VOLUME IV TTheThehe PPracticePracticeractice BBuildingBuildinguilding BBULLETINBULLETINULLETIN ISSUE V

ATHLETIC MOUTHGUARDS

sense of protection.4 So, if you 3.Fill the space of missing teeth. are still advising your patients to 4.Help prevent neurological injury purchase boil and bite and stock by separating the condyles from mouthguards, it is time to re- the base of the skull during evaluate your position. impact, reducing intracranial pressure and bone deformation 5.Help prevent neck injury 6.Prevent opposing teeth from » PRACTICE POTENTIAL: coming in violent contact, reducing the risk of tooth fracture Picture falling off your bike and and supporting structures. breaking a tooth or receiving a blow 7.Provide support to the mandible to the mouth while playing basket- by absorbing the forces of ball. Now imagine taking in a deep impact. breath of cold air or having a sip of water. Even if you have never per- 8.Provide the athlete with the sonally experienced the pain that confi dence that they are less comes from an accident like this, likely to sustain injuries, thus just seeing the results of this type of giving them the competitive edge trauma can send chills down your for aggressive competition. spine. Every patient in your practice who There are four basic types of It is estimated by the National Youth is involved in any athletic activity mouthguards: Sports Foundation that more than where contact can be made or a fall fi ve million teeth will be knocked can occur should be using a dentist out in sporting activities this year.1 prescribed, heat/pressure laminated In fact, dental injuries are the most intraoral mouthguard. Wearing this common type of orofacial injury type of custom mouthguard not only sustained during participation in protects the teeth and soft tissues, sports.2 but will also reduce the potentially dangerous forces that may cause head concussions, neck injuries, Fortunately, many of these injuries 5 can be prevented. The American and jaw fractures. Dental Association has reported that faceguards and mouthguards » DESCRIPTION 1.Stock Mouthguards: These are annally prevent more than 200,000 an over the counter product that can orofacial injuries in football alone.3 The functions of a mouthguard usually be purchased at sporting according to Andreasen and Stevens goods stores. These mouthguards in their 1981 study are as follows. A require no alterations. Just open While it clearly makes good sense 6 to wear a mouthguard when playing properly made mouthguard must: the package and place the guard a sport, the most recent research directly in your mouth. This type 1.Hold the soft tissues of the lips offers the least amount of protection idicates that not all mouthguards and cheeks away from the teeth, are equal. In 1993 at the First as there is no retention and can so that lacerations and contusions only be held in place by constantly International Symposium on Dental of the soft tissue during impact Biomaterial, Dr. J. Park stated that biting into it. At impact it usually can be avoided. becomes dislodged because of its dentists should not recommend 2.Cushion the anterior teeth and the store bought boil and bite poor fi t. Speaking is also diffi cult redistribute the forces from a di- because of the lack of retention mouthguards as they are inadequate rect frontal blow. and provide the athlete with a false and added bulk. Again the stock TheThe PracticePractice BBuildinguilding BULLETINBULLETIN

In July 1995, the Courier Mail, the “mouthguard” should never national newspaper of Brisbane, It has also been shown that although be recommended by the Australia highlighted a life these mouthguards fi t well at their health professional. threatening incident where a 17 initial insertion, after several weeks year old had his boil and bite of use in an athlete’s mouth, they 2.Boil and Bite mouthguard lodged in his can become loose. This is believed Mouthguards: oropharynx due to poor fi t to occur because the material used These are the and retention. The athlete to make these low heat vacuum most prevalent collapsed and had to be machined mouthguards retains mouthguards taken to the hospital. some memory of its original shape. used today. This mouthguard is also Just like the stock mouthguard, the Therefore, before diagnosing and purchased over the boil and bite mouthguard should promoting this type of mouthguard counter at sporting not be recommended by the health the health professional must be goods stores. The manufacturers professional. aware of its inherent decrease in have designed these mouthguards thickness and the fact that in time, to be thermoplastic at a low 3. Vacuum Custom Built the mouthguard may not maintain temperature so they can be molded Mouthguard: This mouth- a proper fi t. Any vacuum directly in the athlete’s mouth. guard has in the past, been mouthguard, provided by promoted by the the dentist, must be closely literature and accepted monitored for fi t, occlusal by the health profession thickness, and retention as as the best available they may not provide proper mouthguard. Using a single protection for prolonged sheet of polyvinylacetate- periods of time. polyethylene copolymer material and the same type of vacuum 4.Heat/Pressure Laminated forming machine that is used to Thermoformed Mouthguards: To do this, the wearer must fi rst make bleaching trays, a mouthguard place the appliance in boiling can be formed to fi t either the upper water and then allow it to reach a or the lower arch. This procedure temperature that can be tolerated in is done under low heat and one the mouth. Then it is molded using atmosphere of vacuum. the patient’s fi ngers, tongue and biting pressure. Unfortunately, this lower temperature also allows the boil and bite mouthguard to distort at normal body temperatures This type of mouth guard is con- According to a study by Park, since structed from upper and lower casts the athlete is asked to bite down of the patient’s teeth. The material during the forming procedure, the used is an ethylvinyl acetate that has thickness of the material between a Shore Hardness of 80 with mini- the teeth can decrease from 70% Unfortunately, vacuum processing mal shrinkage or water absorption to 99%. This makes it inadequate can pull the mouthguard material after its fabrication. These mouth- to protect the athlete against an away form the incisal edges of the guards are laminated with a special impact to the mandible. The athlete upper front teeth, which is just the machine, under high heat and high is usually unaware of a continuing area where athletes are most often pressure. Some of the benefi ts of decrease in the occlusal thickness injured. In the same 1993 study by making a mouthguard with this type as they continue to wear the Park, he noted that vacuum custom of technique are: mouthguard during the competition made mouthguards also decreased thus providing the athlete with a in thickness during forming as • The mouthguards will have false sense of protection. Unless much as 25% occlusally (much less excellent tooth and tissue dramatic improvements are made in than the 70-99% noted with the boil adaption these products, they should not be and bite) and 50% buccally and • There will be negligible promoted to the athletes as they are lingually. Because of this thinning, deformation of the guard even now. there appears to be no way to insure after it has been worn for a proper occlusal, palatal, or labial prolonged periods of time. thickness. TheThe PracticePractice BBuildinguilding BULLETINBULLETIN

The INTACT The INTACT Professional Martial Arts The Youth Mouthguard and Adult Mouthguard Mouthguards multi layered three are both multi- ethyl vinyl laminated laminated with layers a difference in acetate their thickness. with a hard polycarbonate insert for added protection

» APPLIANCE DESIGNS: • An area can be thickened as needed • The experience and level of play because of the laminating ability The key to successful mouth guard of the participant. of the high heat/high pressure therapy is to make one that will be • The age of the athlete machine. worn! Therefore, it must fi t the • The athletes dental health (i.e. • The ability to customize the athletes mouth and teeth accurately, tooth mobility, caries, orthodon- mouthguard for each sport, age, stay in place comfortably and tic treatment) and level of competition, ortho- allow the wearer to breath and talk dontics, mixed dentition, clefts, normally. • The patients dental anatomy (i.e. missing teeth, and anatomical and skeletal relationship, stage of occlusal variations. Tear strength, tensile strength, dentition) • The ability to insert a hard modulus of elasticity and drop ball impact are just some of the material Space Maintainers Intact All Sports polycarbonate layer between Mouthguards have four different soft ethyl vinyl acetate materials tests that researchers have been doing to fi nd the ideal mouthguard designs which are based on the for additional protection for parameters specifi ed above. high velocity impact sports such material. Based on these tests, the ideal material should: as hockey, football, or racquet 1.The Intact Youth Mouthguard sports. 1.Be subject to high compressive Recommended for athletes • Achieving a constant occlusal strength who are in primary and mixed separation while maintaining the dentition. Given all the pertinent proper occlusal balance necessary 2.Be thick enough to absorb the information (i.e. sequence of for concussion prevention energy of an impact exfoliation, type of orthodontic • There is no interference with 3.Be able to dissipate the energy of movement being accomplished) breathing or speech a blow throughout the material the mouthguard can be modifi ed rather than allowing it to transfer to allow for these changes. • The ability to individually design to the underlying teeth. the guards to meet the specifi ca- Because children’s arches con- tions of the treating dentist. 4.Be durable enough to eliminate tinue to change, it is necessary any physical changes that might to have a guard that will provide Recent published studies and papers occur under normal use an adequate amount of retention are showing that the multi-laminate and protection yet be inexpensive mouthguards are now considered The actual performance of the enough to be replaced throughout the mouthguard of choice for mouthguard in vivo not only growth. This guard is usually 3-4 the ultimate in orofacial athletic depends on the material properties, mm in thickness. protection. but also on design parameters such 2.The Intact Adult Mouthguard as the number and type of layers and Recommended for the majority By acknowledging that there are its fi nal thickness after fabrication. of athletes with an adult dentition substantial differences in mouth Selecting the proper design for your involved in recreational sports. guard types and designs, we, as patient will depend on: This mouthguard is made to last. health care professionals, can se- It is composed of 2-3 laminated riously look at providing a much • The type of sport being played sheets making it thicker (approx. higher level of protection and stan- • The type of sporting equipment 5mm.) and stronger than the dard of care for athletes. used. Youth. TheThe PracticePractice BBuildinguilding BULLETINBULLETIN

3.The Intact Professional Mouth- The National Youth Sports Foun- 3.Take alginate impressions of the guard: This guard is recommended dation for Safety reported that upper and lower arch making sure for professional athletes, and for dental injuries are the most com- to record the vestibular and palatal anyone involved in a sport where mon type of orofacial injury sustained extensions completely. hard impacts to the face and jaw during participation sports. In 1995, 4.Pour the impressions in a hard are to be expected. Some exam- Flanders and Mohandas stated, in stone, and check them for accuracy. ples are hockey, football, rugby the Journal of the American Dental and most racquet sports. These Association that the orofacial in- 5.Take an accurate bite registration at guards are multi-layered with a jury rate was only .07% in football the desired horizontal and vertical thin polycarbonate insert on the where faceguards and mouthguards relationship. The mouthguard will labial and buccal surfaces of the are worn. However, in basketball, be made to reproduce this rela- teeth. This extra protection is also where mouthguards are not tionship allowing you to achieve a needed for anyone who has a his- normally worn there was an oro- constant occlusal separation while tory of trauma facial injury rate of 34%. maintaining the proper occlusal balance necessary for concussion 4.The Intact Martial Arts Mouth- prevention. guard: This guard is recommended A report in Pediatric Dentistry for anyone involved in any of the magazine clearly indicated the 6.Carefully wrap up the models martial arts or boxing. Because importance of wearing mouthguards. and bite relationship separately these athletes often receive strong Interviews involving 2,470 junior and send them along with your impacts to the face and jaw, a and senior high school athletes specifi c design instructions to the mouthguard must protect not only receiving injury during sports laboratory. their teeth but also their temporo- revealed the following: Nine 7.Based on your instructions, the mandibular joint. With that pur- percent of all players suffered from laboratory can customize the pose in mind, the Martial Arts some form of oral injury while mouthguard for each sport, the guard is composed of three lami- another three percent reported loss age of the athlete, and the level of of consciousness. Seventy-fi ve nated layers to give these athletes the competition. the added protection they need. percent of the injuries occurred while not wearing mouthguards, and 8.The laboratory can also modify 5.The Professional Boxer’s Mouth- of this total forty percent occurred the mouthguard to take into guard: This guard is ideal for any during baseball and basketball. consideration active orthodontic athlete where intentional contact Fifty-six percent of all concussions treatment, a changing mixed to the head or face is involved. It were suffered while not wearing dentition, existing clefts, missing is also recommended for any ath- mouthguards. teeth, and any anatomical and lete with a prior history of multiple occlusal variations. concussions, mandibular trauma Mouthguards may help prevent 9.Mouthguards should be monitored and temporomandibular dysfunc- concussions, cerebral hemorrhage, tion. It is fabricated using two and replaced when necessary. and possibly death, by separating the Extra care should be taken during separate mouthguards laminated jaws, thus preventing the condyles together at the mandibular rela- the mixed dentition stage. During from being displaced upward and this time the mouthguards should tion provided by your properly backward against the wall of the taken construction bite be replaced every six months. glenoid fossa. Due to the diversity of During orthodontic therapy, close sports that can produce oral trauma, All Intact mouthguards are fi nished communication should be kept it is recommended that mouthguards with the orthodontist to establish on articulated models to a balanced be worn by all participants. Some occlusion creating the best protection a time sequence for mouthguard examples are baseball, basketball, replacement. for the joint and dentition. boxing, rugby, hockey, squash, soccer, racquetball, tennis, lacrosse, 10.Upon delivery discuss how » INDICATIONS: karate, judo, volleyball, touch and to wear, clean, and store the contact football, bicycling, and appliance. A 1984 study by Davis and Knott skating. in Australia, showed that over 80% » LAB REQUIREMENTS: of all dental injuries from sports » TREATMENT PROCEDURES: occurred to the front four maxillary 1.A set of accurate working models teeth. It has been estimated that the 1.Ask your patient if he or she is in- with full buccal vestibular exten- total rehabilitation costs for a single volved in any sports. sions and palate poured in dental knocked out tooth are more than stone along with an accurate bite twenty times the preventative cost 2.Discuss the need for using a registration. for a custom laminated professional mouthguard. grade mouthguard. TheThe PracticePractice BBuildinguilding BULLETINBULLETIN

2.A prescription (see sample) » CARE FOR THE APPLIANCE: 7.Special care needs to be taken including the type of mouthguard when designing mouthguards for desired. Indicate color/s, sport to The patient should be instructed in the edentulous patient. Please be played, level of competition, the proper care of the mouthguard. consult with the lab for further age of athlete, and any special If it is exposed to heat or pressure information. instructions. For example, if it may permanently deform. This 8.Third molars – the most frequent the patient has a history of may occur if the mouthguard is site of mandibular fracture is concussion; maintain occlusal squashed in the bottom of a player’s in the area of unerupted third thickness of 4mm. sports bag, left in a hot car, or out in molars. Each athlete should have direct sunlight. his or her third molars evaluated » LAB FEE: for possible extraction. The mouthguard should be kept The lab fees for the four Intact All moist allowing it to maintain its 9.Erupting teeth – the area of tooth Sports Mouthguards are: fl exibility and resilience. After use, eruption should be blocked out on the dental model to allow a guard 1. The Intact Youth...... $59.75 the mouthguard should be cleaned with an appliance system using to be made which will allow for 2. The Intact Adult...... $86.65 retainer Brite® and a sonic cleaner its normal eruption. 3. The Intact Professional....$95.75 (both available from Success 10.Orthodontics – mouthguards 4. The Intact Martial Arts..$107.65 Essentials – see supply list). should be modifi ed to allow for the 5. The Intact Pro Boxer.....$167.50 anticipated changes over a three » CONTRA-INDICATIONS month period. Patients in fi xed AND CONCERNS: appliances should be wearing » SUPPLY LIST: either an upper mouthguard Alginate* 1.Mouthguards are most commonly and a lower bleaching tray or Mixing bowl and spatula* made for the maxillary arch. For a bimaxillary mouthguard to Water the athlete with a prognathic prevent the possibility of severe Dental Stone mandible, it is recommended that soft tissue trauma. Impression Trays* a custom mouthguard be made to 11.At this point it is impossible to Per-Fect Bites* cover the mandibular arch. properly increase the thickness Retainer Brite* 2.Prior to receiving a mouthguard, of the mouthguard through Sonic Appliance Cleaner* a complete oral exam should lamination or thermo-forming Patient Appliance Care CD* be completed to insure that the with a simple “in offi ce” vacuum Patient Calendar Booklets* patient is in good health. machine. Colored Retainer Cases* Carbide Burs* 3.All new or recurrent caries should be treated prior to the fabrication » CUSTOMARY FEE RANGE: *Available from Success Essentials of a mouthguard. The decay call 800.423.3270 process could be accelerated if the The customary fee range for mouthguard is worn over carious these appliances is $150 - $300 » ADJUSTMENT TIPS: lesions. per arch depending on the type of mouthguard delivered. These 4.New restorations placed after the During the seat and adjustment fees can be kept low to encourage mouthguard is delivered could mouthguard use and because of the appointment, make sure affect the fi t of the guard. the occlusion is balanced powerful practice building potential and all teeth are hitting 5.It may be necessary to of offering this service. simultaneously. Check that block out any undercuts in the proper occlusal thickness an area where there is a Remember to mention to your is present and the athlete is fi xed prosthesis (posterior patient – it has been estimated that comfortable with the bridge) the total rehabilitation costs for a fi t. The mouthguard single knocked out tooth are more 6.Removable than twenty times the preventative should be diffi cult prosthodontic devices to remove once it cost for a custom laminated (appliances) should professional grade mouthguard. is seated properly. be removed prior to Check the patient’s taking impressions INCOME POTENTIAL: speech while the for the mouthguard. » mouthguard is The patient must be in place. If it is Many doctors make mouthguards instructed to remove for their patients at or below cost necessary, reduce these appliances the palate to allow for because of their effectiveness as a while wearing the marketing tool. Promoting mouth- better speech. mouthguard. TheThe PracticePractice BBuildinguilding BULLETINBULLETIN guard care is one of the best ways to • A complete orthodontic evaluation 15.Stenger J.M., Mouthguards: Protection Against Shock to Head Neck and Teeth, JADA 1964, attract new patients and build your which can provide you with the 69:273-281. practice. Some effective marketing opportunity to do minor treatment 16.Lee-Knight, C.T.:Protective Mouthguards in ideas I have heard while lecturing i.e. retract protruding upper Sports Injuries, Journal of Canadian Dental Asso- around the country are: anteriors. ciation, Vol. 57, No. 1, pp3941, Jan 1991. • Their third molars evaluated for 1.Offer this service to local gyms possible extraction, since the INTACT ALL SPORTS and sports clubs. most frequent site of mandibular MOUTHGUARD MANUAL 2.Become a school dentist. fracture is in the area of the 3.Give talks to community service unerupted or impacted third The SMILE Foundation, the edu- clubs i.e. P.T.A., Rotary, etc. molars. cational member of the Appliance Therapy Group, has available for 4.Make the service available to the Just one mouthguard per week purchase an independent learning neighborhood sports teams i.e. at $150 each equals $7,800 in course on Mouthguards, Winning soccer, Little League, Youth Foot- additional gross revenue for your with Customized Mouthguards. To ball. practice. order, please call 800-423-3270. 5.Contact businesses such as martial Also available are reception area arts studios, gymnastic schools, By: Rob Veis D.D.S. pamphlets with rack, prescription sporting goods stores and bike Director of Practice Development slips and shipping supplies. shops. Cooperative coupons and fl yers can be used to promote your » REFERENCES: Steps you need to take to add this mouthguard service and the local service to your practice: business. 1.Dental Injury Fact Sheet, National Youth Sports 6.You might want to supply a Foundation for the Prevention of Athletic Injury, 1.Make sure you have the supplies personalized tooth brush (with Inc., Needham, Massachusetts, 1992. you need (see supply list). practice name and phone number) 2.Flanders, Raymond A. DDS, Mohandas Bhat, DDS, The Incidence of Orofacial Injuries in 2.Obtain an Intact Mouthguard Man- and a small carrying bag with ual Kit (see above). each mouthguard. Sports, A Pilot Study In Illinos, JADA Vol. 126, April 1995;p.491-6. 3.Display poster and patient bro- 7.Become a sports dentist and be 3.American Dental Association, Council on Dental chures in your reception area. added to the Space Maintainers Materials, Mouth Protectors and Sports Team Laboratory referral list for athletic Dentists. JADA 1984; 109:84-7. 4.Begin routinely asking patients 4.Park et al, Methods of Improved Mouthguards, what sports they play. trainers and coaches in your area First International Symposium on Biomaterials, – call us for details. Taejon, Korea, August, 1993. 5.Optional – join the Academy for 5.Chapman, P.J.:Mouthguards and the role of Sport- Sports Dentistry (details on how to ing Team Dentists, Australian Dental Journal, Vol. join will come with your manual). All Space Maintainers Laboratory 34, No.1, p36-43, 1989 Intact Mouthguard clients are placed 6.Stevens 0.0.In:Andreasen Jo, ed., Traumatic Inju- The Practice Building Bulletin is a special in our exclusive national network ries to the Teeth, Copenhagen: Mustgaard 1981: service of Space Maintainers Laboratory pro- of sports dentists. As inquiries p.442 duced solely for the private use of our clients. are obtained from our extensive 7.Padilla R, Dorney B, Balikov S, Mouthguards; It is designed to help expand and enhance your advertising to coaches, athletic Prevention of Oral Injuries, California Dental As- ability to provide comprehensive patient care. sociation Journal, March, 1996, pp 30-36. Information included is the opinion of the au- trainers, and sports organizations, thor and may not be reproduced in any form they are then referred to the Intact 8.Padilla R, Balikov S, Sports Dentistry Coming of Age in the 90’s, California Dental Associate Jour- without written consent. Sports Dentist in their area. nal, April 1993, p 27-34 Appliance Therapy Group Headquarters: 9.Craig, Goodwin, Physical Properties of Materials Space Maintainers Laboratory Offering mouth protection to your for Custom Made Mouth Protectors, J. of Mich. P.O. Box 4184, Van Nuys, CA 91409-4184 patients will open up many treat- State Dental Assoc., 1967, No. 49, pp34-40. Copyright © 2005 ment opportunities for you. Every 10.Davis G T and Knott S C Dental Trauma in Aus- www.appliancetherapygroup.com tralia, Australian Dental Journal, August 1984. patient who needs a mouthguard Regional Labs: should have: Vol. 29, No. 4, pp 217-231 11.McNutt T., Oral Trauma in Adolescent Athletes, Southwest 800-423-3270 • A comprehensive dental Pediatric Dentistry, Vol. 11, No. 3, PP209, Sept Northwest: 800-423-6509 1989. examination Northeast 866-310-5800 12.McCarthy, M: Sports and Mouth Protection, Gen- • Their periodontal status evaluated eral Dentistry, Vol. 38, No. 5, p343-346, Sept/Oct. Midwest: 800-325-8921 for pericoronitis, periodontitis or 1990. CANADA 800-661-1169 gingivitis. 13.Hunter, Keith DDS, Practical Tips, Dental AUSTRALIA 03-9521-0299 Outlook, Volume 15, No.3, September 1988, • All caries and restorative work Australia. MALAYSIA 03-6251-8599 completed. 14.Chapman P J, Nasser B P Attitudes to Mouthguards TAIWAN 886-7-235-5612 and Prevalence of Orofacial Injuries in Four Teams Competing at the Second World Cup. British Jour- nal Sports Medicine 1993: 27 (3), pp197-199. TheThe PracticePractice BBuildinguilding BULLETINBULLETIN ORDERING INTACT MOUTHGUARDS Please help us by fi lling each Mouthguard prescription slip out as completely as possible. A few minutes spent here will pay big dividends in better doctor-laboratory communications and save us both time and extra expense. Please be sure to give us the patient’s full name. For a team, one prescription for the entire team is all that is necessary provided all the models are shipped together and a list of individual names is attached. Indicate any design change requirements next to that person’s name on the list (example – an Intact “Professional” for a goalkeeper). It is always a good idea to give us a due date in the space provided on the prescription slip. On occasion, a case will arrive late due to a delay in the mail. When this happens, you will receive a call from our client service staff immediately advising you of the need to reschedule your patient. You can always check on a mouthguard in progress by calling our Client Services people or leave a message on voice mail. Every prescription is entered into our computer system within minutes of its arrival in the lab. Team and quantity discounts are also available, call for details. outhguard SPACE MAINTAINERS ALL-SPORTS MOUTHGUARD MPrescription INTACT MULTI- Dentist’s Name LAMINATE MOUTHGUARD PRESCRIPTION FORM Practice Address City State/Province The Intact Mouthguards Prescrip- tion slip has been designed to Postal Code Country Contact Telephone: ensure all details for laboratory Male Female construction are covered completely Patient Name Age and in an organized manner. While Sport being played Position we will be happy to work from any Level of Competition Olympic prescription you prefer, including Casual School Club Professional the regular Space Maintainers Experience Level Beginner Years of Experience Laboratory appliance form, it will Date Needed help the technician do a better job RX if the Intact form is used when INTACT MOUTHGUARD DETAILS possible. With so many options for style, color, and logo/s, in addition Athlete’s name to be in guard to having the athletes name spelled Patient’s first initial and last name as above correctly and client details for Patient’s given name or nickname warranty purposes, use of the Intact Mouthguards Prescription slip will TYPE OF MOUTHGUARD help ensure nothing is forgotten. YOUTH - primary and mixed dentition PLEASE NOTE: In some sports it ADULT - recreational adult sports is recommended players at high-risk PROFESSIONAL - contact, racquet, and pro sports positions wear Intact Professional Mouthguards regardless of age MARTIAL ARTS - intentional contact to face or participation level (example: a PRO BOXER - prior history of concussions, mandibular trauma, and soccer or hockey goal keeper). For temporomandibular dysfunction a small extra charge ($3.25), your MOUTHGUARD COLOR Clear White Pink Red name and offi ce number can also OrangeBlue Yellow Black Green Purple be placed in the mouthguard as Multi-colored (call for selection) another practice-building feature. When your patients/athletes are LOGO REQUEST (Youth and Adult level only) asked “where did you get the great Football Soccer Baseball Hockey Tennis mouthguard?” Your name and School or team logo enclosed (can’t exceed 1/2” in diameter) number is right on the tip of their tongue. Please include dentist’s name and practice phone as above or as:

Please feel free to photo copy the ($3.25 extra charge for this service) adjacent prescription form for Dentist’s Signature additional copies or better yet, just Referrring Sports Professional call client services for all of the free shipping supplies you need. Athletic Trainer Coach Team Physician The S.M.I.L.E. Foundation Presents Gaining the Competitive Advantage with Comprehensive Care

Winning With Customized Mouthguards An Independent Learning Course Every patient in your practice engaging in an athletic activity, involving possible contact or a fall, should be using dentist prescribed, pressure laminated, intraoral mouthguards. This independent learning course features discussion on all the functions of a properly made mouthguard, detailed description on the different types of mouthguards that are available to the public, details of the benefi ts of the dentist prescribed, pressure laminated mouthguard, information on why it is the dentist’s job and only the dentist’s job to fi t his or her patients with custom-made mouthguards, and much, much more! What We Provide: • A complete full-color Manual of Intact Mouthguards • Professionally recorded DVD • Complete set of easy-to-follow course notes • Chairside and lab-constructed appliance designs • Insurance narratives and billing codes • Patient forms and reception room pamphlets • Self-test for 8 hours of continuing education credit • Marketing strategies for your practice Space Maintainers Laboratory is an ADA CERP Recognized Provider Only $129.50, per course. To Order Call 800-423-3270 or visit www.appliancetherapygroup.com