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Mouthguards Part 2

Mouthguards:  Helping to prevent dental trauma during 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 advise on the advantages of prevention & the options available to you.

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.

Ideal characteristics of a mouthguard

  • Protective
  • Comfortable
  • Resilient
  • Tear resistant
  • Odourless
  • Tasteless
  • Inexpensive
  • Easy to fabricate
  • No interference with speech/performance

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
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

Type 2 :Mouth Formed (Boil and Bite)
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

Type 3: Custom-made Mouthguard which includes the single and multi-layered
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.

 

Type Material Fabrication Advantages Disadvantages
STOCK Polyvinyl chloride  (PVC) none
  • Inexpensive

 

  • Poor fit, limited protection
MOUTH FORMED (BOIL & BITE) Rigid outer layer, soft resilient inner thermoplastic layer Moulded in mouth following heating
  • Inexpensive
  • Bulky
  • Poor fit & retention
  • Clench to hold in situ (Chapman 96)
  • Bite through reduces effectiveness Park 94)
CUSTOM MADE SINGLE LAYER Ethylene vinyl acetate (EVA) 

Polyvinyl-acetate-ethylene copolymer

Alginate maxillary impression 

Vacuum fabricated from model of maxillary arch

  • Improved fit & retention
  • 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!)
 
CUSTOM LAYER LAMINATED Ethylene vinyl acetate (EVA) 

Polyvinyl-acetate-ethylene copolymer

 

Intermediate resin layer or space (Takeda 96)

Alginate maxillary impression 

High temp & pressure layering of materials on maxillary arch model

  • 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!)
 

 

 

 

 

 

 

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’d like further advice  please call us on 01-6684357 or email:  reception@burlingtondentalclinic.com

 

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