

Custom sports mouthguard modified for orthodontic patients and children in the transitional dentition

Young athletes with ever-changing transitional dentitions and those wearing fixed orthodontic appliances can benefit from custom-formed protective mouthguards. Modifications of the traditional vacuum-forming method are useful to fabricate mouthguards for such patients and extend the useful life of these devices. The purpose of this case report is to document fabrication of custom-formed protective mouthguards for a 10-year-old boy wearing fixed orthodontic appliances and a 9-year-old girl with a fixed palatal expander in place.     

Are all mouthguards the same and safe to use? Part 2. The influence of anterior occlusion against a direct impact on maxillary incisors

Abstract –  The purpose of this study was to clarify the influence anterior occlusion, of mouthguards, has on protecting against a direct collision to the maxillary anterior teeth. In other words, the support mandibular dentition has when wearing a mouthguard. Two types of mouthguards were used for this study, one with an appropriate anterior occlusion or a mouthguard with positive anterior occlusion (MGAO+) and another which was a single-layer mouthguard lacking the same occlusion or a mouthguard with negative anterior occlusion (MGAO−) but with the same thickness on the buccal side. The instruments used for testing were a pendulum-type impact device with two interchangeable impact objects (a steel ball and a baseball), with a plastic jaw model having artificial teeth. Four testing conditions were observed: one with the jaw open without a mouthguard (Open NoMG), the second with the jaw clenching (loaded with 30 kg weight) without a mouthguard (Clench. NoMG), the third with the jaw clenching with MGAO− (Clench. MGAO−) and the last with the jaw clenching with MGAO+ (Clench. MGAO+). The results are as follows: both types of mouthguards showed the effects in reducing the distortion of the teeth. However, the effect was significantly obvious (steel ball = about 57% shock absorption ability, baseball = about 26%) in the mouthguard with anterior occlusion or support by lower dentition through mouthguard (Clench. MGAO+) than Clench. MGAO−. Thus, the influence of anterior occlusion of mouthguards or the support of mandibular dentition through wearing a mouthguard (MGAO+) is indispensable in reducing the impact force and tooth distortion. The results of this research should further contribute to the establishment of guidelines for safer mouthguards.     

Prevention of sports-related traumatic dental injuries

Many sports-related traumatic dental injuries are preventable with the use of appropriate, properly fitted athletic equipment such as helmets, facemasks, and mouthguards. This article presents information regarding the current generation of athletic mouthguards, and issues a challenge for the development of future independent scientific research that will transform current clinical empiricism into evidence based knowledge in sports dentistry.     

Use of mouthguard rates among university athletes during sport activities in Erzurum, Turkey

Abstract –  The purpose of this study was to determine the attitudes of mouthguard users in Erzurum, Turkey. The participants' appreciation in the use of protective devices, such as mouthguards, during sport activities was also evaluated. In this study, a 10-item questionnaire was distributed to 50 coaches and a 10-item questionnaire was distributed to 768 university athletes of three different sport modalities (basketball, soccer and volleyball) in the Atatürk University Sport Competitions. The Sport Competitions are composed of 20 faculty, except the faculty of dentistry. The result of the coaches' questionnaires indicated that none of the athletes used mouthguards while participating in sports. Of the coaches, 64% had seen orofacial trauma in their athletes during sport activities and 76% believed that mouthguards prevented oral injuries. Of the coaches, 76% reported that university athletes should use mouthguards in sport activities. The result of the university athletes' questionnaires revealed that the mouthguard utilization rate was 0%. Of all players, 78.1% were males (age 17–29) and 21.9% were females (age 18–23). Of all players, 7.31% had suffered from one or more type of oral injury while not wearing mouthguards. The results indicate that in Turkey, the use of mouthguards is rare in sports. It should be a combined duty of dentists, sports physicians, and coaches to encourage the use of mouthguards during training and sport activities. Doctors and dentists need to recommend a more intensive education of students in sports medicine and sports dentistry.     

Attitudes of Central Collegiate Hockey Association ice hockey players toward athletic mouthguard usage

OBJECTIVE: The purpose of this study was to examine Central Collegiate Hockey Association ice hockey players' attitudes regarding the use of athletic mouthguards and to determine the effects of mouthguard type, player position, education, and usage time with respect to attitudes. METHODS: A questionnaire measuring players' attitudes toward mouthguards was sent to certified athletic trainers (ATC) responsible for providing healthcare coverage at 10 institutions of the Central Collegiate Hockey Association (CCHA). The ATC's distributed the surveys to all the players on their respective collegiate teams. Out of a total of 265 players listed on the roosters of the CCHA, one hundred and sixty five (62%) players returned the surveys, with 158 surveys used in the analyses (60%). RESULTS: Approximately 13.3% of players (n=21) reported wearing mouthguards 50% of the time or greater during games and 3.8% (n=6) reported wearing mouthguards 50% of the time or greater during practices. Twenty-six percent (n=41) of the players never received educational information regarding using mouthguards. Thirty-nine percent (n=59) of the players reported altering mouthguards to obtain a better fit while 91% of the players were not influenced by the cost of the mouthguard. A 2 x 2 x 2 ANOVA revealed a significant interaction among player position and mouthguard type with respect to player attitudes (F(1,131) = 4.96, P < 0.05), with defensive players having more negative attitudes toward mouthguard usage compared to offensive players. CONCLUSION: No one specific factor affecting attitudes was identified, however, players reported limited educational opportunities to learn about the effectiveness of mouthguards. Therefore, coaches, dentists, and healthcare providers should engage in more preventive educational programs to increase player attitudes and compliance.     

Protective mouthguards and sports injuries

In summary the advantages of providing custom-fitted mouthguards for athletes, especially those involved in contact sports, has been discussed along with the methodology of construction. Because of the apparent lack of negative effects on physical performance and the superior protective characteristics of custom-fitted mouthguards, it seems logical to recommend their use in the competitive sports arena.     

Orofacial/cerebral injuries and the use of mouthguards by professional athletes in Switzerland

Abstract –  The objective of the present study was to measure the occurrence of orofacial and cerebral injuries in different sports and to survey the awareness of athletes and officials concerning the use of mouthguards during sport activities. Two hundred and sixty-seven professional athletes and 63 officials participating in soccer, handball, basketball and ice hockey were interviewed. The frequency of orofacial and cerebral trauma during sport practice was recorded and the reason for using and not using mouthguards was assessed. A great difference in orofacial and cerebral injuries was found when comparing the different kinds of sports and comparing athletes with or without mouthguards. 45% of the players had suffered injuries when not wearing mouthguards. Most injuries were found in ice hockey, (59%), whereas only 24% of the soccer players suffered injuries when not wearing mouthguards. Sixty-eight percentage of the players wearing mouthguards had never suffered any orofacial and cerebral injuries. Two hundred and twenty-four athletes (84%) did not use a mouthguard despite general acceptance by 150 athletes (56%). Although the awareness of mouthguards among officials was very high (59%), only 25% of them would support the funding of mouthguards and 5% would enforce regulations. Athletes as well as coaches should be informed about the high risk of oral injuries when performing contact sports. Doctors and dentists need to recommend a more intensive education of students in sports medicine and sports dentistry, and to increase their willingness to become a team dentist.