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There has been a dramatic increase in sports injuries with the expanding field of sports and vigorous recreational activities. Tallies have shown an increase in the incidence of lacerations, fractures, concussions and orofacial injuries (injuries in and around the mouth) with increase in the population of avid sports participants.

Not all sports have the same likelihood of encountering injuries to the orofacial regions. American football, rugby, ice hokey and boxing carry more risk, in comparison to non-contact sports such as volleyball, softball, or figure skating. However, a cross-sectional study of athletes from high school, college, and professional levels showed that most of them had had at least one orofacial injury. It is estimated by the American Dental Association that mouthguards prevent approximately 200,000 injuries each year in high school and collegiate football alone.

Most injuries are acquired during the actual game than in practice sessions, but this should not limit the use of mouthguards only in the actual competition. There are a number of sports where the use of these protective equipment, both in practice and the real game, are mandatory. Boxing is a prime example, especially since facial injuries and fractures commonly occur in the younger age group, and mostly among amateur athletes.


The American Society for Testing and Materials has defined mouthguards or a mouth protector as ‘a resilient device or appliance placed inside the mouth (or inside and outside), to reduce mouth injuries, particularly to teeth and surrounding structures’.

The use of makeshift mouthguards made from rolled cloths, sponges, or pieces of wood have been employed as early as in the 1830s by boxers who recognized the protective advantage of a guard in their mouths. In the 1890, Woolf Krause, a dentist from London, invented a more formal mouthguard for the benefit of the boxers. This indeed helped in reducing lip lacerations and teeth fractures that by 1920, the use of mouthguards for this sport became mandatory.

After boxing, American football was the next sports to use the mouthguards. By 1950, it was observed in the US, that 25-30% of all injuries sustained in the game were dental in nature. The American Dental Association encouraged that use of the athletic mouthpieces that in the US high school football season of 1962, the use of these protective agents were mandated.

Materials used in mouthguards

Earlier mouthguards were made from latex rubber but its use have declined since it has lower shock absorbancy, lower hardness, less tear and tensile strenths – characteristics that are the fundamental basis of protection of mouthguards. Nowadays, mouthguards are mostly made out of polyvinylacetate-polyethylene or ethylene vinyl acetate (EVA) copolymer; polyvinylchloride; acrylic resin; and polyurethane. EVA copolymer is fast becoming a popular choice because of its easy pliability, a great quality in shaping and molding.

Physical properties of mouthguards

A well-designed mouthguard will only be effective if it is worn. Therefore, attention should be paid in making mouthguards comfortable to wear and stay in place.

A well-fitted mouthguard should not cause any difficulty in breathing of speaking in the part of the user. Usually, ill-fitted and loose mouthguards forces the wearer to constantly clench his or her teeth to put the guard back in place. This constant mouthguard loosening and clenching of teeth to put it back not only hampers breathing and speech, but also makes the athlete lose concentration, thus forcing him or her put away the guard instead.

Depending on the type of mouthguard, it can either cover only the upper set of teeth and jaw, or both upper and lower sets of teeth and protects both upper and lower jaws. In any case, an ideal mouthguard should cover as far the back teeth (molars) as this protects the jaws from fractures. Those who wear braces require lip and cheek protection from the wires and brackets.

When worn, the mouthguards separates the upper from the lower set of teeth, covers them as well as the surrounding tissues. The effectiveness of the mouthguard to protect teeth and surrounding tissues depend on its physical characteristics, its size and fit, and the type of materials used. All these add up to make the guards appealing and comfortable to wear. Failure to meet an athlete’s comfort is the main reason why mouthguards are oftentimes not worn.

Different sports have different risks of injuries as well as strength of impacts. As such, mouthguards should be tailored according to the sport that it will be used in. Understandably, mouthguards should be thicker and heavier for those sports where blows to the face are a constant danger; mouthguards used in boxing should be thicker and heavier compared to those used in tennis.

The physical properties required in mouth guards are:

  • shock-absorbing capability
  • hardness
  • stiffness or resilience
  • tear strength
  • tensile strength
  • water absorption

Published research has consistently shown that mouth guards offer significant protection against dental injury. Although not everyone is convinced despite these studies, sports doctors and dentists should strongly advocate to their clients the use of these personal protective gears to reduce incidences of injuries, especially to those who are into contact sports. Custom-fitted guards are more advisable compared to over-the-counter ready-made ones, as the latter may be uncomfortable or more injurious due to the ill fit. A properly fitted mouthguard can help prevent broken teeth and injuries to the lips, tongue, face or jaw.

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