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Mouth Guards in Dentistry-A Review

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DOI: 10.21276/sjds.2018.5.9.10

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Scholars Journal of Dental Sciences (SJDS) ISSN 2394-4951 (Print)
Abbreviated Key Title: Sch. J. Dent. Sci. ISSN 2394-496X (Online)
©Scholars Academic and Scientific Publisher
A Unit of Scholars Academic and Scientific Society, India
www.saspublisher.com

Mouth Guards in Dentistry-A Review

Srikanthan Sriram1*, Arasan Nandhini2, Parangimalai Diwakar Madan Kumar3
1
Post graduate student, Department of Public Health Dentistry, Ragas Dental College and Hospital, 2/102, East Coast
Road, Uthandi, Chennai, India
2
House surgeon, Ragas Dental College and Hospital, 2/102, East Coast Road, Uthandi Chennai, India
3
Professor and Head, Department of Public Health Dentistry, Ragas Dental College and Hospital, 2/102, East Coast
Road, Uthandi Chennai, India

Abstract: A physically active lifestyle which is essential for a healthy living is achieved
Review Article by means of sports. However, participation in sports carries risk of traumatic injuries. Of
such trauma, dental and orofacial injuries have been reported the commonest. Sports
*Corresponding author dentistry is a composite branch encompasing aspects of treatment, prevention, education
Srikanthan Sriram and research in which sports and dentistry come together. Mouth guard an intra oral
device, worn over teeth is reported to be the most efficient in protecting such injuries.
Article History This article reviews the various dental and orofacial sports injuries, to throw light on
Received: 21.09.2018 Mouth guard, its types and fabrication, awareness and usage among professionals from
Accepted: 25.09.2018 various sports disciplines.
Published: 30.09.2018 Keywords: lifestyle, sports, oral health, traumatic injuries.

DOI: INTRODUCTION
10.21276/sjds.2018.5.9.10 In today‟s world everybody is crazy about staying fit and healthy and oneway
of achieving it is by means of sports. People participate in sports and related activities
for pleasure, relaxation, motivation, competition, improvement of fitness and health.
However, participation in sports carries risk of traumatic injuries which may even be
fatal, affecting the quality of life of the athlete [1]. Sports activities carry six times
higher risk than work related accidents and three times higher risk than traffic accidents
[2]. During sports related activities various traumatic injuries are encountered of which
dental and orofacial injuries are the most common type during participation [3]. The
traumatic dental injuries happen as a result of falls and coming into collisions which
frequently happens during sports activities [4].

Younger individuals and contact sports in organized sports programs and all the types have an
represent an important group in dental trauma etiology increased risk of traumatic injuries resulted from fall,
[5]. As the number of athletes in contact sports and collisions, contact with hard substances and related
competitiveness increase, the traumatic accidents in the equipment [9].
last few years have also increased thus insisting the
need for prevention [6]. However dental trauma in Gassner and colleagues reviewed
sports differ from other dental trauma as it is possible to craniomaxillofacialtrauma cases presenting to the
easily prevent it by use of protective devices such as department of oral and maxillofacial surgery in 10years.
mouth guards that protect all dental and periodontal Approximately, 3,385 cases with 6,060 injuries were
structures [7]. This review article discusses various reviewed by them among which, 31.8% of injuries in
aspects of sports related dental and orofacial injuries children were related to sports-related activities.
,the risk factors associated, protection and prevention of Children between the age group of 7 and 11 years are
traum. most susceptible to sports-related traumatic dental
Injuries [10]. Muller and colleagues surveyed the
Dentistry and sports related activities incidence of dental injuries in four countries including
Traumatic dental injuries in sports are the main Switzerland, Austria, Germany and Italy and observed
link between the sports and dentistry. Castaldi governed that the anterior teeth are the most commonly affected
the factors such as the popularity, organized youth by dental trauma. The upper incisors are most
sports and the high level of competitiveness to be cause predisposed to injury (52-90%), due to their anatomical
of recent rise of prevalence of orofacial injuries during location. The prevalence
sports activities [8]. About 30 million youth participate

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Srikanthan Sriram et al., Sch. J. Dent. Sci., Vol-5, Iss-9 (Sept, 2018): 458-462
Of uncomplicated crown fractures was 44- In 2002, Carlos Henrique Ferrari, studied six
62.5% [11]. Huang and colleagues documented the different sport modalities: two involved martial arts
highest occurrence of traumatic dental injuries in young (judo and jiu-jitsu) and four involved ball games
male athletes in the age group of 15-18 years [12]. Hill [football (soccer), basketball, handball and skate
and colleagues found that in some sports, such as hockey], in social competitions which took place
cycling, horse riding and skateboarding, the younger betweenMarch1998 and November 19991 Groups of
age group are most at risk of dental injury because they athletes with the highest rate of dental traumas were jiu-
are learning, but in team sports the highest risk is in jitsu, handball and basketball players, respectively,
young adults aged 20-30 because they play more which were the sports presenting the lowest rate of
frequently. The risk of injury also increases with higher Mouth Guard usage [18].
levels of competition when players are more committed
and probably have more exposure. The risk in cricket is Preventive measures
highest in 40-49-year-olds, which is a reflection of the Sports dentistry
age at which people play cricket and, perhaps, on the Dentistry always has an overlook over
slowing of reactions in older players [13]. Soccer is one prevention in any aspect. Sports dentistry is a branch of
of the most popular team sports in the world, with sports medicine that deals with the composite skills for
roughly 240 million amateur and 200,000 professional treatment, prevention, education, and research in which
players [14]. Despite the popular belief that soccer is dentistry and sports come together.
not a violent sport, it presents a high risk of injuries
compared to athletes, including oral and craniofacial Mouth guards
injuries [15]. The risk occurs due to the aggressive The American Society for Testing and
defense system, resulting in greater possibility of Materials has defined a mouth protector as a resilient
traumatic accidents [16]. In a study of Gay-Escoda device or appliance placed inside the mouth (or inside
21.4% of the soccer players were suffering from dental and outside) to reduce mouth injuries particularly to
trauma [17]. teeth and surrounding structures.

Fig-1: Mouth guard

History of mouth guards STOCK MOUTH GUARDS

Boxing was the first sports activity to use These are prefabricated and must be clenched
mouth guard. Boxers used devices like cotton, tapes, between teeth for protection. Clenching a stock mouth
sponge or small pieces of wood. They clenched these guard in place can interfere with breathing and speaking
materials between teeth believing that they will act as and, for this reason; stock mouth guards are considered
shock absorbent. However it was thought that the by many to be less protective [22].
players were distracted in order to keep these materials
clenched between teeth and it is also stated that these MOUTH FORMED MOUTH GUARDS
materials were dislodged from oral cavity and entered Mouth-formed, also known as “boil-and-bite”,
larynx.Thus in 1930s the first description of mouth mouth guards are made from a thermoplastic material
guards came into existence into dental literature [19, adapted to the mouth by finger, tongue, and biting
20]. pressure .Woodansey added that because they are
formed at body temperature, they readily distort and
Classification of Mouth Guard ASTM (American wear off. They often lack proper thickness and
society of testing and Materials) reapproved the extension leading to lesser protection and retention [23].
classification for athletic mouth guards as follows
CUSTOM MADE MOUTH GUARDS
Type I - Stock Mouth guards. (Least preferred) They are more expensive, most comfortable,
Type II - Mouth formed mouth guards. best-fitting custom-designed mouth guards
Type III - Custom fabricated (over a dental cast) mouth recommended by the dentist [24]. Varieties of materials
guards (Most preferred)[21]. are currently being used for mouth guards, most
commonly polyvinyl-acetate-polyethylene copolymer
and polyvinyl chloride. Silicone rubber, natural rubber,
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Srikanthan Sriram et al., Sch. J. Dent. Sci., Vol-5, Iss-9 (Sept, 2018): 458-462
soft acrylic resin, and polyurethane are less widely used recommended this type of mouth guard for athletes to
after immersing the appliance in hot water.ADA has prevent sports-related injuries..

Fig 2.Stock mouth guards

Fig 3. Mouth formed mouth Guards

Fig-4: Custom made mouth guards

FUNCTIONS OF MOUTH GUARD so that the condyles were distracted from their fossae
Dental and orofacial trauma prevention [26].
It acts as a buffer between hard and soft tissues
preventing lacerations, bruising of lips, cheeks and  Psychological effect
tongue during impact. It also provides a cushioning Psychologically the player feels more
effect redistributing the force of the blow over all the confident that they are less likely to sustain injuries
teeth. Mandible is made elastic preventing fracture to [27].
the unsupported angle of lower jaw [25].
Dental trauma and level of information of mouth
 Concussion prevention guard use in different contact sports
Stenger et al. claimed a benefit for both head
and cervical spinal injuries by mouth guard use. They 2002-A research in Brazil- Findings of an
concluded that a mouth guard in situ, there was an interview taken on 1189 athletes [18]
altered mandibular position on lateral skull radiographs,

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Srikanthan Sriram et al., Sch. J. Dent. Sci., Vol-5, Iss-9 (Sept, 2018): 458-462

BARRIERS TO USE 5. Edward s, Nord CE. Dental injuries of school

Apart from cost, other barriers to mouth guard children. Svensk Tandlak. 1968;61:511-516.
use include problems with retention,speech, nausea, 6. Padilla R,Balikov s. Sports dentistry:coming of age
dryness and difficulty in breathing. Girls and lower in the 90s.J Calif Dent Assoc. 1993;21:27-34.
social groups appear to be less likely to wear mouth 7. Kerr IL. Mouth guards for the prevention of
protection [28]. Australian amateur football players injuries in contact team sports. Sports
reported that the primary reasons for not wearing a Med.1986;3:415-27
mouth guard were „too much hassle‟ and „never thought 8. Castaldi CR. Sports-related oral and facial injuries
of it‟ [29]. Student athletes revealed that they preferred in the youngathlete: A new challenge for the
custom- made mouth guards to self-adapted types but pediatric dentist. Pediatr Dent. 1986; 8(4):311-316.
the cost and the inconvenience of having to make a 9. Adirim T, Cheng T. Overview of injuries in the
dental appointment to obtain a custom-made one young athelete. Sports Med.2003;33(1):75-81
stopped them from the usage of mouth guards[30]. 10. Tesini DA, Soporowski NJ. Epidemiology of
orofacial sports-related injuries. Dental clinics of
CONCLUSION North America. 2000 Jan;44(1):1-8.
Thus injuries during sports activities 11. Muller KE, Persic R, Pohl Y, Krastl G, Filippi A.
inevitable. Preventive measures can be adopted such Dental injuries in mountain biking:a survey in
that these injuries become less traumatic and also Switzerland, Austria, Germany and Italy. Dent
enhance the competitiveness among players. The Traumatol. 2008;24:522-7.
published researches show mouth guard use during 12. Huang B, Wagner M, Croucher R, Hector M.
sport activities to consistently offer significant Activities related to the occurrence of traumatic
protection against orofacial injuries. However its usage dental injuries in 15- to 18-yearolds. Dental
among players is considerably less and thus sports Traumatol. 2009;25(1):64-68.
dentistry in conjunction with the respective contact 13. Hill CM, Crosher RF and Mason DM. Dental and
sports associations must mandate the use of mouth facial injuries following sports accidents: a study of
guards in all sports activities. 130 patients. Br J Oral Maxillofac Surg. 1985; 23:
268-274.
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