Mouthguards (Updated 2010)

Dr. Bradley Selvan BDS(Wits)

  1. Dental injuries are the most common type of orofacial injury sustained during participation in sports; the majority of these dental injuries are preventable.
  2. A sportsman/woman is 60 times more likely to sustain damage to the teeth when notwearing a protective mouthguard.
  3. The cost of a fractured tooth is many times greater than the cost of a dentist diagnosed and designed professionally made mouthguard.
  4. Every athlete involved in contact sport has about a 10% chance per season of an orofacial injury, or a 33-56% chance during an athletic career.
  5. The cost to replant a tooth and the follow-up dental treatment is about R20 000-R50 000.
  6. Victims of tooth loss tooth who do not have a tooth properly preserved or replanted may face a lifetime of dental costs, hours in the dental chair, and the possible development of other dental problems such as periodontal disease.
  7. The stock mouthguard which is bought at sports stores without any individual fitting, provide only a low level of protection, if any. If the wearer is rendered unconscious, there is a risk that the mouthguard may lodge in the throat potentially causing an airway obstruction.
  8. Types of dental injuries (direct and Indirect) and intrinsic and extrinsic factors:
  9. Direct Trauma for example to the upper top front teeth (four times more common than other teeth) and the mouthguard must be well fitting and thick enough to prevent these injuries.
  10. Indirect Trauma for example under the chin causing damage to the teeth and concussion.
  11. Intrinsic Factors for example teeth position e.g. Class 2 or 3.
  12. Extrinsic Factors for example a hockey ball, fist etc.
  1. Classification of Mouthguards: From worst to best.
  2. Type 1. Stock (Small, Medium and Large)
  3. Type 2. Boil and Bite (Bought from stores and made from thermoplastic materials)
  4. Type 3. Custom, single layer, vacuum. (Types 3 and 4 supplied by the dentist)
  5. Type 4.  A custom fabricated mouthguard formed on models of the users jaws, using multiple layers of plastic adapted under pressure to specific designs.

General design principles

  1. Mixed dentition- to distal of maxillary first molar.
  2. 2-3 mm labially
  3. 3 mm occlusally
  4. 2 mm palatally
  5. Labial flange 2mm from vestibular reflection
  6. Palatal flange 10 mm from gingival margin
  7. Even occlusal contact

For extreme sports the mouthguard should be extended to the distal of the second molars.
Mouthguards are made by pressure lamination at 140 C at 6 atmospheres of pressure with machines like a Drufomat or a Biostar.

Recommendations from Prof. Francois De Wet – Pretoria University

  1. Gr 1-5: 1 x 3 mm sheet
  2. Gr 6-9:  1 x 4 mm sheet
  3. Gr 10-12:  1 x 2 mm sheet  with a 1 x 3 mm sheet over it
  4. Seniors: 1 x 2 mm sheet, then a  layer of sponge, then a 1 x 3 mm sheet over everything
  5. Boxers: Same as seniors. Can increase the thicknesses even more.

Dr. Brett Dorney’s Recommendations (Australian Sports Dentist) for mouthguard designs

  1. Rookie (up to 14 years of old) 3mm +2mm (labial 3mm and occlusal 3mm)
  2. Classic (teenage years) 3mm+3mm (labial 3mm and occlussal 4mm)
  3. Elite 2mm+3mm+3mm with balanced occlussion distal of first molar ( labial 4mm and occlusal 4mm)
  4. Boxer 4mm+3mm extended over all the upper teeth with balanced occlussion (labial 5mm and occlusal 4mm)

I encourage my patients to have proper mouthguards made – one day your properly designed mouthgurad may save their life!

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