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.