Effectiveness of Mouthguards

Many sports injuries involve intraoral trauma that can be reduced or eliminated by proper use of appropriate mouthguards. Despite this, participants are often reluctant to wear such protection. Dental care providers, however, can be instrumental in changing these attitudes.

Much of the attention on athletes wearing mouthguards has been focused on American football and rugby. The sport known as football or futbol in many other countries is known as soccer in Canada and the United States. Apart from football and rugby, amateur sports that require the use of mouthguards include boxing, ice hockey, wrestling, field hockey, and lacrosse. Authorities on the subject recommend extending this requirement to basketball, baseball, and soccer.

Three basic types of mouthguards are available: type I, or stock mouthguards; type II, or mouth-formed mouthguards; and type III mouthguards that are custom-made by a dentist using a model of the patient's upper teeth. Type I models are widely viewed as inferior by most evaluations. Some type II mouthguards are made from thermoplastic materials that are molded directly onto the maxillary arch after being softened by boiling; hence the term boil and bite. Type III models may be worn over orthodontic work. Commonly used materials include polyvinylchloride, polyvinylacetate, and styrene butadiene sheet.

One in vitro study constructed a crash test-type instrument to simulate impacts on various types and models of mouthguards. Results showed that type II mouthguards were only marginally more effective in preventing tooth and jaw injuries than no protection at all, averaging 6.0 broken teeth per impact for no mouthguard and 4.5 broken teeth with a type II mouthguard. Type III mouthguards achieved the best score of 0.5 broken teeth, but considerable variation between models was noted. Optimal results were found for mouthguards that used multiple layers to reach desired thickness, incorporated a 9 mm labial flange, extended to at least the first molar, and where palatal flanges were designed for wearer comfort.

Before the use of mouthguards became mandatory in the early 1960s for US high school football, some 50% of all injuries were to the mouth or surrounding areas, with an incidence of facial and dental injuries of 2.26 per 100 players. After mouthguards and facemasks became mandatory, the incidence rate fell to 0.3. Conservative estimates put the number of football injuries prevented annually due to the use of protective mouthguards at 100,000 to 200,000. Mouthguards have subsequently become mandatory in college football, though not in professional football.

Changing Attitudes

Much of the resistance to using mouthguards comes from attitudes that view these protective devices as unnecessary for serious athletes. However, some success has been noted in educational campaigns with ice hockey players after it was shown that mouthguards can also reduce the risk of concussion, a major cause of player disability in the sport.

In the United States, the use of mouthguards is mandated for such amateur sports as football, ice hockey, men's lacrosse, and women's field hockey. Inexplicably, female teams are often ignored in educational programs promoting the use of mouthguards, perhaps due to the erroneous belief that women and girls play a gentler sport, making facial injuries less common. In fact, injury rates for specific sports tend to be quite similar between the two sexes. It is also perplexing that while boxing mandated the use of mouthguards back in 1913, widespread use of these protective devices has not occurred in other contact sports.

Other common reasons given for resistance to the use of mouthguards include a perception that they are uncomfortable, impede breathing or talking, don't fit correctly, and cause dry mouth. It is believed most of these complains can be resolved through correct fitting. Attractive designs, perhaps displaying the team logo, also seem to make mouthguards more readily accepted. Positive role models, support from the coach and a younger age of initiation to mouthguards all improve acceptance of this important protective gear.

Dental care providers can play a major role in promoting the use of mouthguards, beginning with advice on the subject. They can fabricate properly fitted mouthguards as an integral part of their practice. Dental care providers can also help assure the success of clinics devoted to promoting mouthguards by serving as consultants to teams and sponsoring more stringent regulations for player safety.