Mouth Guards Make a Difference
by Jane Busch, DDS

In the 17 years that I have been in practice, I never saw a patient with an oral facial injury from a school-sanctioned football or ice hockey game. Now, ask me to count the teens, adolescents, and even adults who sustained an oral injury from a so-called non-collision sport like basketball, volleyball, or soccer. I wouldn't have enough fingers to count on. Is this similar to your experience? What makes the difference? The answer is in the use of mouth guards. High school athletes who participate in so-called collision sports — football, ice hockey, and rugby — are required to wear athletic mouth guards. No similar requirement currently exists for such sports as baseball, basketball, soccer, volleyball, wrestling, and gymnastics.

According to the October 1998 Journal of the American Dental Association, a survey of 1,020 male high school varsity basketball players in Florida found that nearly one third sustained at least one oral facial injury in a season. Only about 4 percent of the players reported using mouth guards. None of the athletes who wore mouth guards sustained oral facial injuries.

Dentists, as a profession, have done an excellent job educating their patients on preventive health habits. But have we fallen short on our responsibility to educate both our patients and their coaches on the need for protective athletic mouth guards? Why are mouth guards so important? A properly fitted mouth guard protects the active individual from oral injuries such as tooth/alveolar fractures, intrusions, and avulsions.

Also, mouth guards are important in the prevention of concussions. Anatomically, as we open our jaw, the condyles translate downward and forward from the articular eminence. Therefore, with a mouth guard intraorally, we are placing the jaw in a less susceptible position for a concussion. During a blow to the chin, the force applied is transmitted through the jaw of a non-mouth-guard athlete and into the temporal bone which houses many ports for the cranial nerves as they exit the base of the brain. These ports also include blood supply to the brain as well as auditory and balance mechanisms. Two studies by Itenger & Chapman reported that properly fitted custom mouth guards reduced the rate of concussions. In a separate study, Hickey reported in 1967 that intercranial pressure and brain deformation were reduced when mouth guards were worn. (Statistics taken from an interview with Dr. Ray Padille by Steve Ryan from Dental X Change.)

But what is a properly fitted mouth guard? There are three types of mouth guards. The stock mouth guard, purchased at most sporting goods stores, are bulky and uncomfortable. Little can be done to adjust them. They interfere with breathing and speaking, and to hold them in place the jaws must be held closed, which fatigues the athlete's jaw muscles and thus the athlete.

The second type is the mouth-formed mouth guard. Better known as the "boil and bite" mouth guard, it is first softened in hot water before biting it into a mold. Again, this is a poor attempt at fit. It has all of the same problems as the first type. Last is the custom-made mouth guard. This one is individually designed and fitted. With a stone model from a quick alginate impression, the dental laboratory can make a custom mouth guard using a vacuum machine and a specified thickness of ethyl vinyl acetate (EVA) material, with or without a strap. A custom mouth guard gives the athlete a more comfortable fit, the best protection, and is well worth the cost investment. This properly fitted mouth guard stays in place on its own, no biting required. It is least likely to interfere with speech or breathing. As a result of this, the athlete will not fatigue as rapidly in the game and will be less likely to notice the mouth guard in place.

Custom-made mouth guards can also be worn over fixed dental appliances such as orthodontic braces where it will help protect the soft oral tissues from lacerations from the metal in the appliances. The mouth guards also are important for the protection of fixed crown and bridgework, as well as the protective the role of cushioning the jaw and brain from blows even for people with few or no natural teeth remaining.

In conclusion, as I urge you to take a more active role in promoting the use of sport mouth guards to the coaches and athletes of team sports, let us also not forget the increasing number of youth and adults engaging in high-risk recreational sports. The threat of oral facial injuries and concussions are just as important in such individual sports as in-line skating, horseback riding, mountain biking, skateboarding, downhill skiing, surfing, and weight lifting. So spread the word and be a role model. Do you wear a properly fitted custom mouth guard when you enjoy your favorite sport?