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Sporting Injuries

Aug. 1, 1999
Millions of people participate in sports to improve their health and physical fitness. With participation comes the possibility of orofacial injury. These injuries may be as simple as a laceration or abrasion to the gingiva, lips, and tongue. Or, they may be as complex as luxations and avulsions of the teeth and mandibular and maxillary fractures.

Educating patients about custom mouthguards is a key to preventing injury.

Margaret J. Padilla, RDH, and

Ray R. Padilla, DDS

Millions of people participate in sports to improve their health and physical fitness. With participation comes the possibility of orofacial injury. These injuries may be as simple as a laceration or abrasion to the gingiva, lips, and tongue. Or, they may be as complex as luxations and avulsions of the teeth and mandibular and maxillary fractures.

The National Youth Sports Safety Foundation, Inc. (NYSSF) reports that every child or athlete involved in a contact sport has about a 10 percent chance per season of an orofacial injury, or a 33 to 56 percent chance during an athletic career. Also, an athlete is 60 times more likely to sustain damage to the teeth when not wearing a protective mouthguard. Flanders reported in the Journal of the American Dental Association that in basketball, 34 percent of the injuries sustained were orofacial. One-third of all dental trauma in contact team sports occur at the junior- and senior-high-school level.

Dental injuries are unique in that they are lifelong. When someone breaks an arm or leg, the bones heal. When someone breaks a tooth, it does not heal and requires a lifetime of repairs, replacement, and management.

Dental team members, especially the dental hygienist and dentist, has the unique opportunity to help prevent these injuries. The hygienist, while discussing brushing, flossing, sealants, micro dentistry, fluorides, and other preventive dentistry modalities, now can include custom-made athletic mouthguards in the discussion. They can explain to the patients and parents of young athletes the differences in mouthguards, especially the vast discrepancies between store-bought mouthguards and custom mouthguards provided by the dentist.

Both children and adults are candidates for mouthguards. Sports such as football, basketball, rugby, soccer, martial arts, bicycling, skiing, skateboarding, rollerblading, hockey, baseball, volleyball, lacrosse, and racquetball are but a few of the sports where an orofacial injury is likely to occur. Currently, over 90 percent of our patients are seeking their dentistry at sporting goods stores. Why? Most are unaware that they may obtain custom mouthguards from their dentist.

Three types of mouthguards.

Stock mouthguards are available at most sporting goods stores. They come in limited sizes (usually small, medium, and large) and are the least expensive and least protective. These mouthguards are ready to be used without any further preparation; simply remove from the package and immediately place in the mouth. There is no attempt for a proper fit. They are bulky and lack retention. They are held in place by constantly biting down. This interferes with speech and breathing. The stock mouthguard is the least acceptable and least protective.

Boil and bite mouthguards currently are the most commonly used. Made from thermoplastic material, these over-the-counter mouthguards are immersed in boiling water and formed in the mouth by using finger, tongue, and biting pressure. Available in limited sizes, these mouthguards also lack proper extensions and do not cover all the posterior teeth. They also have a poor fit, poor retention, and gagging effects.

Custom made mouthguards are supplied by the dental office. Custom mouthguards provide the dentist and hygienist with the critical ability to address several important issues in designing and fitting the mouthguard. These questions include those addressed at the pre-season screening and dental examination. Is the mouthguard designed for the particular sport being played? Is the age of the athlete and the possibility of providing space for erupting teeth in mixed dentition (ages 6-12) going to affect the mouthguard? Will the design of the mouthguard be appropriate for the level of competition being played? Does the patient have any history of previous dental injury or concussion, thus needing additional protection in any specific area? Is the athlete undergoing orthodontic treatment? Does the patient present with cavities and/or missing teeth? These are important questions that the sporting goods retailer cannot begin to address.

Custom mouthguards designed by the dentist fulfill all the criteria for adaptation, retention, comfort, and stability of material. They interfere the least with speaking and breathing.

The two types of custom mouthguards are vacuum and pressure laminated.

Vacuum mouthguards are made from a stone cast of the mouth, usually of the maxillary arch, using an impression fabricated in the dental office. The thermoplastic mouthguard material is adapted over the cast with a special vacuum machine. These mouthguards are superior to the boil and bite mouthguards because they have a better fit.

Pressure-laminated mouthguards also are made from a stone cast of the maxillary arch using an impression fabricated in the dental office. Recognized as the best fitting and most comfortable mouthguard available, it has multiple layers and is fabricated by a special, pressure-laminated machine. It is modified for full-contact sports by laminating two or three layers of mouthguard material to achieve the necessary thickness. Lamination is defined as the layering of mouthguard material to achieve a defined end result and thickness under a high heat and pressure environment with machines such as the Drufomat4, the Erkopress5, or the Biostar6.

Dr. Keith Hunter says the advantages of pressure laminated mouthguards are: precise adaptation, negligible deformation when worn for a period of time, and the ability to thicken any area as required.

Vast amounts of promotional pamphlets and videos may be acquired through dental laboratories and dental associations. State dental associations in California, Ohio, and Washington supply videos for patient education. Qualified dental laboratories, such as Glidewell, Space Maintainers, and Sportguard provide patient-education materials.

As a hygienist, you can help prevent horrendous dental injuries by simply educating your patients. This will enable them to make an informed decision about where to obtain protection for their mouths. Over-the-counter mouthguards do not offer the same advantages as professionally made, custom mouthguards provided by the dental office. The fit and comfort of the custom mouthguard will allow the athlete to be compliant. Mouthguards provide protection only if they fit properly, are comfortable, and are worn.

Remind the patients that the cost of replacing a tooth or treating an injury far exceeds the cost of a mouthguard. Replacing a single tooth with an implant or a bridge may run into thousands of dollars, especially when considering that the appliances will need to be replaced several times during the life of the patient. The best way to treat trauma is to avoid it.

By acknowledging the substantial differences in mouthguards, the hygienist can make a difference in educating patients and preventing injuries. We can now look seriously at providing a higher level of care and protection for our patients, advising our patients to not seek dentistry from a sporting-goods store.

Margaret J. Padilla, RDH, and Ray R. Padilla, DDS, practice in West Covina, Calif.


* NYSSF Dental Injury Fact Sheet, NYSSF, Boston, Mass. 1993

* Flanders, The Incidence of Orofacial Injuries in Sports, A Pilot Study in Illinois, JADA, Vol.126, April 1995

* Sane, Yipaavalniemi, Dental Trauma in Contact Team Sport, Endod Dent Tramatol, 1998;4:164-9

* Hunter, K, Modern Mouthguards, Dental Health and Research Foundation, Australia, Vol. 15, No.3, Sept. 1989.

* California Dental Association, Sacramento, California

* The Illinois Department of Public Health OProject MouthguardO Chicago, Ill.

* Washington State Dental Association OMouthguard - In Your face,O Seattle, Wash.

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Click here to enlarge image

Various types of mouthguards

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Note the small size of the properly fitted custom-made mouthguard worn by the child on the first page of this article. No over-the-counter mouthguard would comfortably fit this child.