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.
Mouthguards
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.
