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Mouthguards are preventative dentistry’s contribution to sports
We dentists have an obligation to promoting the use of well-fitted & properly designed mouthguards
to prevent dental trauma. Your dentist is able to address these issues by providing more comfortable,
high quality & appealing mouthguards that do not impede on your sporting performance. Your dentist
can help to identify high-risk patients and advice on the advantages of prevention & the options
available to you.
Patients at increased risk of dental trauma:
 Playing contact sports
 Increased overjet
 Anterior restorations
 High smile line
 Orthodontics – increased tooth
mobility, fabrication difficulty,
additional injury from appliance
 Mixed dentition – immature teeth
 Previous trauma
Barriers to wearing mouthguards
 Uncomfortable
 Poor fit
 Problems breathing, speaking,
swallowing, closing lips
 Fear of reduced performance
 Slipping sensation
 Image
 Cost
 Need to visit dentist
The most common barriers we find that deter our patients from properly wearing their mouthguard
are discomfort & difficulty in breathing and speaking. In 1991, approx 1 in 5 players were not wearing
a mouthguard fitted by a dentist, even though almost 50% had experienced an oral-facial injury
playing rugby (Chapman 1993). In a survey of their rugby clubs in October 2011 the IRFU found that
84% of them had it as a club policy for players to wear mouthguards for both training and matches.
Types of mouthguards
There is a huge range in mouthguards, from over the counter to dentist-prescribed, custom-fitted
which are classified into 3 types by the Academy for Sports Dentistry:
Type 1: Stock Type
Type 2 :Mouth Formed (Boil and Bite)
Type 3: Custom-made Mouthguard which includes the single and multi-layered
Ideal characteristics of a mouthguard (Newsome 2000)
 Protective
 Comfortable
 Resilient
 Tear resistant
 Odourless
 Tasteless
 Inexpensive
 Easy to fabricate
 No interference with speech/performance
Stock Mouthguards; These simple inexpensive over the counter appliances are found to be
unretentive and patients do not adapt well to them as one has to hold them in place with the teeth
clenched together (Figure 1).
Figure 1
Stock mouth guard held by clenching teeth together
Mouth Formed; The ‘boil and bite’ prefabricated mouthguard are softened in boling water then
placed in the mouth and moulded to the teeth and gum tissue. They tend to be underextended and
perhaps too thin in places (Figure 2).
Figure 2
Mouth Formed; ‘boil and bite’ mouthguard
Custom-made Mouthguards (Figures 3&4):
These are fabricated on a master model usually made from an alginate impression of the maxillary
arch. Your dentist will have a list of guidelines to follow when making the impression as there are
many aspects that influence the final product: It is important that we make an accurate model that
extends fully into the gum area. Like all master impressions it is essential that we pick the correct size
of stock tray for our impression. The use of adhesive is essential. We must endeavour to capture the
border movements as we would with a secondary impression for a complete denture. It is only when
this is done can we properly mark out the extensions for your mouthguard to 2mm from the reflection
of sulcus (Figure 5). The stone model needs to be poured up within 20mins to maintain accuracy and
allowed to completly dry out before using the vacuum forming technique.
We must choose the correct type of material for our thermoplastic mouthguard. The material of
choice is Ethylene Vinyl Acetate(EVA). Thickness of the final guard must be thick enough to offer
protection but not so thick that it compromises the ability to wear and tolerate the guard.
Custom mouthguards can be single or multilayer. The use of multilayering can be useful as it can allow
for increased stability and comfort of the final guard. This multilayer can allow for the incorporation
of team logos and specific colour conbinations
As well as proper fit, proper outline & occlusion (bite) should be considered. If well designed and
executed, all of the above should significantly increase comfort, ease of breathing and speaking.
Figure 3 Single Layered Vacuum Formed Customised
Mouthguard
Figure 4 Multilayered Vacuum Formed Customised
Mouthguard
Figure 5 Good land area required for adequate
extension of the protective guard
Type
STOCK
Material
Polyvinyl
(PVC)
Fabrication
chloride none
Advantages

Inexpensive
MOUTH
Rigid outer layer, soft Moulded in 
FORMED
resilient
inner mouth
(BOIL & BITE) thermoplastic layer
following
heating
vinyl Alginate

maxillary
impression
Polyvinyl-acetateethylene copolymer
Vacuum
fabricated
from model
of maxillary
arch
CUSTOM
MADE
SINGLE
LAYER
Ethylene
acetate (EVA)
CUSTOM
LAYER
LAMINATED
Ethylene
acetate (EVA)
vinyl Alginate
maxillary
impression
Polyvinyl-acetateethylene copolymer
High temp &
pressure
Intermediate resin layering of
layer
or
space materials on
(Takeda 96)
maxillary
arch model






Inexpensive
Improved
retention
fit
Disadvantages

Poor
fit,
limited
protection
 Bulky
 Poor
fit
&
retention
 Clench to hold in
situ (Chapman 96)
 Bite
through
reduces
effectiveness Park
94)
&  May
stretch
unevenly
 Thin
incisal
reduces
protection
 Shrink over time
(park 94, waked
05)
 Cost (Our charge
is €100 but may
change so please
call to check!)
Good fit & retention

Reduced shrink
Uniform thickness
Increased comfort
No detrimental effect
performance/breathing
(Duddy 12)
User preferred (Kenyon
05)
Cost (Our charge is
€100 but may
change so please
call to check!)
Table 1 Summary of the characteristics of different mouthguard types
Orthodontic appliances & mouthguards
The most common age for orthodontic appliance wear is around teenage years, corresponding with
the peak age for sporting activity related traumatic injuries. Some children are advised to avoid sport
during orthodontics but it is possible to encourage participation with well-fitting mouth protection.
Children in orthodontic appliances are particularly at risk of trauma so must be encouraged to wear
mouthguards. Compliance with mouthguard wear may be compromised by poor fitting, stock
mouthguards and constant adjustments needed. Stock trays are available e.g. Total Guard but these
are not an ideal fit. For older children, approaching the end phase of orthodontics custom trays can
be made. A maxillary alginate is made with orthodontic wax blocking out the undercuts around
brackets. The leeway allows excellent fit & protection & can also be used post-orthodontics.
Conclusion:
We hope that our 2-part series on Mouthguards have given you some insight to the world of
sportsguards and have answered some of your questions. If you need to contact us for any specific
advice please call us on 01-6684357 or email: [email protected]