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Registered On: 14/05/2011
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Types of mouthguards:
I. Stock Mouthguards:
The stock mouthguards, available at most sporting good stores, come in limited sizes (usually small, medium, and large), least expensive but the least protective. As they cannot be prepared to mimic the mouth, they fit poorly, bulky, interfere with talking and breathing and can be held in place only when the jaws are closed.Some athletes try to make it more comfortable by cutting parts of their stock mouthguard that further reduces the required retention and protection. Unfortunately, these are still the most commonly used mouthguards on the market of many developing countries.
Ranalli, 1991, consider stock mouthguards to be potentially hazardous and should not be recommended.
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Stock Mouthguard
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II. Mouth Formed Mouthguards:
Presently, most mouthguards sold worldwide are of this type. They are available in limited sizes and are of two subtypes: the shell-liner and the thermoplastic.
a) The shell-liner type: consists of a preformed outer shell of polyvinyl chloride that fits loosely over the maxillary dentition. The liner is made of a plasticized acrylic gel or a silicon rubber. This mixture is placed in the player’s mouth, permitted to mold to the teeth, and then thermoset or chemoset. Because the outer shell is a stock tray resembling the stock mouthguards in size, they are also bulky and interfere with breathing and talking.
Heintz, 1968, and Bureau of Health Education and Audiovisual Services, and Council on Dental Materials, Instruments, and Equipment, 1984, found that by repeated biting on the shell liner mouthguards the liner material crept or spread, resulting in decrease in retention. Moreover, as the material is continually exposed to oral fluids, the plasticizers are leached out causing the liner to become hard. This in turn further reduces the protective properties of these mouthguards.
b) The thermoplastic type (boil and bite mouthguards): made from thermoplastic copolymer of polyvinyl acetate-ploy ethylene, immersed in boiling water for about 45 seconds, dipped in cold water for a few seconds and formed in the mouth by using finger, tongue, and biting pressure.
Woodmansey, 1999, added that because these mouth guards are formed at near-body temperatures, it has been reported that they can readily distort and wear through. Moreover, these mouthguards often lack proper thicknesses and extensions. So, they do not cover the needed area with the appropriate thickness on the posterior teeth leading to lesser protection and retention. Moreover, athletes usually try to alter thicknesses and extensions to get more comfort that further reduces the required retention and protection. In one reported incident in Australia, a boil-and-bite mouth guard dislodged from the teeth and impacted in an athlete’s oropharynx.
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Mouth Formed Mouthguard
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Tawfik and Moselhy, 2001, as many other researchers all over the world found that Custom Mouthguards are still superior to the Stock and Mouth Formed Mouthguards because they have a better fit and retention, thickness, comfort, life span and ease of breathing and talking.
For about 17 years of experience dealing with athletes and athletic injuries, I found that Stock and Mouth Formed Mouthguards do not provide the expected comfort and injury protection that Custom Made Mouthguards do. Additionally, most of the athletic community believe that mouthguards are uncomfortable, unretentive, bulky, interfere with talking and breathing and introduce gagging simply because most mouthguards worn are of the Stock and Mouth Formed Mouthguards and the majority of athletes do not wear Custom Made Mouthguards provided by the dentist.
So, as a sports dentist, I do not recommend both Stock and Mouth Formed Mouthguards to my patients and athletic teams.
III. Custom Made Mouthguards:
As they are made by the dentist, they are the most expensive, but are the best from the standpoint of fit, retention, comfort, and ease of speech. This type is fabricated on a cast of athlete maxillary dentition and surrounding tissues. Before fabrication of the Custom Made Mouthguard, your dentist will address medical and dental history, conduct thorough oral and para-oral examination and may conduct other investigations as taking necessary x-rays. Many factors should be considered before the Custom Mouthguard fabrication because they may affect the mouthguard fabrication technique and design. These may include general and personal factors as:
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Type of sport and level of competition being played.
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Position of the player e.g. goalkeeper, wing, …etc. Moreover, famous athletes usually are more vulnerable to sports injuries due to intentional or unintentional tough play of opponents.
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Previous history of dento-facial injuries or concussion thus needing additional protection in any specific area.
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Age of the athlete as young athletes at the mixed dentition period (approximately 6-12 years old) should be supplied with mouthguard that provide adequate space for the developing jaw and the erupting teeth or sometimes mouthguard replacement.
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Sex of the athlete as females practicing sports are less prone to vigorous injuries than males. Additionally, females usually like some feminine touches added to their mouthguards.
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Type of occlusion as some athletes close their teeth in a way that need the fabrication of mouthguard on their lower jaw instead of the upper jaw or even the fabrication of what is called Bimaxillary Mouthguard on both jaws.
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Athletes who are under orthodontic treatment need special technique for mouthguard fabrication and recurrent replacements primary to protect their teeth and soft tissues (e.g. lips and cheek) from laceration or abrasions by either the orthodontic bands and/or wires and secondary to protect the orthodontic treatment itself.
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Athletes presented with cavities, impacted teeth as canines, missing teeth and/or removable or fixed prosthesis would have special professional attention.
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Mouthguard colors should be picked in harmony with the athletes complexion, colors of his/her hair and eyes …etc. Moreover, it may carry names, team logo or country flag.
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Athletes’ desires as some sportsmen like some colors that emotionally affect their performance or their opponents’ performance.
These are some important factors that only the well-experienced sports dentist would consider before fabrication of Custom Made Mouthguard to any athlete.