The Use of Mouthguards - Information for the School Community

Because mouthguards play an important role in providing protection against oro-facial sporting injuries they contribute significantly to safety in sports.

The following information is provided for the consideration of parents and caregivers when choosing a guard for their children.

A mouthguard is a shock absorber for the teeth and jaw. When properly fitted, a mouthguard will protect teeth, stop them biting into the lips and can act as a shock absorbing layer between teeth to reduce concussion and jaw fracture.

There already exists a culture of mouthguard-wearing by young people in contact and non-contact sports in both club and school settings. The NSW Youth Sports Injury Report 1997, published by the Northern Sydney Area Health Service, indicates the following percentage of participants wearing mouthguards: Rugby Union - 82%, Hockey - 64%, Rugby League - 58% and Australian Football - 56%.

With the increased popularity of contact sports and encouragement to participate at an early age, the role of mouthguards in relation to prevention of sporting injuries to dental and other oral tissues has become more important.

Dental injuries are the most common type of facial injury sustained during participation in contact sports. The majority are preventable if a properly fitted mouthguard is worn (Sport Medicine Australia).

Dental injuries often cause significant pain and/or distress at the time of injury. Further, the injury sustained or the traumatic episode itself, may have an adverse psychological effect on a young person's attitude to further sporting participation, social interaction or scholastic achievement. In addition, dental traumatic injuries can be costly to treat initially and there are often restoration costs and longevity considerations over a patient's lifetime.

A mouthguard should be comfortable to wear, have good retention and fit, and cause minimal interference of speech and breathing. These features are more likely in a custom fitted mouthguard.

The capacity of a mouthguard to lessen impact injury (both direct and indirect) depends on the dynamic interaction of the guard's material(s) properties and its design features. In general, mouthguards serve to both 'absorb' impact energy and spread it over a larger surface area.

The protective functions of a properly made and fitted mouthguard are:

• prevention of the tongue, lips and cheeks from being lacerated against the sharp edges of the teeth
• significant lessening of the risk of injury to the anterior teeth following a blow from the front
• lessening of the risk of injury to the posterior teeth of either jaw following a blow from the front
• lessening of the risk of concussion resulting from a heavy blow to the lower jaw.

To date, there are no national or international standards for mouthguard construction or performance, so unfortunately there are some products currently available that do not provide the protection that they are intended for.

There are currently three types of mouthguard which are commercially available. The relative merits of each type is outlined in order for parents and caregivers to choose the correct type of guard.

TYPE I. These are available from pharmacies and sports stores. They are a bulky gutter of rigid plastic and are only available in small, medium or large sizes. They are held in the mouth by a constant biting pressure. They may interfere with speech and breathing and are a potential airway hazard.

TYPE II. These so called “boil and bite” types are readily available at sports stores and pharmacies. They are made of thermo plastic material, which is heated in hot water and then placed in the athlete’s mouth and moulded. Due to their low temperature of formation they may continue to deform. Hence, the thickness between the teeth also continues to decrease lowering the shock-absorbing qualities and increasing risk of concussion.

TYPE III. These are custom made on a plaster mould of the athlete’s teeth. They are a thermoplastic mouthguard being vacuum adapted over the plaster mould. This type offers the greatest form of protection. They provide exact fit, are more tear resistant, provide superior shock absorption and protection of the gums, stay in place comfortably and allow normal breathing and speech.

Mouthguards are used in both contact and non-contact sports ranging from football and basketball to water polo and hockey.

National and state sporting organisations strongly recommend the wearing of properly fitted mouthguards. The NSW Department of Health, Sports Medicine Australia, Australian Dental Association (NSW Branch) and Dental Health Foundation Australia recommend the wearing of custom-made mouthguards for participants involved in training and competition games.