Athletic Mouthguards
Who, What, How, and Why. Assessing optimal protection and comfort, giving highest athletic performance.
The Scary Facts
Athletes have a 33-56% chance of receiving an orofacial injury — an injury to the mouth or face — during their playing career.
Risk of injury is 2x higher in athletes who do not wear mouthguards.
Mouthguard users are up to 95% more likely to avoid dentofacial injuries while
Non-mouthguard users can have up to a 25% higher change of concussion injuries.
A broken or damaged tooth from a sports injury doesn’t heal, meaning lifelong maintenance, appointments and surgeries with a lifetime cost of approximately $20,000 PER TOOTH.
A custom fitted mouthguard each season for under $300 can prevent a lifetime of problems and costs!
Types of injuries
Frontal/direct impact (often prevented by face shields in contact sports)
Impact to jaw
Impact under the chin
Athletes of which sports need mouthguards?
Contact and collision sports: basketball, boxing, combat sports, football, handball, ice hockey, field hockey, lacrosse, martial arts, rugby, soccer, water polo, wrestling
Non-contact sports: acrobatics, baseball, bicycling, equestrian events, field events, gymnastics, inline skating, racquetball, shot-putting, skiing, skydiving, softball, squash, surfing, volleyball, weightlifting
Types of mouthguards: Stock, Boil and bite, Custom
Stock Mouthguards
Manufactured in a limited range of sizes
Pre-fabricated without adaptation to the athlete’s mouth
Require the athlete to bite down on it to hold it in place, which can cause soreness, pain, headaches and poor athletic performance from discomfort and poor airflow
Stock mouthguards are generally not recommended for any athletes
Boil and Bite Mouthguards
A thermoplastic rim is heated in hot water then placed in the mouth and molded by biting and sucking.
This is the most commonly used mouthguard on the market.
These mouthguards have a poor fit on the teeth and can be loose or unevenly fitted.
They tend to be thin over prominent teeth that are prone to damage and do not cover all the way to the very back teeth, which must be covered for proper protection.
Boil and bite mouthguards decrease in thickness 70%-99% during molding thus taking away the protective properties of the mouthguard. A properly protective mouthguard should be 3 mm thick with variations only depending on the athlete and on the sport.
Athletes often alter these mouthguards due to poor fit, poor retention, and gagging effects. When the athlete cuts the back borders or bites through the mouthguard during forming, the athlete increases their chance of injury, especially concussion, from a blow to the chin. Some of these injuries, such as concussion, can cause life long effects. Certain thicknesses and extensions are necessary for proper mouthguard protection.
Custom Mouthguards
Custom-made mouthguards are made in a dental laboratory from molds or scans taken by a trained dentist.
Of the types listed it is generally thought that the custom-made mouthguards are the best and offer the most protection.
Custom mouthguards can be made in multiple layers to allow for reduction and spread of impact forces to protect teeth.
A digital scan, with no goopy impression material and no gagging, is all it takes to have this mouthguard made.
They can be made in custom colors, designs, logos, and personal contact information. Helmet straps can be added as well.
The thickness, types and numbers of layers and the fit can all be custom designed by a trained dentist to ensure your athlete is comfortable and protected.
Grades of Protection(1)
Not wearing a mouthguard (grade 0) clearly offers the lowest protection for the obvious reasons of teeth being knocked out, lacerations to the lips, chipped teeth, and concussion.
A stock mouthguard (grade 1) of the type that must be clenched between the teeth to stay in the mouth is ranked next. As previously stated, these mouthguards are dangerous and should not be worn as they instill a false sense of security in the wearer, are easily dislodged, and may present a choking hazard.
Boil and bite mouthguards (grade 2) are generally regarded as being little better than stock mouthguards. The fitting process may not result in a good, close fit. Also, if the mouthguard is bitten too hard during the fitting process, the occlusal thickness may be reduced sufficiently to compromise the already limited protection.
An old custom-made mouthguard >5 years old (grade 3) will have lost much of its initial properties and therefore will not be effective enough in the event of an impact. Such mouthguards become hard, may wear down on the occlusal surface, and become too thin to prevent concussion. They may also not fit very well after a few years if teeth have been moved, worn down, or restored.
Mouthguards between 2 and 5 years old (grade 4) may suffer some or all of the same problems of mouthguards >5 years old depending on the amount of use and/or abuse they have received and how much the wearer’s dentition has changed.
A recent custom-made mouthguard (grade 6) offers the best protection against trauma and concussion. However, it must be correctly made and conform to certain guidelines in relation to thickness and coverage of the dentition; if the mouthguard is too thin (grade 5) there will be insufficient thickness to offer adequate protection.
The following criteria should apply to mouthguards used in contact sports(1):
They should enclose the maxillary teeth to the back of the second molars.
Thickness should be 3 mm on the front, 2 mm on the biting side, and 1 mm on the tongue side.
The extension above the teeth should be within 2 mm of the top of the cheek
The extension towards the tongue should extend about 10 mm above the gingival margin but can be as short as 1-2 m beyond the gingival margin for increased comfort.
The edge of the labial flange should be rounded in cross section whereas the palatal edge should be tapered.
When a maxillary guard is constructed, it should be articulated against the matching mandibular model for optimum comfort and made with balanced occlusion and maximum number of contacts with mandibular anterior teeth to reduce risk of mouthguard displacement from an impact force during athletic activity.
Remember, the most protective and comfortable mouthguard isn’t the bulkiest or thinnest one. It’s the mouthguard that is designed correctly and specifically for the athlete. Comfort means the athlete can breathe easily, speak with it in, drink with it in, no gag reflex, not causing clenching reflex, and doesn’t rub blisters on the cheeks/lips.
Dr. Thorn is acutely aware of athletic needs and consults athletic trainers for input to be able to improve comfort and compliance her athlete patients. If you, a family member, a child, or friend play any of the high-risk contact, collision, or non-contact sports listed above, reach out today to discuss a custom mouthguard.
A $300 investment today can save a lifetime of trouble and costs from preventable injuries.
Group/team discount rates available. Call today to find out more.
(540) 904-4020
A sleek custom fitted mouthguard
Patrick DG, van Noort R, Found MS. Scale of protection and the various types of sports mouthguard. British Journal of Sports Medicine 2005;39:278-281.