Athletic mouth guards are designed to protect against bruising of the lips and cheeks, intra oral soft tissue lacerations; protect the teeth from crown fractures, roots fractures, dislocations, and avulsions; protect the jaws from fractures and dislocations; as well as provide support for edentulous spaces for those athletes who wear removable partial dentures.
They reduce the incidence and severity of injuries that occur during athletic practice and competition. They also have been shown to prevent head and neck injuries, indirect concussions and jaw fractures, cerebral hemorrhage, unconsciousness, serious central nervous system damage, and death. It also reduces the possibility of direct impact of head of condyle to the glenoid fossa, thereby decreasing impact and forces to the entire temporal region.
Mouthguards or "gum shields" were originally developed in 1890 by Woolf Krause, a London dentist, as a means of protecting boxers from lip lacerations. Such injuries were a common and often disabling accompaniment of boxing contests in that era. These gum shields were originally made from gutta percha and were held in place by clenching the teeth. By 1930s, mouthguards were part of the standard boxers' equipment and have remained so since that time.
Classification of mouth guards
Type I : Stock mouth guards :
These preformed, over-the counter mouthguards are very popular since they are readily available, inexpensive, and can be purchased in a variety of colors and styles. They are ready to wear because one size is intended for all users, and they must be held in place by biting the teeth together. Because they are the least retentive and often bulky, stock mouthguards interfere the most with the athlete's ability to breathe and speak and often cause the athlete to gag. Because of all these factors, stock mouthguards are unacceptable to most athletes and offer the least protection for the prevention of sports-related traumatic dental injuries.
Type II : Mouth – formed mouth guards :
Mouth-formed protectors are available in two varieties; the thermoplastic and the shell-lined are both adapted directly to the teeth and the maxillary arch. The shell-lined variety is fabricated by placing freshly mixed ethyl methacrylate into a hard shell, which is then inserted into the athlete's mouth and molded over the maxillary teeth and soft tissues. The excess is trimmed with crown and bridge scissors and the mouthguards are then ready for use. Prior to the fabrication of either type of mouthformed mouthguard, the dentition should be examined and all restorative procedures should be completed.
Type III : Custom-fabricated (over a dental cast) mouth guards :
- Prefabricate Custom-Formed Mouthguards -- The thermoplastic boil-and-bite mouthguard is fabricated by placing the mouthguard in boiling water to soften the material. The softened material is then placed into the athlete's mouth, where it is molded with finger pressure as well as with facial and intraoral muscular movements to enhance adaptation to the hard and soft tissue structures of the mouth.
- Custom-Formed (Vacuum) Mouthguard are made professionally over a dental cast of the athlete's arch. Because of their superior adaptation and retention, custom-fabricated mouthguards are believed to interfere least with breathing (oxygen exchange) and speech. These also offer the highest degree of protection, comfort, superior fit and durability with optimal fit. These are designed to cover all back teeth and cushion the entire jaw. They are more likely to be accepted by athletes.
- Photopolymerized urethane diacrylate custom lip guards and mouthguards are also used nowadays for better adaptation and better comfort and protection. Studies done show that there is always lesser trauma caused to a person wearing any kind of protective gear than that caused to a person without wearing it.
Although mouth guards have been shown to be effective and have been advocated for more than 30 years, mouth protectors are not considered as an integral part of protective equipment for most sports. Dentists need to educate patients on the need and benefits of protective devices.
Factors contributing to the use and discontinuation of a mouthguard
Overall mouthguard use was low as 31.1%, especially for custom-fitted mouthguard (1.8%), followed by stock mouthguard (7.7%). Boil-and-bite type was most commonly used (21.1%). Of those who wore a mouthguard before, only 28% continued using it.
The discontinuation rate for each type was as follows: Stock, 57.1%; boil-and-bite, 80.2%; and custom-made, 37.5%.
- Age was a significant factor for mouthguard use.
- Breathing disturbance and general discomfort were significant factors in discontinuing mouthguard use.
- Among those who discontinued wearing mouthguards due to breathing difficulties and comfort, there was higher incidence of injury.
Needed action to make mouthguards popular
- Education of all those involved is the key because many athletes are not aware of the health implications of a traumatic injury to the mouth or of the potential for incurring severe head and orofacial injuries while playing.
- The dentist can play an imperative task in informing athletes, coaches and patients about the magnitude of dental sciences in preventing orofacial injuries in sports.
- Team physicians, dentists, athletic trainers, and coaches must take into consideration both the athlete's previous medical history and the sport.
- Improve the quality of mouth guards for player safety as one way of attempting to reduce the incidence of concussion in athletes.
- There is need to popularize the use of orofacial protective devices in a variety of sports events by interacting with coaches, sports administrators and sports persons as well as familiarizing the Indian dentists in a relatively new field.
