Properly designed and custom-fabricated mouthguards are essential to the prevention of athletic oral/facial injuries. It is estimated by the American Dental Association that mouthguards prevent approximately 200,000 injuries each year in high school and collegiate football alone.
A properly fitted mouthguard must be protective, comfortable, resilient, tear-resistant, odourless, tasteless, and not bulky. They should also cause minimal interference to speaking and breathing, and (possibly the most important criteria) have excellent retention, fit, and sufficient thickness in critical areas.
Unfortunately, the word “mouthguard” is universal and generic, and includes a large range and variety of products, from “over-the-counter” models bought at sporting goods stores to professionally manufactured and dentist-prescribed, custom-made mouthguards. Presently, over 90% of the mouthguards used in sport are store-bought, while only 10% are of the custom-made variety, diagnosed and designed by a health professional (dentist and/or athletic trainer). Custom-made mouthguards are supplied by a dentist. They can be designed and fabricated to meet the individual needs of the athlete or the sport and fulfil all of the criteria for adaptation, retention, comfort, and stability of material. They interfere the least with speaking, and have no significant effects on breathing.
- Stock mouthguard
- The stock mouthguard, available at most sporting goods stores, come in limited sizes (usually small, medium and large) and are both the least expensive (between USD 3 and 25) and least protective. These protectors are ready to be used without any further preparation – simply remove from the package and immediately place in the mouth. They are bulky and lack any retention, and therefore must be held in place by constantly biting down. This interferes with speech and breathing, making the stock mouthguard the least acceptable and least protective. This type of mouthguard is often altered and cut by the athlete in an attempt to make it more comfortable, further reducing any protective properties. There is general agreement in the medical/dental literature that these types of mouthguards be avoided due to their poor retention and lack of protective properties.
- Mouth-formed or “boil-and-bite” mouthguard
- This is the most commonly used mouthguard on the market. Made from thermoplastic material, they are immersed in boiling water and formed in the mouth by using finger, tongue, and biting pressure. These mouthguards often lack proper extensions and often do not cover all of the posterior teeth. Athletes also cut and alter these bulky and ill-fitting boil-and-bite mouthguards in an attempt to improve their poor fit, poor retention, and gagging effects. This, in turn, further reduces the already minimal protective properties of these mouthguards. It is also common during the fitting process for the athlete to bite almost completely through the softened material, leaving very little thickness for protection.
Despite the clever marketing schemes of the manufacturers producing these devices, these boil-and-bite mouthguards have very little place in competitive or recreational sport.
- Vacuum mouthguard
- This is made from a stone cast of the mouth, usually of the maxillary (upper) arch, using an impression (mould) fabricated by a dentist. A thermoplastic mouthguard material is adapted over the cast with a special vacuum machine. Vacuum machines are adequate for single-layer mouthguards. However, multiple-layered mouthguards (laboratory pressure-laminated) may be preferred to single-layer vacuum mouthguards.
It should be noted that these vacuum custom mouthguards are still superior to store-bought stock and boil-and-bite mouthguards in fit, comfort and retention. However, they do not represent the best mouthguard currently available.
- Multiple-layered mouthguard
- The custom-made, multiple-layered mouthguard is the best mouthguard available. These guards can be modified for full-contact/high-impact sports by laminating two or three layers of EVA material to achieve the desired thickness. Lamination (layering) is achieved using both high heat and pressure, while at the same time creating an exceptional fit. This technique also creates a stable guard with minimal deformation over an extensive period of time. Proper thickness is important to both absorb and dissipate any traumatic forces. This system allows the development of adequate thickness in the mouthguard to accommodate the type of injury anticipated in the sport.
Dr Ray Padilla