Citizen Article – Mouthguards

It was a typical December evening just a few months ago which brought back some unpleasant memories. It was a blustery, snowy night and I was in prime “male-gender” position: in my recliner, remote in hand, my dog snuggled up between my legs and college basketball on the television. I was watching Syracuse play someone, which team is not important. During one play there was a clash of the titans underneath the basket going for a rebound. One player came out of the pack with the ball and another player came out with a handful of blood and a large chunk of his front tooth in his hand.
Shortly after this my cell phone rang and it was one of our awesome Auburn Memorial Hospital Emergency Room physicians. A JV basketball player in a high school game had trauma to his face and sure enough, his front tooth was knocked out. Thanks to my hospital experiences, treating this patient is no problem for me. Fortunately, the tooth was replanted immediately and the ER doctor finished the repositioning.

I rolled back in my head about 20+ years to my undergraduate days at Siena College. It was an intramural game. At 6’ 5” tall I was the guy that was always sent down low to rebound. I came down with a ball, turned to pass it and smacked right into an elbow from another player. There was nothing malicious about it, just one of those collisions that happened. After a lot of dental work, all is back together (minus three of my own teeth).

After finishing my scary flashback, I thought about the experiences that I have had either during my residency at Strong Memorial Hospital or in my own practice with dental trauma. It’s amazing how much trauma could be prevented just by having a mouthguard in place. When you think of a mouthguard, you think of its function being to protect the teeth. This is true. In fact, studies have shown that a mouthguard will lessen the risk of injury to the front teeth by 90%. The guard will also lessen the risk of damage to the back teeth when the lower jaw is struck and the teeth are bashed together. Let’s consider the rest of the purposes of a mouthguard. It prevents lacerations to the tongue, cheek and lips by preventing a tooth from piercing the tissue. The guard will lower the risk of jaw fractures by absorbing the energy of a traumatic blow to the chin. When the lower jaw is hit from the front or the side there is a huge risk of concussion. The lower jaw is jammed backwards into the skull in this type of trauma and can also cause damage to the joint itself. A mouthguard will absorb and redirect the force of a blow to the lower jaw thus lessening this risk.

The American Society of Testing and Materials has three classifications of mouthguards:

Type 1 is a stock guard. In other words, one size fits all. This is the least fitting, the most bulky and can interfere with speech and breathing.

Type 2 is the mouth formed. There are two styles of this type. The first is a rigid outer with a soft lining that needs to be replaced at each use. The second is the common “boil and bite” style. What many people are not aware of is that these can do more harm than good if not fitted with precision.

Type 3 is a custom fabricated guard. This is made over a cast of the teeth. Impressions are made of the upper and lower teeth then a thermoplastic material is vacuum formed over the cast of the upper teeth for precise fit and comfort. The bite is then adjusted to the lower teeth for an integral fit.

The Type 3 guard is going to give the maximum protection against jaw fracture, concussion and also tooth damage. A traumatic blow to the lower jaw at any angle can have the forces evenly distributed along the mouthguard material and transferred evenly to the upper teeth. If a mouthguard is uneven in the slightest bit the chances of concussion or jaw fracture are greatly elevated. If the lower jaw receives a blow straight on and the bite is uneven then the jaw will be caused to tilt by the mouthguard. The force of the blow will then be accelerated to the uneven side thus causing a transfer of force even greater to the joint. This will more likely result in fracture, concussion, or damage to the joint structures.

When it comes to mouthguards in sports, the choice becomes obvious. Not only the choice of wearing or not but what type. In my years as a dentist I have heard many excuses for why athletes don’t wear mouthguards unless they are mandated. When those excuses are put up against the reasons in favor of wearing a guard such as medical bills, dental bills, time out of school or work, permanent damage to the jaw joint structures or surrounding structures, the excuses pale in favor of the reasons. There is one college basketball player with stitches in his lip and a busted tooth and one dentist in Auburn with three replaced teeth because of not making the right choice. If you play sports, see your dentist and have a proper mouthguard made.