Sport is one of the common causes of dental injuries.
A sports mouthguard is an important for children who are active in sports.
HOW DOES A MOUTHGUARD HELP?
A mouthguard protects against dental and orofacial injuries by absorbing and spreading the force of impact (when collision/s occur) and stablilising the jaw during trauma.(1,2) A mouthguard may also minimize concussion by absorbing impact forces and preventing these forces from transmitting to the skull or brain.(1-3) Any sports with risks of collisions can benefit from wearing a well-fitted mouthguard.(1,3) The adverse effects of a single dental injury can last a lifetime and involve much stress and costs. Prevention is paramount.
WHAT SPORTING ACTIVITIES REQUIRE THE USE OF MOUTHGUARDS ?
Traditional recommendation suggests that mouthguard is only necessary for contact sports such as rugby, hockey, boxing, wrestling.(4)
Current recommendation by professional bodies such as the Australian Dental Association and Sports Medicine Australia states that mouthguard is a good idea during any sports that pose risks of mouth and teeth injuries, including basketball, netball, soccer, cricket (4-6). Recent research studies have highlighted that even seemingly non-contract sports such as handball, can lead to significant dental injuries risks, especially when played at a competitive level (7-8).
Other recreational activities such as trampoline jumping and riding skateboards, scooters and bicycles also contribute to dental injuries risks. Although it is impossible to avoid all accidents and injuries, the use of mouthguards for sporting activities can reduce significant risks.
In addition, it is critical to know how to provide emergency care / first aid for a dental injury when it does occur. For some dental injuries such as avulsion of a permanent front tooth, appropriate first aid and immediate dental care will determine the outcome.
TYPES OF MOUTHGUARDS
There are several types of mouthguards including stock, boil-and-bite, customized. Most mouthguards over the upper teeth only. For elite sports players of high intensity sports such as rugby union, where jaw fracture risks are severe, customized bimaxillary mouthguards covering both upper and lower teeth, are also available from the dentist.
Commonly, mouthguards are made of a soft material such as ethylene vinyl acetate (EVA) or silicone. Some types of mouthguards may have inserts and/or air cells within the design to enhance shock absorption capacities.(9)
Over-the-counter mouthguards are usually under AUD$20, come in limited sizes (e.g. small, medium, large) and allow only limited adjustments.
Stock mouthguards are worn as it is and cannot be adjusted to any great extent other than shortening the length by cutting off the ends.
The “boil and bite” mouthguards which involve softening a preformed mouthguard in hot water before inserting into the mouth to self-mould the mouthguard into shape.
Generally, over-the-counter mouthguards are loosely fitting, which can lead to difficulty talking, breathing and keeping the mouthguard in position inside the mouth.
Many dental practitioners are happy to assist patients with the fitting of over-the-counter mouthguards. This may improve the fit of boil and bite mouthguards. For children, when baby teeth are being replaced by permanent teeth and frequent changes of customized mouthguards become unaffordable, this may be an interim option.
Custom-made mouthguards require a visit to a dental practitioner for impressions (moulds of teeth and mouth) to be taken of the teeth from which a plaster model is made. The mouthguard is then constructed to fit exactly to the shapes of your teeth and grooves of your gums and mouth. A custom-made mouthguard is usually thicker (e.g. 4mm in thickness).(10) It has been shown that mouthguards with thicker material over front teeth provide better shock absorption.(11)
Custom-made mouthguards fit much better than the over-the-counter ones thereby more comfortable to wear and easier to talk with and to breathe.
Custom-made mouthguards are not reserved for elite sports players, it is the gold standard for all sports players regardless of age. Custom-made mouthguards can be made, even for players with orthodontic braces.
Custom-made mouthguards are more expensive and must be replaced when the mouth changes e.g. when changing teeth, when new dental fillings are placed, when the jaw has grown. Custom-made mouthguards generally cost approximately AUD$150. Many dental practices offer “exclusive sports club prices” for custom-made mouthguards. In some states in Australia, mobile mouthguard services to sporting clubs, runned by dental practitioners, are also available.
WHEN DOES A MOUTHGUARD NEED REPLACEMENT?
Mouthguards need to be changed when there are obvious tear and wear or not fitting well. Discomfort is often the reason for not wearing mouthguards among sports players.(5)
Ideally, mouthguards are best replaced every 12-18mths even if they still fit as overtime, wear, tear and microbial build-up are unavoidable. For children who are changing teeth, mouthguards may need to be replaced more frequently.
SHOULD MY CHILD WEAR A MOUTHGUARD?
In summary, every school-aged child playing team sports should ideally be wearing a mouthguard. This is especially critical for those who play competitive sports or sports with significant collision risks.
Children don’t want to be the odd one out, so if their peers are not wearing mouthguards, it can be difficult to convince them to wear one. Some ways to encourage wearing of mouthguards include:
- Educate children about the importance of mouthguards,
- Schools and clubs to mandate mouthguards for all sports e.g. make mouthguard a part of the uniform,
- Parents to team together and provide mouthguards for their children to wear for sporting activities in and outside of school thereby making "no mouthguard, no play" the norm.
Children's teeth and jaws are definitely worth protecting!
- Green JI. The role of mouthguards in preventing and reducing sports-related trauma. Prim Dent J 2017; 6(2): 27-34. doi: 10.1308/205016817821281738.
- Black AM, Patton DA, Eliason PH, Emery CA. Prevention of sport-related facial injuries. Clin Sports Med 2017; 36(2): 257-278. doi: 10.1016/j.csm.2016.11.002.
- Knapik JJ, Marshall SW, Lee RB, Darakjy SS, Jones SB, Mitchener TA, delaCruz GG, Jones BH. Mouthguards in sport activities: history, physical properties and injury prevention effectiveness. Sports Med 2007; 37(2): 117-144.
- Ilia E, Metcalfe K, Heffernan M. Prevalence of dental trauma and use of mouthguards in rugby union players. Aust Dent J 2014; 59(4): 473-481. doi: 10.1111/adj.12223.
- Tuna EB, Ozel E. Factors affecting sports-related orofacial injuries and the importance of mouthguards. Sprts Med 2014; 44(6): 777-783. doi: 10.1007/s40279-014-0167-9.
- Kroon J, Cox JA, Knight JE, Nevins PN, Kong WW. Mouthguard use and awareness of junior rugby league players in the Gold Coast, Australia: a need for more education. Clin J Sport Med. 2016 Mar;26(2):128-32. doi: 10.1097/JSM.0000000000000206.
- Petrovic M, Kuhl S, Slaj M, Connert T, Filippi A. Dental and general trauma in team handball. Swiss Dent J 2016; 126(7-8): 682-686.
- Bergman L, Milardovic Ortolan S, Zarkovic D, Viskic J, Jokic D, Mehulic K. Prevalence of dental trauma and use of mouthguards in professional handball players. Dent Traumatol 2017; 33(3): 199-204. doi: 10.1111/edt.12323.
- Handa J, Takeda T, Kurokawa K, Ozawa T, Nakajima K, Ishigami K. Influence of pre-laminated material on shock absorption ability in specially designed mouthguard with hard insert and space. J Prosthodont Res 2011; 55(4): 214-220. doi: 10.1016/j.jpor.2011.02.003
- Westerman B, Stringfellow PM, Eccleston JA. EVA mouthguards: how thick should they be? Dent Traumatol 2002; 18(1): 24-27.
- Bochnig MS, Oh MJ, Nagel T, Ziegler F, Jost-Brinkmann PG. Comparison of the shock absorption capacities of different mouthguards. Dent Traumatol 2017; 33(3): 205-213. doi: 10.1111/edt.12324