IMPORTANCE OF MOUTH GUARDS IN SPORTS: A REVIEW

Abstract

Teens and adults experience thousands of injuries on the
playing field, while biking and
during other activities. Injuries to the face in nearly every sport can harm teeth, lips, cheeks and
tongue. A properly fitted mouth protector is important to protect teeth and smile. This article gives a
brief review on the
mouth guards to be used to protect smile.

Full text

REVIEW ARTICLE
Journal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 46/ November 18, 2013 Page 8903
IMPORTANCE OF MOUTH GUARDS IN SPORTS: A REVIEW
Priyadarshani G Pawar1, Mukesh M. Suryawanshi2, Ashishkumar K. Patil3, Pravin S Purnale4,
Fareedi Mukram Ali5
HOW TO CITE THIS ARTICLE:
Priyadarshani G Pawar, Mukesh M Suryawanshi, Ashishkumar K Patil, Pravin S Purnale, Fareedi Mukram Ali. “Importance
of mouth guards in sports: a review”. Journal of Evolution of Medical and Dental Sciences 2013; Vol. 2,
Issue 46, November 18; Page: 8903-8908.
ABSTRACT: Teens and adults experience thousands of injuries on the playing field, while biking and
during other activities. Injuries to the face in nearly every sport can harm teeth, lips, cheeks and
tongue. A properly fitted mouth protector is important to protect teeth and smile. This article gives a
brief review on the mouth guards to be used to protect smile.
KEY WORDS: mouth guard, mouth protector
INTRODUCTION: Sports have the potential to seriously harm the head, face or mouth as a result of
head-to- head contact , hazardous falls, tooth clenching or blow to the mouth. Knowing how to
prevent injuries is important if you participate in organized sports or other recreational activities.
When it comes to protecting your mouth, a mouth guard is an essential piece of athletic gear that
should be part of an athlete’s standard equipment from an early age. In fact, an athlete is 60 times
more likely to suffer harm to the teeth when not wearing a mouth guard. Mouth guards help buffer
an impact or blow that otherwise could cause broken teeth, jaw injuries or cuts to the lip, tongue or
face. Mouth guards also may reduce the rate and severity of concussions. Sport, leisure and
recreation activities are the most common cause of dental injuries. Dental injuries can be painful,
disfiguring and expensive to treat. Dental injuries may result in time off work or school to recover,
and lengthy (and expensive) dental treatment. A mouth guard, custom-fitted by your dentist and
worn every time you play or train, will protect against dental injury.
HISTORY: The exact origins of the mouth guard are unclear. Most evidence indicates that the
concept of a mouth guard was initiated in the sport of boxing. Originally, boxers used to wear mouth
guards out of cotton, tape, sponge, or small pieces of wood. They bite the material between their
teeth.(1) These devices proved impractical, a British dentist, began to fabricate mouthpieces for
boxers in 1892. Krause placed strips of a natural rubber resin, gutta-percha, over the maxillary
incisors of boxers. (2) Philip Krause was an amateur boxer used his own device before 1921.(3) In the
early 1900s, Jacob Marks created a custom fitted mouth guard in London.(4) In 1927 boxing match
between Jack Sharkey and Mike McTigue. McTigue was winning for most of the fight, but a chipped
tooth cut his lip, and he was forced to forfeit the match. From that point on, mouth guards were
acceptable.(4,5) In 1947, a Los Angeles dentist, made a breakthrough by using transparent acrylic
resin to form an "acrylic splint”. In the 1948 issue of the Journal of the American Dental Association,
the procedure for making and fitting the acrylic mouth guard was described in detail by Dr.
Lilyquist.(6) He was awarded nationwide as the father of the modern mouth guard for athletes. (6,7) In
the 1940s and 1950s, dental injuries were responsible for 24-50% of all injuries in American
football. In 1952, Life magazine did a report on Notre Dame football players without incisors.(8) In
the 1950s, the American Dental Association (ADA) began conducting research on mouth guards and

REVIEW ARTICLE
Journal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 46/ November 18, 2013 Page 8904
soon promoted to the public.(9) In 1960, the ADA recommended the use of latex mouth guards in all
contact sports. The National Collegiate Athletic Association (NCAA) followed suit in 1973 and made
mouth guards mandatory in college football. Since the introduction of the mouth guard, the number
of dental injuries has decreased dramatically.(10) Mouth guards have become a standard in many
sports.
SPORTS WHICH NEED MOUTHGUARD:
The ADA recommends mouth guards be used in
Acrobatics
Ice Skating
Water polo
Basketball
Inline Skating
Weight Lifting
Bicycling
Lacrosse
Wrestling
Boxing
Martial Arts
Volleyball
Equestrian Events
Racquetball
Squash
Extreme Sports
Rugby
Surfing
Field Hockey
Shot putting
Soccer
Football
Skateboarding
Softball
Gymnastics
Skiing
Skydiving
Handball
Common Dental Injuries And Risk factors: Common Dental Injuries Incurred During Sport Or
Leisure Activities Include Cut lips, Cut gums, Cut cheeks, Cuts to the tongue or face, Chipped teeth,
Broken teeth, Knocked out teeth, Broken jaw, Temporomandibular joint fractures. Some people are
at higher risk of dental injury. Risk factors include: Protrusive front teeth, Inadequate lip coverage
over the front teeth, Current orthodontic treatment, such as wearing braces .Participation in sports
or leisure activities that carry a high risk of collision or falls. In 1995 Dr. Raymond Flanders st
reported on the high incidence of injuries in sports other than football, in both male and female
sporting activities. In football where mouth guards are worn, .07% of the injuries were orofacial. In
basketball where mouth guards are not routinely worn, 34% of the injuries were orofacial. Various
degrees of injury, from simple contusions and lacerations to avulsions and fractured jaws are being
reported. Dental injuries can be painful, disfiguring and expensive to treat. Dental injuries may result
in time off work or school to recover, and lengthy (and expensive) dental treatment. Without using
mouth guards, the athlete increases their chance of injury, especially concussion, from a blow to the
chin. Some of these injuries, such as concussion, can cause lifelong effects.
Mouth guard features: Wearing an appropriately designed and made mouth guard while
participating in sport will protect against dental injuries. Players of all ages involved in sports and
activities where they are at risk of an injury to the face should protect their teeth with a properly

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Journal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 46/ November 18, 2013 Page 8905
fitted mouth guard. A protective mouth guard should be comfortable yet tight-fitting, allows normal
breathing, speech and swallowing. It does not cause gagging or irritation. It should be odourless and
tasteless and thick enough (4mm) to provide protection against impact. The mouth guards were
made of the following materials: (1) Poly (vinyl acetate-ethylene) copolymer clear thermoplastic (2)
Polyurethane (3) Laminated thermoplastic.
Types of Mouth guards: The Three Basic Types Of Mouth guard Include:
The Ready-Made Or Stock Mouth guard
The Mouth- Formed “ Boil-And- Bite” Mouth guard
The Custom-Fitted Mouth guard --- A) The Vacuum Mouth guard
B) Pressure Laminated Mouth guard.
Stock – a ready-to-wear mouth guard that comes pre-formed. The stock mouth guard, available at
most sporting good stores, come in limited sizes and are the least expensive and least protective. The
stock mouth guard is the least acceptable. This type of mouth guard is often altered and cut by the
athlete in an attempt to make it more comfortable, further reducing the protective properties of the
mouth guard. these are the least expensive mouth guard, they also offer the least amount of
protection. They tend to be uncomfortable and fit poorly.(fig.1)
Boil-and-bite – once the lining is softened in boiling water, the person bites on the mouth guard to
help it take the shape of their mouth. These mouth guards may not conform to the person’s bite and
can be uncomfortable to wear. Athletes also cut and alter these bulky and ill fitting boil and bite
mouth guards due to their poor fit, poor retention, and gagging effects11.(fig.2)
Custom-fitted – It considered to provide the best protection for the teeth, lips and jaw. Custom-
fitted mouth guards are made by a dentist or a dental technician to fit the individual’s mouth. They
provide the best protection due to their close fit, comfort and cushioning (shock absorption) effect.
They are the most expensive option. However, the cost of an injury to the teeth or jaw will be a lot
more expensive. Dentists recommend custom-fitted mouth guards. There are two categories of
custom mouth guards, the Vacuum Mouth guard and the Pressure Laminated Mouth guard.
It is made from a stone cast of the mouth, usually of the maxillary (upper) arch, using an
impression by dentist. A thermoplastic mouth guard material is adapted over the cast with a special
vacuum machine which will chemically fuse under high heat and pressure with machines such as the
Drufomat, the Erkopress 2004, or the Biostar. (fig. 3, 4) The most common material for this use is a
poly-EVA (ethylene vinyl acetate) copolymer. (fig. 5) The mouth guard is then trimmed and polished
to allow for proper tooth and gum adaptation. (fig. 6) All posterior teeth should be covered and
muscle attachments unimpinged. (fig. 7, 8) It should be noted that these mouth guards are still
superior to the store bought stock and boil and bite mouth guards because they have a much better
fit, made from a mold of your mouth, and are designed by dentist.
How To Care For Mouth guard – It include:
Rinse the mouth guard in soap and warm water after each use. Allow it to air-dry.
Disinfect the mouth guard from time to time with a mouthwash.

REVIEW ARTICLE
Journal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 46/ November 18, 2013 Page 8906
Keep the mouth guard in a well-ventilated plastic storage box when not in use. The box
should have several holes in it.
Do not leave the mouth guard in direct sunlight, in a closed car or in the car’s glove box. Heat
can damage it.
Ensure your mouth guard is in good condition before each use.
Ask your dentist to inspect your mouth guard at every dental check-up.
Replace the mouth guard if it is damaged.
Replace a child’s mouth guard every 12 to 18 months, even if it appears to be in good
condition. Growth and new teeth can alter the fit.
Replace an adult’s mouth guard after dental treatment or tooth loss. Otherwise it should last
for several years.
Wear the mouth guard at all times, including games and training sessions.
Players undergoing dental treatment can have a custom-fitted mouth guard made by their
dentist to fit comfortably and accurately over their braces.
DISCUSSION: As sports dentists and health professionals, we highly recommend the custom made
mouth guard, especially those of the laboratory lamination type for the very best in oral/facial
protection as well as concussion deterrence. This section has presented a discussion of the various
issues relating to injury prevention and mouth guards. By acknowledging these significant
differences in mouth guards, the public will be better informed and educated to seek their dental
sports protection from dental health professionals.
CONCLUSION: Sport, leisure and recreation activities are the most common cause of dental injuries.
A mouth guard, custom-fitted by your dentist, is considered to provide the best protection for the
teeth, lips and jaw. The cost of an injury to the teeth or jaw far exceeds the cost of a custom-fitted
mouth guard.
REFERENCES:
1. Knapik J. J., Marshall S. W., Lee R. B., Darakjy S. S., Jones S. B., Mitchener T. A., & Jones, B. H.
Mouth guards in Sport Activities. J Sports Medicine 2007;37(2), p.120.
2. Reed, R. V. Origin and early history of the dental mouthpiece. British Dental Journal 1994 ;176 :
p. 479.
3. Knapik et al., 2007: p. 120.
4. Pontsa, Peter T. (2008). Mouth Guards Prevent Dental Trauma in Sports. The Dent-Liner
2008;12 (3).
5. Knapik et al., 2007 :p. 121.
6. "Acrylic Splints for Athletes: Transparent Slip Casings for the Teeth as a Protection From
Blows." Journal of the American Dental Association 36.1 (1948) 109-110.
7. "Protecting Athletes' Teeth." Pittsburgh Post-Gazette 1948 :21.162-18.
8. Using Mouth guards to Reduce the Incidence and Severity of Sports-related Oral Injuries."
Journal of the American Dental Association 137.12 (2006): 1712-1720.

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9. Zadik Y, Jeffet U, Levin L . "Prevention of dental trauma in a high-risk military population: the
discrepancy between knowledge and willingness to comply". Mil Med 2010; 175 (12): 1000–
1003.
10. Zadik Y, Levin L. "Orofacial injuries and mouth guard use in elite commando fighters". Mil Med
2008;173 (12): 1185–1187.
11. Zadik Y, Levin L. "Does a free-of-charge distribution of boil-and-bite mouth guards to young
adult amateur sportsmen affect oral and facial trauma?". Dent Traumatol 2009; 25 (1): 69–72.
Fig. 1: Stock mouth guard
Fig. 2 (A) Boil and bite mouth guard- before fitting
Fig. 2 (B) boil and bite mouth guard- after fitting
Fig. 3: Biostar vaccum machine
Fig.4: Fabricate a Biostar vinyl base on the cast

REVIEW ARTICLE
Journal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 46/ November 18, 2013 Page 8908
AUTHORS:
1. Priyadarshani G. Pawar
2. Mukesh M. Suryawanshi
3. Ashishkumar K. Patil
4. Pravin S Purnale
5. Fareedi Mukram Ali
PARTICULARS OF CONTRIBUTORS:
1. Lecturer, Department of Prosthodontics,
MGV’s KBH Dental College and Hospital,
Nashik.
2. Senior Resident III, Department of Plastic
Surgery, Grant Medical College, Sir J.J. Group
of Hospitals, Mumbai.
3. Senior Lecturer, Department of Conservative
& Endodontics, SMBT Dental College,
Sangamner Taluka, Maharashtra State.
4. Post Graduate Student, Department of
Prostshodontics, Rural Dental College, Loni.
5. Reader, Department of Oral & Maxillofacial
Surgery, SMBT Dental College, Sangamner
Taluka, Maharashtra.
NAME ADDRESS EMAIL ID OF THE
CORRESPONDING AUTHOR:
Dr. Priyadarshani G. Pawar,
Lecturer,
MGV’s KBH Dental College and Hospital,
Nashik.
Email – pri_s77@yahoo.com
Date of Submission: 15/10/2013.
Date of Peer Review: 17/10/2013.
Date of Acceptance: 31/10/2013.
Date of Publishing: 12/11/2013
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Fig. 5: Bio-star vinyl sheet after fabrication
Fig.6: Try-in on cast after removal of excess
Fig.7 Custom fitted sports mouth guard prepared
Fig. 8: Intraoral view