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Aim: Custom-made mouthguards have many advantages compared to the stock and ready-made types, but sport treatments with custom made mouthguards involve changes in ecological factors of the oral cavity. In the present study we investigated the potential protective role of salivary factors, such as pH value, volume, prostaglandin E2 (PGE2) and 8-iso-prostaglandin F2? (8-iso-PGF2?) levels during training with customised mouthguards., Materials and Methods: A total of 80 subjects were selected: 40 athletes, of whom 20 practice volleyball and 20 basketball (test group), and 40 subjects who attend a gym at a non-competitive level (control group). The athletes (test group) were analyzed at baseline (T0), pre-training (T1), post-training with custom-made Ethylene-Vinyl-Acetate (EVA) mouthguards (T2), post-training without mouthguards (T3). The control group was analyzed only at baseline (T0). On each player, in the 4 time points, and on the control group at T0, we stimulated saliva for determining PGE2 and 8-iso-PGF2? levels by radioimmunoassay and pH value by a pH meter and volume/ml. Saliva pH was calculated with a pH meter., Results: We observed an inhibition of 8-iso-PGF2? salivary release induced by physical exercise and by use of custom-made mouthguard, while we found an increase in PGE2 salivary level in athletes after training and wearing the mouthguard. Furthermore, in the test of the volume of saliva produced in 5 minutes, a significant inhibition of saliva production emerged in the athletes who did not use the mouthguard during sports activities., Conclusion: Sports activity could lead to a reduction in oxidative stress and the use of mouth guards seems even more effective for athletes.

This is second of a two-part series on the history and effectiveness of mouthguards (MGs) for protection from orofacial injuries. MGs are hypothesized to reduce orofacial injuries by separating the upper and lower dentation, preventing tooth fractures, redistributing and absorbing the force of direct blows to the mouth, and separating teeth from soft tissue which helps prevent lacerations and bruises. The single study on MG use in military training found that when boil-and-bite MGs were required for four training activities, orofacial injury rates were reduced 56% compared with when MGs were required for just one training activity. A recent systematic review on the effectiveness of MGs for prevention of orofacial injuries included 23 studies involving MG users and nonusers and a wide variety of sports. For cohort studies that directly collected injury data, the risk of an orofacial injury was 2.33 times higher among MG nonusers (95% confidence interval, 1.59-3.44). More well-designed studies are needed on the effectiveness of MGs during military training. Despite some methodological limitations, the current data suggest that MGs can substantially reduce the risk of orofacial injuries in sport activities. MGs should be used in activities where there is a significant risk of orofacial injuries., (2020.)

This is the first of a two-part series on the history and effectiveness of mouthguards (MGs) for orofacial injury protection. Military studies have shown that approximately 60% of orofacial injuries are associated with military training activities and 20% to 30% with sports. MGs are hypothesized to reduce orofacial injuries by separating the upper and lower dentation, preventing tooth fractures, redistributing and absorbing the force of direct blows to the mouth, and separating teeth from soft tissue, preventing lacerations and bruises. In 1975, CPT Leonard Barber was the first to advocate MGs for military sports activities. In 1998, Army health promotion campaigns promoted MG education and fabrication. A US Army basic training study in 2000-2003 showed that more MG use could reduce orofacial injuries and the Army Training and Doctrine Command subsequently required that basic trainees be issued and use MGs. Army Regulation 600-63 currently directs commanders to enforce MG use during training and sports activities that could involve orofacial injuries. In the civilian sector, MGs were first used by boxers and then were required for football. MGs are currently required nationally for high school and college football, field hockey, ice hockey, and lacrosse, and are recommended for 29 sport and exercise activities., (2020.)

Background: Sport activities can account for up to one-third of all orofacial injuries. Mouthguards (MGs) have been proposed as a way to reduce these injuries., Objectives: To present a systematic review and meta-analysis of the effectiveness of MGs for the prevention of sports-related orofacial injuries and concussions., Methods: Using specific search terms, PubMed, Ovid Embase, and the Cumulative Index to Nursing and Allied Health Literature were searched to find studies that (1) contained original quantitative data on MGs and orofacial injuries and/or concussions, (2) included groups involved in sports or exercise activities, (3) included MG users and non-MG users, and (4) provided either risk ratios (RRs) and 95% confidence intervals (95% CIs) comparing injuries among MG users and non-MG users, or data that could be used to calculate RRs and 95% CIs., Results: Twenty-six studies met the review criteria. Investigations employed a variety of study designs, utilized different types of MGs, used widely varying injury case definitions, and had multiple methodological weaknesses. Despite these limitations, meta-analyses indicated that the use of MGs reduced the overall risk of orofacial injuries in 12 cohort trials (summary RR [nonusers/users] = 2.33, 95% CI 1.59-3.44), and 11 trials involving self-report questionnaires (summary RR [nonusers/users] = 2.32, 95% CI 1.04-5.13). The influence of MGs on concussion incidence in five cohort studies was modest (summary RR [nonusers/users] = 1.25, 95% CI 0.90-1.74)., Conclusion: These data indicate that MGs should be used in sports activities where there is significant orofacial injury risk.

Background: Although there is evidence that mouthguards prevent orofacial trauma occurrence during sport practice, the influence of this device on athletic performance has not been systematically quantified., Objectives: We aim to systematically review the literature to determine the effect of mouthguards on athletic performance and if the type of mouthguard influences this overcome., Materials and Methods: A comprehensive search was performed in the Systematic Electronic Databases: Pubmed, Scopus, Web of Science and the Cochrane Library from their inception to February 2017. The publications were grouped based on their outcome: (i) the use of mouthguards; or (ii) the type of mouthguards. We conducted descriptive analyses and quality assessments of the included studies., Results: The search identified 489 citations. After screening the studies, we identified 15 trials comprising a population of 312 athletes. According to the risk of bias evaluation, nine studies were considered 'high' risk of bias, and six 'low' risk of bias. Overall, custom-made mouthguards did not interfere or improve athletes' performance when compared with the control group (without mouthguard). Custom-made mouthguards showed the smallest range of changes in players' performance compared with other types of mouthguards., Conclusions: This systematic review provides evidence for sports professionals to advocate the use of custom-made mouthguards to prevent injury, and these devices do not impair performance. The scientific evidence should be interpreted carefully because there is a great variability in outcome measures and lack of important methodological details., (© 2018 FDI World Dental Federation.)

a mouthguard, also known as a gumshield, mouth protector or sports guard is an appliance that covers the teeth and surrounding mucosa with the aim of preventing or reducing trauma to the teeth, gingival tissue, lips and jaws. The device is usually worn on the maxillary arch and works by separating the maxillary and mandibular dentition, protecting the teeth from the surrounding soft tissue, absorbing or redistributing shock and/or stabilising the mandible during traumatic jaw closure. They may also play a role in preventing and reducing concussion by absorbing impact forces that would otherwise be transmitted through the base of the skull to the brain, although the evidence for this is less conclusive. A mouthguard will usually fall into one of three categories: stock mouthguards (which are made ready to use and are believed to give the least protection), the mouth-formed or 'boil and bite' type (which are heated in hot water, placed in the mouth and moulded to the teeth) and custom-made mouthguards (which are usually made on a stone model of the maxillary teeth and surrounding tissue and are thought to give the most protection). These devices can be made from various materials but ethylene-vinyl acetate is by far the most popular material, probably because of the ease with which it can be used for the production of custom-made mouthguards. This paper gives a review of the role of mouthguards in preventing and reducing sports-related trauma and examines the materials that are used to fabricate them.

Purpose: Intraoperative transcranial motor-evoked potential monitoring causes contraction of the masseter muscles, which may cause injuries to the oral cavity and damage to the orotracheal tube. We developed a mouthpiece made from vinyl-silicone impression material to prevent these injuries. The purpose of this study was to examine its efficacy and safety., Methods: Twenty-two patients undergoing spinal surgery under transcranial motor-evoked potential monitoring were fitted with bespoke vinyl-silicone mouthpieces by dentists before surgery. On induction of general anesthesia and orotracheal intubation, the mouthpiece was attached to the upper and lower dental arches. A lateral cervical X-ray was taken at the end of surgery to examine the condition of the orotracheal tube. The incidence of endotracheal tube deformation was compared with an historic control group of 20 patients in whom a conventional gauze bite block had been previously used before induction of the mouthpiece. The oral cavity was examined by a dentist the day before surgery and 3 days postoperatively, and intraoral injuries were recorded., Results: No endotracheal tube deformation was found in 22 patients fitted with the new mouthpiece. The incidence of tube deformation (none of 22 patients, 0 %) was significantly lower than in those who had been fitted with the gauze bite block (9 of 20 patients, 45.0 %; p < 0.001). Application of the mouthpiece resulted in no tongue or tooth injuries., Conclusion: A novel mouthpiece reduced the incidence of damage to the endotracheal tube caused by intraoperative transcranial motor-evoked potential monitoring.

The purpose of this study was to examine factors hindering the use of mouthguards and the incidence of orofacial injury among young male rugby players. 69 high school rugby players (Group 1) and 431 medical student rugby players (Group 2) participated in this study. Participants in Group 1 used custom-made mouthguards fabricated according to a standardized method, whereas participants in Group 2 used custom-made or over-the-counter mouthguards of their choice. The factors associated with orofacial injury were assessed by logistic regression analysis, while factors hindering mouthguard use were assessed by multinomial logistic regression analysis. All data were obtained from a questionnaire developed by the Japanese Academy of Sports Dentistry. We found that breathing problems were the main factor contributing to the reduced frequency of mouthguard use. In both groups, a significant negative association was observed between the frequency of mouthguard use and the risk of orofacial injury. The group using standardized custom-made mouthguards reported fewer complaints about breathing problems and a higher frequency of mouthguard use. The results of this study suggest that increasing the frequency of mouthguard use would reduce the risk of orofacial injury among young male rugby players. We also conclude that users of custom-made mouthguards complain less frequently of breathing difficulties., (© Georg Thieme Verlag KG Stuttgart · New York.)

We investigated the associations of mouthguard awareness and use with the rate and type of orofacial trauma during sports activities among professional athletes. In this cross-sectional study of athletes aged 12 to 22 years who trained for participation in national and international competitions, data were collected by using a questionnaire and a clinical examination that included an index of dental injury. There were significant differences in mouthguard awareness and use and injury rates, i.e., athletes who did not wear mouthguards had more injuries. Traumatic injuries to teeth were significantly more frequent among contact athletes (15; 9%) than among noncontact athletes (4; 2.5%). Limited mouthguard awareness could be due to lack of information and education on dental injuries and their prevention.

Background: Mouth guards are used to reduce the risk of experiencing dental injuries. Various individual and commercial designs are available., Methods: The authors prepared 20 artificial maxillae from a polyether-resin to simulate teeth, jaw bone and gingiva. They customized two designs of mouth guards by using stone models from impressions of the artificial maxillae; one (n = 10) was constructed of four layers of ethylene vinyl acetate (EVA) (total thickness = 4.0 millimeters) (group EVA), and the other (n = 10) was constructed of EVA with an intermediate layer of 1.0-mm-thick sheet titanium from the left maxillary canine to the right maxillary canine (total thickness = 4.0 mm) (group EVA-Ti). They used a drop-weight impact testing machine (DTM 1000-S, Omnipotent Instruments, Seremban, Negeri Sembilan Darui Khusus, West Malaysia) for a frontal impact with 1.7 kilograms of mass dropped at 0.34 meter per second. The force of the drop was verified by means of a laser Doppler vibrometer (laser model OFV-323 and controller model OFV-3020, Polytec, Irvine, Calif.) to calculate the absorbed energy. They used a high-speed camera (FastCam APX-RS, Photron, San Diego) to obtain images of energy dissipation over the length of the mouth guard., Results: The mean effective total impact energy that reached the maxillae-mouth guard models was 5.66 (standard deviation [SD], 0.035) joules. The mean absorbed energy in group EVA was 4.39 (0.023) J (77.8 percent of total impact energy). The mean (SD) absorbed energy in group EVA-Ti was 4.28 (0.013) J (75.9 percent of total impact energy). The mean (SD) total dissipated energy was 1.26 (0.21) J in group EVA and 1.36 (0.11) J in group EVA-Ti. The mean (SD) transmitted energy for the mouth guards was 1.08 (0.19) J in group EVA and 0.99 (0.05) J in group EVA-Ti. There was no statistically significant difference between the groups in terms of any energy transmission or absorption., Conclusion: The results of this study suggest that an additional intermediate titanium layer in the anterior area of a mouth guard may not have a beneficial effect on impact absorption and dissipation., Practical Implications: The use of mouth guards is a general requirement for physical sports activities, and it should be strongly encouraged for people playing contact sports in particular. However, the authors' results indicate that the total thickness of a mouth guard is more important than is the use of an additional intermediate layer (in this case, titanium).

Sports dentistry is one of the most recent and upcoming fields in dentistry. It includes mainly the prevention and management of sports-related orofacial injuries and associated oral diseases or traumas. The dentist can play a critical role in informing athletes, coaches, and patients and their parents about the importance of prevention, treatment, and diagnosis for orofacial injuries in sports. The most significant aspect in preventing sports-related orofacial injuries is wearing basic protective devices such as properly fitting helmets, face masks, and/or mouthguards. A properly fitted mouthguard prevents violent contact between the upper and lower dentition. According to the American Society for Testing and Materials, there are three types of mouthguards: custom-fabricated mouthguards, mouth-formed guards, and stock mouthguards. Essential properties of the various materials used in the manufacture of mouthguards include water absorption, density, and thickness as well as temperature transmission, energy absorption, and drawing strength (tensile strength) of custom-made mouthguards. Currently, a variety of materials is being used for mouthguards, most commonly polyvinyl acetate-polyethylene copolymer or ethylene vinyl acetate copolymer and polyvinyl chloride. Mouthguard use is significant for athletes, since dentists play an important role in the design and application of these in clinical practice. The purpose of this article is to review the importance of mouthguard use, the incidence and location of orofacial sports injuries, the risk factors for such injuries, and the types of mouthguards and their roles in the prevention of sports-related orofacial injuries.

Background/aim: The yearly cost of sports injuries, which affects Swedish society, is estimated to 3 billion SEK (460 million USD). Injuries in ice hockey represent at least 270 million SEK (42 million USD). Despite the high number of injuries, mouth and face guards are rarely used in Swedish ice hockey. The major aim of this study was to examine the attitudes of mouth and face guards in two ice hockey clubs in Sweden (one elite and one division 3 club). A second purpose was to determine why some players use mouth and face guards, while others do not. A third goal was to present a material that ice hockey clubs could use for further discussions., Materials and Method: A phenomenographic analysis of focus groups interviews., Results: The phenomenographic analysis of the data resulted in 12 categories. Within each category, issues, activities and engagement of the participants were described. Further, similarities and differences in the discussions between the elite club and the division 3 club were described. The following categories were found to engage the participants the most: 'Ice hockey is a high-velocity collision sport in which injuries are expected', 'Attitudes towards personal protection guards' and 'Suggested measures'., Conclusions: The participants were aware of the risk of playing ice hockey, but they know little about the consequences of a dental injury. Although ice hockey players wish to protect themselves, they refuse to accept just any mouth or face guard. Through the discussions about reducing dental and jaw injuries by routine use of protection devices, many reform proposals were presented that could be useful in future discussions., (© 2013 John Wiley & Sons A/S.)

Introduction: Claims for tooth damage following intubation are increasing. An anaesthetic chart (AC) has been proposed to describe patient's pre-existent dental diseases and any possible lesions caused during intubation and extubation., Materials and Methods: We conducted a retrospective study of 235 cases of dental lesions reported in litigation files from January 2000 to June 2009. Based on preoperative oral inspection the anaesthetist decided whether or not to use a protective aid. Two different tooth protectors were applied: (i) a standard mouthguard and (ii) silicone impression putty., Results: The study population consisted of 110 female (age 6-88 years) and 125 male patients (11-90 years) patients. In 66% of cases greater risk of perianesthetic dental injury was reported in the AC due to pre-existing poor dentition. In intubation procedures without protective devices dental subluxation/luxation occurred in 55% of patients, dental avulsion in 43%, exfoliation in 2%, and soft tissue damage in five patients. One patient suffered from transient facial nerve paralysis. The costs of treatments and of impression materials, as well as the total value of compensation for injuries are reported., Discussion: Definition and demonstrability of damages on the AC is important in order to separate the cases worthy of compensation from the non-compensable ones, as to evaluate the possibility of solving the litigation by extrajudicial channels. There are cases in which, based on AC reporting and device adoption the damage resulted to be compensable, but the costs were defined on different estimates of lesions. The use of a protective device makes it possible to down-modulate the damage compensation., Conclusion: The analysis of litigation records and 'incident reports' has suggested that the choice of accurate proceeding and the use of protection aids could reduce the number of claims, insurance premiums and the costs of litigation process, thus improving physician-patient relationship., (© 2011 John Wiley & Sons A/S.)

Objective: To determine the prevalence of orofacial injuries among basketball players in Benin City, Nigeria and to survey the athletes' awareness, attitude and use of mouthguards., Methods: A cross-sectional survey of basketball players in the standard basketball arena in Benin City was conducted between November 2009 and January 2010. A self-administered questionnaire elicited information on demography, the prevalence of oral and facial injuries, distribution of site and cause of orofacial injuries, athletes' knowledge, attitudes and usage of mouthguards. Data were subjected to descriptive statistics and Chi square test., Results: The response rate was 78%. Of the 156 respondents, 79.5% were male and 20.5% female, with a mean age of 23.1 years. The distributions was amateurs (61.5%) professionals (38.5%). The mean number of injuries in previous 12 months was 3.7 ± 1.8. The prevalence of both facial and oral injuries among the respondents was 62.8% with the lip and gingiva most commonly involved respectively. The common causes of the orofacial injury reported were from elbows of opponents, falling and collisions with other players. The prevalence of injury was not significantly associated with demography, category, competition and duration of participation. More than half had heard and seen mouthguards and the coach was the leading source of information. The reasons for non-use of mouthguard were mostly ignorance, non-availability and non-affordability., Conclusion: The high prevalence of orofacial injury among basketball players reported in this study justifies the need for multidisciplinary injury prevention interventional approach with emphasis on the rules of the games., (© 2011 FDI World Dental Federation.)

The prevention and treatment of orofacial trauma is now a very important part of the general practice. Children as well as adults are participating more in events where the probability of trauma is apparent. Attendance at health clubs and gymnasiums is on the rise. With the increase in sports participation comes an increase in orofacial injuries. The general population is taking its health more seriously. Athletic participation is on the rise, and Title IX4 has introduced increased female participation at all levels. This only increases the possibility that our patients will present themselves in our offices with the need for trauma treatment and also our opinions on the methods of preventing such traumatic experiences.

Purpose: The aim of this study was to investigate the effect of two types of occlusal accommodation on the arch separation in centric and eccentric arch positions and to assess the opposing tooth contacts in professionally made, thermoformed sports mouthguards., Materials and Methods: Maxillary and mandibular alginate impressions, a wax interocclusal record of centric occlusion together with maxillary/condylar face-bow registrations, were recorded clinically for 10 undergraduate dental students who are sports activist volunteers of the School of Medicine and Dentistry, Queen's University Belfast. Two ethylene vinyl acetate thermoformed maxillary mouthguards were made for each player (N = 20) using a standardised procedure. Ten mouthguards served both as the control (i.e. the non-accommodated) group and also the accommodated, occlusally 'imprinted' group. The other 10 mouthguards served as the accommodated, occlusally 'ground' group. Casts were articulated, each non-accommodated and accommodated mouthguard was seated and the extent of the interocclusal opening was recorded in all three arch relationships. The number of mouthguard and mandibular tooth contacts were also recorded in each position., Results: The increased vertical occlusal dimension that was found in the presence of non-accommodated mouthguards equated to the full-sheet thickness of the material that was used to form the mouthguards. Only mouthguards accommodated by grinding retained high levels of occlusal contact in all arch relationships that were tested., Conclusions: Within the limitations of this study, the modification of the occlusal surface made by flat grinding reduced the arch separation in eccentric movements and increased the opposing tooth contacts in custom-made mouthguards. This may contribute to increased comfort, compliance and the protective effect of these appliances thus resulting in a reduction of injuries to the teeth, arches and soft tissues.

All orthodontic patients who wear fixed appliances and participate in contact sports are recommended to wear a mouthguard for protection against dental trauma and injury. An overview of the different types of mouthguards currently available is described together with their relative suitability for orthodontic patients.

Purpose: To examine the orofacial injuries and attitudes toward mouthguards reported by professional ice hockey players of the American Hockey League [AHL]., Methods: A survey was created and sent to the certified athletic trainers [ATC] of 23 AHL teams. A total of 25 questions were posed regarding age, position, orofacial injury, frequency of prophylaxis by a dental hygienist and methods to clean a mouthguard. The influence and responsibility of professional athletes as role models was also explored., Results: A total of 344 surveys of the original 394 surveys [87.3%] were returned. Three hundred twenty-four [82.2%] were acceptable for analysis. All respondents were male, with 74% between the ages of 19 and 25. Almost all players [93.8%] had been advised to wear a mouthguard, with a parent / family member first to advise on their use. Approximately 67.3% of players reported wearing a mouthguard in some capacity. Of those who did not, 31% stopped wearing a mouthguard upon arrival into the AHL. Dental injuries were numerous, occurring within 63.3% of ice hockey players. The most frequently reported injury was chipped teeth. As professional athletes, 88.6% consider themselves role models., Conclusion: It is recommended that mouthguards be mandated within the professional arena as the prevalence of orofacial injuries remains a concern within ice hockey. Emphasis should be placed on educating health professionals of all disciplines who interact with athletes, as well as utilizing the promotional power of professional athletes.

Beginning in January 2000, all individuals participating in basic military training at Fort Leonard Wood, Missouri, were issued boil-and-bite mouthguards. From January 2000 to March 2001, trainees were required to wear mouthguards only for a single activity, pugil stick training. After March 2001, mouthguards were required for four activities including pugil stick training, unarmed combat, rifle/bayonet training, and the confidence/obstacle course. Dentists systematically tracked trainees who reported to the dental clinic with orofacial injuries during three periods: January 2000-March 2001 (phase 1), April-September 2001 (phase 2) and September 2002-June 2003 (phase 3). Orofacial injury rates were 3.35, 1.89 and 1.91 cases/10,000 person-years in phases 1, 2 and 3, respectively. The overall risk of an orofacial injury was 1.76 (95% confidence interval = 1.03-3.02) times higher in phase 1 compared with the combined phases 2 and 3 (P = 0.006). Thus, orofacial injury rates were lower when mouthguards were required for four training activities as opposed to one training activity. Mouthguards are now required at all five Army basic training sites when trainees are performing any of the four training activities.

Pediatric patients who are comatose may develop a neuropathological chewing or clenching reflex that results in self-inflicted injury to the soft tissues of the oral cavity. An early and quick response to these problems may minimize the extent of soft tissue trauma. The use of a stock fluoride tray in the hospital management of a pediatric patient who was neurologically impaired and unconsciously traumatizing his oral soft tissues is described. This treatment modality may serve as an initial or interim device in managing pediatric patients with uncoordinated mandibular movements or clenching. In some instances, given the sometimes self-limiting nature of this problem, fluoride trays may serve as the sole mode of treatment

The importance of sports dentistry has become even greater due to the role that sports have in modern society. As the risk of sports-related injuries appears already in the period of children's play and is constantly present in various risk-related sporting activities, the role of dental profession has become extremely important. Custom-made mouthguards are the most highly recommended mouthguards used for successful prevention of orofacial and dental injuries. It is important to inform athletes of the best characteristics of a custom-made mouthguard such as retention, comfort, fit, ease of speech, resistance to tearing, ease of breathing as well as good protection of the teeth, gingiva and lips. The shape and surface of the mouthguard which encloses the teeth, the gingival and the hard palate can vary depending on the anatomical features of the athlete's jaw, his/her dental arch, the type of sports activity, as well as the materials used in the manufacture of the mouthguard. Mouthguards should not extend distally further than the first molars because some athletes complain of the vomiting reflex. In addition, mouthguards may interfere with breathing. They should reach the mucogingival border labially and extend a few millimeters palatally in order to provide the best protection for the labial gingival and good retention. The labial flange should extend up to 2 mm of the vestibular reflection. The palatal flange should extend about 10 mm above the gingival margin thus enclosing the greatest part of the anterior palate surface with a slight narrowing distally not further than the first molars. Materials used in the manufacture of mouthguards should satisfy a number of physical, mechanical and biological requirements. Essential properties of materials used in the manufacture of mouthguards include water absorption, density, thickness as well as temperature transmission, energy absorption and drawing strength (tensile strength) of custom-made mouthguards. Such materials should have an optimal consistency in order to cushion the traumatic impact. Currently, ethylene-vinyl acetate (EVA) is the most commonly used mouthguard material. An optimal thickness of the mouthguard is achieved by the application of vacuum forming pressure-lamination technique in two layers of a thermoplastic sheet of EVA copolymer and if needed, by placing two layers of protective air-cells against the critical area. Some investigations in the Croatian samples showed that the most common injuries in water polo occur in the orofacial region (96.4% of cases), of which 80% are injuries of lips, tongue and cheek. In the period from 1997 to 2005 the number of orofacial injuries increased by 62%. Dental trauma occurs in 7.6% of cases. In basketball players soft tissue injury in the orofacial complex was established in 69.4% and dental trauma in 11.3% of the respondents. In the selected sample of handball players, soft tissue injuries were established in 78.8%, dental trauma and loss of teeth in 13.6% and temporomandibular joint injuries in 6.8% of the cases. In tae-kwon-do players 88% of orofacial injuries were lacerations, but only 12% reported dental and temporomandibular joint trauma. Only a half of the examined professional basketball players wore mouthguards, and none of the examined tae-kwon-do players. Clinical value of intraoral custom-made mouthguards was proven. Dentists play the key role in the prevention and treatment of sports-related dental and orofacial injuries, collection and dissemination of relevant information, as well as promotion of research on the preventive procedures related to injuries of such a specific aetiology.

Context: Extensive changes to mouthguards may occur as a result of wear and tear and equipment abuse., Objective: To examine how the shape and thickness of custom-fabricated mouthguards change over the course of a complete season of high school football., Design: Repeated-measures, case-series study., Setting: High school., Patients or Other Participants: Fifteen high school varsity football players aged 15 to 17 years began the investigation; 4 participants lost their mouthguards before the end of the season., Main Outcomes Measure(s): Custom-made mouthguards were examined before the start of the season, midway through the season, and at the end of the season to document changes to material thickness and shape. Along with evaluating the thickness of mouthguards at the incisor/canine and molar regions, we assessed shape retention by evaluating the width of the mouthguard channel at the first molar., Results: Material thickness at the incisor/canine region decreased by approximately 16% (F(2,20) = 34.20, P < .001) after 6 weeks of participation. Over the same time period, the mouthguard thickness at the molars decreased by 23% (F(2,20) = 31.92, P < .001), and the shape of the mouthguards changed as well (F(1,11) = 6.01, P = .029)., Conclusions: Although test mouthguards displayed significant deterioration in shape and material thickness, more research is needed to establish wearing length. Frequent inspections of mouthguards are advised to ensure that fit and protective abilities have not been compromised.

The adaptations and applications of mouthguard appliances are many and varied, with uses ranging from protective to therapeutic. These modifications serve the individual needs of patients. This requires problem-solving based on combining form and function with the skills of the dentist.

Objectives: To compare the effectiveness of the WIPSS mouth guard to other currently used mouth guards in the prevention of concussion injuries in athletes participating in varsity football and rugby., Design: : Multicenter, cluster-randomized, controlled trial comparing the WIPSS Brain-Pad mouth guard against the standard use mouth guard of choice. Teams were monitored by their respective athletic therapist, trainer, or sports physician for 1 playing season to diagnose and record incident concussion injuries and dental trauma. Concussion symptoms were also recorded at the time of injury., Setting: Five Ontario universities., Participants: University male football (394) and university male (129) and female (123) rugby athletes reporting to 2003 fall training camps., Main Outcome Measurements: The primary end point was the incidence of any diagnosed concussion events during the 2003 playing season as defined by the American Academy of Neurology Concussion Guidelines. Secondary endpoints included the incidence of dental trauma events and observed concussion symptoms., Results: There was no significant difference in the number of concussions observed between the intervention and control arms of this trial (P = 0.79; odds ratio, 1.06, in favor of controls; 95% CI, 0.51, <<1.61). No dental trauma events occurred. The 5 most common symptoms experienced by concussed athletes were dizziness, general headache, nausea, loss of visual focus, and personality changes., Conclusions: In this study, concussion rates were not significantly different for varsity football and rugby players who wore the WIPSS Brain-Pad mouth guard compared with other types of mouth guards.

Objective: Head/orofacial (H/O) injuries are common in Australian rules football. Mouthguards are widely promoted to prevent these injuries, in spite of the lack of formal evidence for their effectiveness., Design: The Australian football injury prevention project was a cluster randomized controlled trial to evaluate the effectiveness of mouthguards for preventing H/O injuries in these players., Setting and Subjects: Twenty three teams (301 players) were recruited from the largest community football league in Australia., Intervention: Teams were randomly allocated to either the MG: custom made mouthguard or C: control (usual mouthguard behaviours) study arm., Main Outcome Measures: All injuries, participation in training and games, and mouthguard use were monitored over the 2001 playing season. Injury rates were calculated as the number of injuries per 1000 person hours of playing time. Adjusted incidence rate ratios were obtained from Poisson regression models., Results: Players in both study arms wore mouthguards, though it is unlikely that many controls wore custom made ones. Wearing rates were higher during games than training. The overall rate of H/O injury was 2.7 injuries per 1000 exposure hours. The rate of H/O injury was higher during games than training. The adjusted H/O injury incidence rate ratio was 0.56 (95% CI 0.32 to 0.97) for MG versus C during games and training, combined., Conclusions: There was a significant protective effect of custom made mouthguards, relative to usual mouthguard use, during games. However, the control players still wore mouthguards throughout the majority of games and this could have diluted the effect.

A mouthguard is a useful appliance to prevent oral injuries, and their emotional and financial consequences. Most sportsmen are aware of the benefits of a mouthguard. Nevertheless, a relatively small percentage of sportsmen in contact sports are using a mouthguard actually. Whether or not a mouthguard is used, is predominantly determined by its comfort. Therefore, a mouthguard must be optimally comfortable. However, to make sportsmen using an even optimal mouthguard, needs motivation. Stimulating of motivation is the task of parents, coaches, (team) physicians, and (team) dentists. Especially coaches seem to have great influence on sportsmen. Children are very much influenced by their parents. It is the task of general dental practitioners not only to inform sportsmen and their parents, but also their coaches and team physicians about the risks of oral injuries and about the benefits of preparing a mouthguard. General dental practitioners must put themselves disposal to prepare mouthguards for their individual patients as well as for all players of a team who wish to have a mouthguard prepared.

Objective: The perception of Nigerian athletes of the use of mouth guards to prevent the stresses of sports injuries was examined using psychological, sociological, and physical stress variables., Methods: The descriptive survey research design was used in this study. Participants (n = 333) were selected using the purposive random sampling technique and data were collected using the 4 point Likert type instrument. The coefficient alpha was used to determine the reliability of the instrument with r = 0.79 for psychological, r = 0.66 for physical, and r = 0.74 for sociological stress., Results: The result reveals that female athletes perceived the use of mouth guards as being more important to prevent the stresses of sports injuries than male athletes, while athletes who had used mouth guards for longer periods also perceived them as being more important to prevent the stresses of sports injuries compared to those who had used them less. The result also revealed a significant difference (p<0.05) among the various sport groups as independent variables on the psychological and physical stress variables. Scheffe post hoc analysis was used to identify the group where significant difference was found., Conclusions: The study concluded that since the impact of injury is perceived to affect the cognitive function of athletes, athletes should be educated on the use of mouth guards in order to reduce the incidence of oral and dental injuries to the barest minimum.

Objective: To understand factors that influence parental perceptions regarding mandatory mouthguard use in competitive youth soccer., Setting and Subjects: A web based survey of parents whose 8-14 year old children participated in outdoor competitive youth soccer during the fall of 2002. Questions focused on: previous injury, education provided, dentist/physician recommendations, and parental perceptions of mouthguard use., Main Outcome Measure: The outcome variable was parental agreement with the statement "mouthguards should be mandatory for competitive youth soccer". Logistic regression and chi(2) were performed using STATA 8.0., Results: Altogether 120 parents participated. The children had a mean (SD) age of 11.8 (1.5) years and 48% were female; 14% wore mouthguards and 11% suffered orofacial injuries. Nineteen percent of parents reported receiving educational material from the youth soccer organization. Although 92% of parents believed that mouthguards were effective in reducing orofacial injuries, only one half agreed that mouthguards should be mandatory. Thirty percent of respondents reported that their dentist/physician recommended mouthguards for competitive youth soccer. Logistic regression showed that dentist/physician recommendation and parental female gender were independently associated with parental agreement for mandatory mouthguard use (odds ratio 2.9, 95% confidence interval (CI) 1.2 to 7.3; odds ratio 3.0, 95% CI 1.1 to 6.5)., Conclusions: Few athletes wear mouthguards during competitive youth soccer. Health care professionals in this study did not capitalize on the apparent influence they have on parental beliefs regarding mouthguard use. Efforts are needed by both health professionals and soccer organizations to educate parents about orofacial injuries and mouthguard use in competitive youth soccer.

Self-inflicted oral trauma occurs in a number of conditions with different etiologic and clinical characteristics. The management of such trauma also varies depending on the medical history of the patient; the etiology of the behavior; and the severity, frequency, and method of inflicting injury. This case report describes a modified oral screen placed in a 10-month-old female infant with cerebral palsy who had been having feeding problems caused by self-inflicted oral trauma. The modified oral screen effectively protected the wounds against further oral trauma to the lower lip and tongue without being fixed to the dentition.

The purpose of this study was to determine the extent of mouthguard awareness and use, as well as the amount and type of oro-facial trauma associated with and without mouthguard wear in adolescent Nigerian athletes. A 13-item self-completion questionnaire was completed and returned by 1,127 secondary school athletes (completion rate of 93.9%) comprising 683 (60.6%) males and 444 (39.4%) females ranging in age from 12- to 19 years (mean age 15.18+/-2.97 SD). The athletes were randomly drawn from 23 secondary schools located in different parts of Ibadan city in Nigeria. Sixty-five-and-a-third percent of the athletes professed awareness of the need for mouthguards for sports, but only 19.6% claimed usage of the device. Thirty-four-and-a-half percent of the athletes reported having sustained one form of oro-facial injury or the other previously. The prevalence of oro-facial injuries was significantly lower while wearing a mouthguard (p<0.05), and most of the injuries occurred during contact sports. The study supports the need for the enforcement of mandatory mouthguard use in contact sports.

- The objective of this study was to assess the perceptions of secondary school sports' coaches about oro-facial injuries and mouth protector usage in sports by the adolescent athletes. A 10-item, self-completion questionnaire was distributed to 42 coaches from 23 secondary schools randomly selected from different parts of Ibadan city in Nigeria between May and June, 2002. The questionnaire sought information on why a mouth protector (mouthguard) is used, when it is required; the types of mouth protector used, the major reasons for choosing a specific mouth protector, and personal feeling as to whether mouthguards prevent oral injury. Descriptive statistics were used for the data while the chi-square statistic was employed to test the significance of association between variables. All the coaches, 25 (59.5%) males and 17 (40.5%) females with age range of 19-51 years and mean age of 38.07 +/- 8.97 years (mean +/- SD), completed and returned the forms (100% completion rate). 95.2% of the coaches believed that mouthguards prevent oral injuries and 95.2% of them also would like more information on different types of mouthguard, while 4.8% each felt otherwise. The main factor determining the choice of the type of mouthguard for athletes by the coaches was the quality of oral protection (57.1%), and the next was the cost (23.8%). Acceptance of mouthguard was scored as positive by 88.1% of the athletes. 81.0% of the coaches felt that mouthguard should be worn at all times (during practices and competitions) while 19.0% would prefer the use during competitions only. The majority of the coaches (71.4%) believed that boxing needs mouthguards, 2.4% each indicated football (soccer) and Judo while 11.9% of the coaches did not indicate any sport. The majority of these Nigerian coaches agreed on the protective effectiveness of mouthguard against sport-related oro-facial injuries, but they are yet to be adequately informed about mouthguards generally so as to correctly advise and influence these adolescent athletes in this regard.

Basketball is a popular sport in Australia. Although orofacial injuries are common, mouthguard (MG) wear in basketball appears to be low. The purposes of this study were: to measure mouthguard wear by basketball players before and after a promotional intervention; to assess players' knowledge of the value of mouthguards for prevention of injury; and to describe their experience of orofacial injury. Two questionnaires (baseline and follow-up) were administered to a convenience sample of 496 basketball players in Victoria, Australia. Players recruited were youths (12-15-year olds, n = 208) and adults (18 years and over, n = 288), from all basketball levels (social to elite). Completion of the baseline questionnaire was followed immediately by an intervention comprising written and verbal information, a mouthguard blank and instructions on mouthguard construction. The follow-up questionnaire was mailed to all respondents 10-12 weeks later; 135 youths (65%) and 157 adults (54%) completed this. Mouthguard wear at baseline was low but was more frequent at games (62%) than at training (25%). Despite 90% of players acknowledging the protective value of a mouthguard, wear by youths did not increase following the intervention, and wear by adults increased by only 14% for training and 10% at games. Previous orofacial injury was recorded at baseline by 23% of players, but few had requested compensation from Basketball Australia (youths, 17%; adults, 30%). Two predictor variables were statistically identified as related to mouthguard wear: previous orofacial injury and age group. Mouthguard wear was significantly more frequent amongst players with previous injury; such players were 2.76 times more likely to be wearers than those without previous injury. Youths were 2.31 times more likely to wear mouthguards than adults. Only 34 players (12% of respondents at follow-up) had a mouthguard constructed from the blank provided. Although youth and adult groups differed, the overall extent of mouthguard use was disappointingly low. Despite wide recognition of mouthguard value, the intervention had little effect on promoting their use.

Sports dentistry is a new discipline that involves the prevention and treatment of sports-related dental diseases and trauma. As dental professionals, we have responsibility to educate ourselves, and the public community on issues related to sports dentistry, and specifically to the prevention of sports-related dental traumatic injuries. It is incumbent upon us to take the lead in conducting this type of educational and research activities. It is crucial for dental professionals to educate and promote all phases of sports dentistry to the public. Dental professionals should emphasize the continued susceptibility of individual to sports-related dental trauma and the importance of implementing appropriate preventive measures; and seeking early intervention of individual who requires preventive treatments.

Purpose: Dental injuries can be permanent and disfiguring. They are also universally expensive to treat. Many dentists, sports physicians, and athletic trainers recommend mouthguards for athletes participating in certain competitive sports, including men's college basketball, because of a common perception that mouthguards afford protection from dental injuries, and even some concussions. However, there are few reliable reports of the incidence of dental injuries and concussions in men's college basketball, and good evidence that mouthguards reduce the risk of these injuries in this population of athletes is notably lacking. This study prospectively recorded dental injuries and concussions among 50 men's Division I college basketball teams during one competitive season, then compared injury rates between mouthguard users and nonusers., Methods: During the 1999 to 2000 basketball season, athletic trainers from 50 men's Division I college basketball programs used an Internet Web site to submit weekly reports of the number of athlete exposures, mouthguard users, concussions, oral soft tissue injuries, dental injuries, and dentist referrals., Results: Response rate was 86%. There were 70,936 athlete exposures. Athletes using custom-fitted mouthguards accounted for 8663 exposures. Injury rates were expressed as number of injuries per 1000 athlete exposures. There were no significant differences between mouthguard users and nonusers in rates of concussions (0.35 vs 0.55) or oral soft tissue injuries (0.69 vs 1.06). Mouthguard users had significantly lower rates of dental injuries (0.12 vs 0.67; P < 0.05) and dentist referrals (0.00 vs 0.72; P < 0.05) than nonusers., Conclusion: Custom-fitted mouthguards do not significantly affect rates of concussions or oral soft tissue injuries, but can significantly reduce the morbidity and expense resulting from dental injuries in men's Division I college basketball.

Objectives: This paper examines the literature dealing with oral-facial injuries received during participation in sport and the possibilities open to athletes for their prevention. In particular, the paper examines five different aspects of this topic: the risk of dental injury while playing sports, the role of the mouthguard in preventing injury, types of athletic mouthguard, implications for patients undergoing orthodontic treatment and behavioural aspects of mouthguard wear., Results: It is clear from this review that participation in a number of sports does carry a considerable risk of sustaining dental injury, not only in the so-called contact sports such as rugby and hockey, but also in less obviously dangerous sports such as basketball. Although some evidence exists to the contrary, the majority of studies have found the mouthguard to be the most effective way of preventing such injuries. It is also clear that the custom-fabricated mouthguard, in particular the pressure-laminated variety, is seen to afford most protection. Athletes undergoing orthodontic treatment present a particular problem as they are potentially at greater risk of injury because of increased tooth mobility and the presence of orthodontic appliances. The fabrication of mouthguards for these patients is also problematic and the literature covering this is reviewed. As with other preventive measures, mouthguard usage is often less than the dental profession would like; the reasons for this are explored in a small number of studies., Conclusion: While much progress has been made in this area, the profession could do much more to promote the greater use of mouthguards.

Although sports mouthguards provide protection against trauma, dentoalveolar injuries can still occur with the mouthguards in place. This study examined the effect of mouthguard protection in an in vitro model. A simulated maxilla, out of a polymethylmethacrylate (PMMA) arch, containing replaceable resin teeth, was used to assess the performance of different mouthguard designs. "Boil and bite" and custom-fitted mouthguards (ethylene vinyl acetate [EVA]) laminated with hard (poly-vinyl chloride [PVC]) or soft labial intermediate EVA layers were fabricated according to manufacturers' instructions. A steel ram was dropped onto the mouthguards at the maxillary incisor region. Changes in voltage, which were induced by a strain gauge at the back of the upper left incisor, were measured with an amplified voltmeter. Data were analysed by ANOVA at a significance level of 0.05. "Boil and bite" and mouthguards layered with silicone or with small hard PVC inserts of 1.5 mm thickness demonstrated less absorption and differed significantly from the other mouthguard systems (p < 0.05). Bilaminated mouthguards with hard PVC inserts of 0.8 mm, 1.5 mm or 2 mm thickness showed no significant differences to those with 1.5 mm thick (EVA) inserts. The absorption rates amounted to 33 % compared with the unprotected tooth.

The oral health strategy for Scotland, which was published in 1995, recommends that dentists promote the use of mouth protection in sport to reduce the risk of injury. There is compulsory mouthguard use in some sports including ice-hockey, fencing, boxing, lacrosse and some forms of autocycling. In cricket, face protection appears to be compulsory for batsmen only. The use of mouth protection in the martial arts is compulsory at international level but, in the UK, the rule does not seem to be always enforced at club level. Players of contact sports, such as rugby and hockey, are considered to be more at risk of dentoalveolar injury and the governing bodies of these sports recommend that players at all levels wear mouth protection but have not made it mandatory.

From the introduction of a protective mouthpiece in the sport of boxing, the evidence for the importance of this piece of athletic equipment in injury prevention has grown. Yet, despite this knowledge, only five amateur sports and one professional sport have regulations requiring the use of mouthguards. Even in the sports that require their use, compliance is not universal. Attitudes of coaches, officials, parents, and players about wearing mouthguards all influence their usage. Studies of the attitudes of these groups reveal that coaches are perceived as the individuals with the most impact on whether or not players wear mouthguards. There is reluctance among college football officials to enforce mouthguard violations that they believe are inappropriate. Parents see themselves as having responsibility in determining mouthguard use; however, their views about when and for whom mouthguards are necessary reveal a lack of complete understanding of the benefits. Resistance on the part of players stems from the physical characteristics of the mouthguard, interference with breathing and speech, and the effect on the players' image. Education on the effectiveness of properly fitted mouthguards for injury prevention, information on the risk for injury, availability of more comfortable and appealing mouthguards, and development of an approach for expanding regulations are all tools that can lead to the development of more positive attitudes and increased usage.

The mouthguard is a resilient device or appliance which is placed inside the mouth to protect against injuries to the teeth, lacerations to the mouth and fractures and dislocations of the jaw. There is clear support in the scientific literature for the use of mouthguards in contact sports such as rugby. Moreover, there is evidence that mouthguards are effective in protecting against concussion and injuries to the cervical spine. There is a high level of acceptance of mouthguards by players and an increasing number are regularly wearing mouthguards. This is especially true among the elite players, but acceptance and wearing rates are moderately high among club players as well. There is strong support among players and researchers for mouthguard wearing to be made compulsory. It is generally recommended that: (i) mouthguards be worn during both practice sessions and games; (ii) the habit of wearing a mouthguard begins at an early age; (iii) mouthguards be regularly replaced while children are still growing; and (iv) adult players replace their mouthguards at least every 2 years. The selection of a mouthguard will depend on a number of factors including the age of the individual, effectiveness and cost. The type I (stock), or 'off-the-shelf', mouthguards are considered inferior when compared with the other available types, and their use is discouraged. Type II (mouth-formed) mouthguards come in 2 forms, the shell-liner version and the popular thermoplastic 'boil and bite' version. While the effectiveness of the shell-liner mouthguard was examined in one experimental study, no such research has been reported for the thermoplastic mouthguard. Type III (custom-fabricated) mouthguards are recommended for players playing in the more vulnerable positions and in the higher grades. Most experimental studies in which the effectiveness of mouthguards has been demonstrated have involved type III mouthguards.

The use of mouthguards in contact sports effectively prevents oral injury and preserves oral structures. We investigated oral injuries and awareness concerning mouthguards among Japanese high school soccer and rugby players. Athletes were asked a series of questions concerning their history of oral injury while participating in sports, and their pattern of mouthguard use was determined. The data were evaluated statistically using chi-square analysis. The incidence of oral injuries was 32.3% for soccer athletes and 56.5% for rugby athletes, with 0.8% and 24.1% of the respective groups having mouthguards. There were significant differences between the soccer and rugby groups (P < 0.001). Although 81.8% of soccer athletes thought mouthguards were unnecessary, only 26.2% of rugby athletes shared this opinion and there was a significant difference between the soccer and rugby groups. Many soccer athletes had insufficient knowledge about mouthguards and were not concerned about preventing oral injury, although it was in fact a common problem in their sport. Athletes as well as coaches must be made aware of the high risk of oral injury when playing soccer, rugby, and other contact sports.

The bimaxillary mouthguard provides enhanced protection for a participant in contact sports. This article describes the fabrication of a polyvinylacetate-polyethylene (PVAc-PE) bimaxillary mouthguard in which the connection of the maxillary and mandibular components is reinforced by pressure thermoforming a 2-mm PVAc-PE sheet over the labial and buccal portions of the mouthguard.