A mouthguard is a protective device for the mouth that covers the teeth and gums to prevent and reduce injury to the

teeth A tooth ( : teeth) is a hard, calcified structure found in the jaws (or mouths) of many vertebrates and used to break down food. Some animals, particularly carnivores and omnivores, also use teeth to help with capturing or wounding prey, t ...

, arches,

lip The lips are the visible body part at the mouth of many animals, including humans. Lips are soft, movable, and serve as the opening for food intake and in the articulation of sound and speech. Human lips are a tactile sensory organ, and can be ...

s and gums. An effective mouthguard is like a crash helmet for teeth and jaws. It also prevents the jaws coming together fully, thereby reducing the risk of jaw joint injuries and concussion. A mouthguard is most often used to prevent injury in

contact sports Contact sports are sports that emphasize or require physical contact between players. Some sports, such as mixed martial arts, are scored on impacting an opponent, while others, including rugby football, gridiron football and Australian rules foot ...

, as a treatment for bruxism or TMD, or as part of certain dental procedures, such as

tooth bleaching Tooth whitening or tooth bleaching is the process of lightening the color of human teeth. Whitening is often desirable when teeth become yellowed over time for a number of reasons, and can be achieved by changing the intrinsic or extrinsic color o ...

sleep apnea Sleep apnea, also spelled sleep apnoea, is a sleep disorder in which pauses in breathing or periods of shallow breathing during sleep occur more often than normal. Each pause can last for a few seconds to a few minutes and they happen many tim ...

treatment. Depending on application, it may also be called a mouth protector, mouth piece, gumshield, gumguard, nightguard, occlusal splint, bite splint, or bite plane. The dentists who specialise in sports dentistry fabricate mouthguards.

Types

Stock or ready made

Manufactured in a pre-formed shape in various sizes but with nearly no adjustment to fit the user's mouth. The only adjustment possible is minor trimming with a knife or scissors.

Mouth adapted or "boil and bite"

A thermoplastic material manufactured in a pre-formed shape in various sizes that can be adapted to fit more closely to an individual's teeth and gums by heating and molding such as boiling then placing in the mouth. Some are now available that incorporate special fins within the fitting zones which increase retention and give an improved fit over traditional boil and bite mouth types. Guards are usually made of Ethylene-vinyl acetate, commonly known as EVA. Some of the newer technologies offer an alternative, stronger thermo-polymer that allows for lower molding temperatures, below 140F to prevent burning by scalding hot water. This is the most popular mouthguard used by amateur and semi-professional sportsmen, providing adequate protection but relatively low comfort in comparison to the custom-made guard.

Custom-made

An impression of the user's teeth is used to create a best-fit mouth protector. The impression may be obtained by using a specially designed impression kit that uses dental putty, or from a dentist who will take an impression in dental

alginate Alginic acid, also called algin, is a naturally occurring, edible polysaccharide found in brown algae. It is hydrophilic and forms a viscous gum when hydrated. With metals such as sodium and calcium, its salts are known as alginates. Its colour ...

material. In the EU, the guard must be sold with a

CE mark On commercial products, the letters CE (as the logo ) mean that the manufacturer or importer affirms the good's conformity with European health, safety, and environmental protection standards. It is not a quality indicator or a certificat ...

and the guard must have passed an EC Type-Examination test, performed by an accredited European Notified Body. *Vacuum form **Custom-made mouth guards using this type of machine produce single layer mouth guards **Fit not as good as pressure laminated but offers more protection than boil and bite *Pressure laminated **Custom-made mouth guards using this type of machine produce multi-layer mouth guards **Offers superior fit, comfort and more protection *Impressionless **Made from a medical-grade thermo polymer, the guards are activated with hot (not boiling) water and create a custom comfort fit, completely unique to the shape of the mouth. **1.6 mm thin, Remoldable, Works with braces, Stays secure in mouth during the entire game or practice **Allows athletes to talk, breathe and drink naturally

Dentistry

Occlusal splints (also called bite splints, bite planes, or night guards) are removable dental appliances carefully molded to fit the upper or lower arches of teeth. They are used to protect tooth and restoration surfaces, manage mandibular (jaw) dysfunction TMD, and stabilize the jaw joints during

occlusion Occlusion may refer to: Health and fitness * Occlusion (dentistry), the manner in which the upper and lower teeth come together when the mouth is closed * Occlusion miliaria, a skin condition * Occlusive dressing, an air- and water-tight trauma ...

or create space prior to restoration procedures. People prone to nocturnal bruxism, or nighttime clenching, as well as

morsicatio buccarum Morsicatio buccarum is a condition characterized by chronic irritation or injury to the buccal mucosa (the lining of the inside of the cheek within the mouth), caused by repetitive chewing, biting or nibbling. Signs and symptoms The lesions are ...

may routinely wear occlusal splints at night. However, a meta-analysis of occlusal splints used for this purpose concluded "There is not enough evidence to state that the occlusal splint is effective for treating sleep bruxism. An indication of its use is questionable concerning sleep outcomes, but there may be some benefit with regard to

tooth wear Tooth wear refers to loss of tooth substance by means other than dental caries. Tooth wear is a very common condition that occurs in approximately 97% of the population. This is a normal physiological process occurring throughout life; but with i ...

." Occlusal splints are typically made of a heat-cured acrylic resin. Soft acrylic or light cured composite, or vinyl splints may be made more quickly and cheaply, but are not as durable, and are more commonly made for short-term use. Soft splints are also used for children because normal growth changes the fit of hard splints. They cover all the teeth of the upper or lower arch, but partial coverage is sometimes used. Occlusal splints are usually used on either the upper or the lower teeth, termed maxillary splints or mandibular splints respectively, but sometimes both types are used at the same time. Maxillary splints are more common, although various situations favor mandibular splints. Stabilizing or Michigan-type occlusal splints are generally flat against the opposing teeth, and help jaw muscle relaxation, while repositioning occlusal splints are used to reposition the jaw to improve occlusion.

Usage

* Dental trauma **Mouthguards are used in sports where deliberate or accidental impacts to the face and jaw may cause harm. Such impacts may occur in many sports including

baseball Baseball is a bat-and-ball sport played between two teams of nine players each, taking turns batting and fielding. The game occurs over the course of several plays, with each play generally beginning when a player on the fielding t ...

boxing Boxing (also known as "Western boxing" or "pugilism") is a combat sport in which two people, usually wearing protective gloves and other protective equipment such as hand wraps and mouthguards, throw punches at each other for a predetermine ...

mixed martial arts Mixed martial arts (MMA), sometimes referred to as cage fighting, no holds barred (NHB), and ultimate fighting, and originally referred to as Vale Tudo is a full-contact combat sport based on striking, grappling and ground fighting, inc ...

puroresu is the predominant style of professional wrestling that has developed in Japan. The term comes from the Japanese pronunciation of , which is shortened to puroresu. The term became popular among English-speaking fans due to Hisaharu Tanabe's ac ...

, rugby,

wrestling Wrestling is a series of combat sports involving grappling-type techniques such as clinch fighting, throws and takedowns, joint locks, pins and other grappling holds. Wrestling techniques have been incorporated into martial arts, combat ...

football (soccer) Association football, more commonly known as football or soccer, is a team sport played between two teams of 11 players who primarily use their feet to propel the ball around a rectangular field called a pitch. The objective of the game is ...

, gridiron football, Gaelic football, Australian football,

lacrosse Lacrosse is a team sport played with a lacrosse stick and a lacrosse ball. It is the oldest organized sport in North America, with its origins with the indigenous people of North America as early as the 12th century. The game was extensiv ...

basketball Basketball is a team sport in which two teams, most commonly of five players each, opposing one another on a rectangular court, compete with the primary objective of shooting a basketball (approximately in diameter) through the defender's h ...

figure skating Figure skating is a sport in which individuals, pairs, or groups perform on figure skates on ice. It was the first winter sport to be included in the Olympic Games, when contested at the 1908 Olympics in London. The Olympic disciplines are m ...

ice hockey Ice hockey (or simply hockey) is a team sport played on ice skates, usually on an ice skating rink with lines and markings specific to the sport. It belongs to a family of sports called hockey. In ice hockey, two opposing teams use ice h ...

underwater hockey Underwater hockey (UWH), (also known as Octopush in the United Kingdom) is a globally played limited-contact sport in which two teams compete to manoeuvre a puck across the bottom of a swimming pool into the opposing team's goal by propelling ...

field hockey Field hockey is a team sport structured in standard hockey format, in which each team plays with ten outfield players and a goalkeeper. Teams must drive a round hockey ball by hitting it with a hockey stick towards the rival team's shooting ...

water polo Water polo is a competitive sport, competitive team sport played in water between two teams of seven players each. The game consists of four quarters in which the teams attempt to score goals by throwing the water polo ball, ball into the oppo ...

skiing Skiing is the use of skis to glide on snow. Variations of purpose include basic transport, a recreational activity, or a competitive winter sport. Many types of competitive skiing events are recognized by the International Olympic Committee ( ...

, and snowboarding. Mouthguards may also prevent or reduce harm levels of concussion in the event of an injury to the jaw. In many sports, the rules of the sport make their use compulsory, or local health laws demand them. Schools also often have rules requiring their use. Studies in various high risk populations for dental injuries are repeatedly reporting of a low compliance of individuals for the regular using of mouthguard during activities. Moreover, even with regular use, effectiveness in prevention on dental trauma is not complete, and injuries can still occur even when mouthguards are used as users are not always aware of the best makes or size, which inevitably result in a poor fit. *

Oral medicine An oral medicine or stomatology doctor (or stomatologist) has received additional specialized training and experience in the diagnosis and management of oral mucosal abnormalities (growths, ulcers, infection, allergies, immune-mediated and autoim ...

**Mouthguards may be used as splints to reduce strain over the

temporomandibular joint In anatomy, the temporomandibular joints (TMJ) are the two joints connecting the jawbone to the skull. It is a bilateral synovial articulation between the temporal bone of the skull above and the mandible below; it is from these bones that it ...

in temporomandibular joint disorderTeeth grinding. Bruxism. https://www.nhs.uk/
/ref> **To prevent tooth attrition in bruxism **To deliver topical medication (e.g., corticosteroids) for chronic gingival diseases such as mucous membrane pemphigoid. **As a therapeutic device in the treatment of

. *Dental aesthetics **During

**As a night protector of thin porcelain bridges * Orthodontics **Transparent or clear aligner, which is basically an acrylic thermoplastic splints, used to correct a series of different malocclusions. Not all malocclusions can be corrected with transparent aligners, only mild and moderate malocclusions. They can be used alone or in combination with brackets. There are many brands. **Two types of mouthguards, the mandibular advancement device (MAD) and the tongue stabilizing device (TSD), are used for treating sleep apnea and snoring

History

The exact origins of the mouthguard are unclear. Most evidence indicates that the concept of a mouthguard was initiated in the sport of

. Originally, boxers fashioned rudimentary mouthguards out of cotton, tape, sponge, or small pieces of wood. Boxers clenched the material between their teeth. These boxers had a hard time focusing on the fight and clenching their teeth at the same time. Since these devices proved impractical, Woolf Krause, a British dentist, began to fashion mouthpieces for boxers in 1892. Krause placed strips of a natural rubber resin,

gutta-percha Gutta-percha is a tree of the genus ''Palaquium'' in the family Sapotaceae. The name also refers to the rigid, naturally biologically inert, resilient, electrically nonconductive, thermoplastic latex derived from the tree, particularly from ...

, over the maxillary incisors of boxers before they entered the ring. Phillip Krause, Woolf Krause’s son, is often credited with the first reusable mouthpiece. Phillip Krause’s invention was highlighted in a 1921 championship fight between Jack Britton and Ted "Kid" Lewis. Lewis was a school friend of Krause and the first professional to utilize the new technology, then called a ‘gum shield.’ During the fight, Britton’s manager successfully argued that the mouthpiece was an illegal advantage. Philip Krause was an amateur boxer himself and undoubtedly used his device before 1921.Knapik et al., 2007, p. 120. There have been other claims to the invention of the mouthguard as well. In the early 1900s, Jacob Marks created a custom-fitted mouthguard in London. An American dentist, Thomas A. Carlos, also developed a mouth guard at approximately the same time as Krause. Carlos claimed that he made his first mouthpiece in 1916 and later suggested his invention to the United States Olympian Dinnie O’Keefe in 1919. Another dentist from Chicago, E. Allen Franke, also claimed to have made many mouth guards for boxers by 1919. The mouthguard’s relevance was again brought to the center of attention in a 1927 boxing match between Jack Sharkey and Mike McTigue. McTigue was winning for most of the fight, but a chipped tooth cut his lip, and he was forced to forfeit the match. From that point on, mouthguards were ruled acceptable and soon became commonplace for all boxers.Knapik et al., 2007, p. 121. In 1930, descriptions of mouthguards first appeared in dental literature. Dr. Clearance Mayer, a dentist and boxing inspector for the

New York State Athletic Commission The New York State Athletic Commission or NYSAC, also known as the New York Athletic Commission, is a division of the New York State Department of State which regulates all contests and exhibitions of unarmed combat within the state of New York, ...

, described how custom mouthguards could be manufactured from impressions using wax and rubber. Steel springs were even recommended to reinforce soft materials. In 1947, a Los Angeles dentist, Rodney O. Lilyquist, made a breakthrough by using transparent acrylic resin to form what he termed an "acrylic splint". Molded to fit unobtrusively over the upper or lower teeth, the acrylic mouthguard was a distinct improvement over the thick mouthguard worn by boxers. It meant that the athlete could talk in a normal manner while the mouthguard was in place. In the January 1948 issue of the Journal of the American Dental Association, the procedure for making and fitting the acrylic mouthguard was described in detail by Dr. Lilyquist. He immediately received nationwide recognition as the father of the modern mouthguard for athletes. The first athlete to wear the acrylic mouthguard was a member of the UCLA basketball team, Dick Perry, who modeled the device at a convention of the Southern California Dental Association. Another early wearer was Frankie Albert, quarterback for the San Francisco 49ers. Football mouthguard

In the 1940s and 1950s, dental injuries were responsible for 24-50% of all injuries in American football. In 1952, Life magazine did a report on Notre Dame football players without incisors. The article drew a lot of public attention and led to the inclusion of mouthguards in other contact sports. In the 1950s, the American Dental Association (ADA) began researching mouthguards and soon promoted their benefits to the public. In 1960, the ADA recommended the use of latex mouthguards in all contact sports. By 1962, all high school football players in the United States were required to wear mouthguards. The National Collegiate Athletic Association (NCAA) followed suit in 1973 and made mouthguards mandatory in college football. Since the introduction of the mouthguard, the number of dental injuries has decreased dramatically.Knapik, et al., 2007, p. 121. Mouthguards have become a standard in many sports. In addition to football, the NCAA currently requires mouthguards in

, and

. The ADA shows that mouthguards are extremely effective in preventing facial injury in contact and non-contact sports. The ADA recommends mouthguards be used in 29 sports: acrobatics,

bicycling Cycling, also, when on a two-wheeled bicycle, called bicycling or biking, is the use of cycles for transport, recreation, exercise or sport. People engaged in cycling are referred to as "cyclists", "bicyclists", or "bikers". Apart from two ...

equestrian The word equestrian is a reference to equestrianism, or horseback riding, derived from Latin ' and ', "horse". Horseback riding (or Riding in British English) Examples of this are: * Equestrian sports *Equestrian order, one of the upper classes i ...

, football,

gymnastics Gymnastics is a type of sport that includes physical exercises requiring balance, strength, flexibility, agility, coordination, dedication and endurance. The movements involved in gymnastics contribute to the development of the arms, legs, s ...

, handball, ice hockey,

inline skating Inline skating is a multi-disciplinary sport and can refer to a number of activities practiced using inline skates. Inline skates typically have two to five polyurethane wheels depending on the style of practice, arranged in a single line by a ...

, lacrosse, martial arts,

racquetball Racquetball is a racquet sport and a team sport played with a hollow rubber ball on an indoor or outdoor court. Joseph Sobek invented the modern sport of racquetball in 1950, adding a stringed racquet to paddleball in order to increase velo ...

rugby football Rugby football is the collective name for the team sports of rugby union and rugby league. Canadian football and, to a lesser extent, American football were once considered forms of rugby football, but are seldom now referred to as such. The ...

, shot putting, skateboarding,

skydiving Parachuting, including also skydiving, is a method of transiting from a high point in the Atmosphere of Earth, atmosphere to the surface of Earth with the aid of gravity, involving the control of speed during the descent using a parachut ...

, soccer,

softball Softball is a game similar to baseball played with a larger ball on a smaller field. Softball is played competitively at club levels, the college level, and the professional level. The game was first created in 1887 in Chicago by George Hanc ...

squash Squash may refer to: Sports * Squash (sport), the high-speed racquet sport also known as squash racquets * Squash (professional wrestling), an extremely one-sided match in professional wrestling * Squash tennis, a game similar to squash but pla ...

, surfing,

volleyball Volleyball is a team sport in which two teams of six players are separated by a net. Each team tries to score points by grounding a ball on the other team's court under organized rules. It has been a part of the official program of the Sum ...

weightlifting Weightlifting generally refers to activities in which people lift weights, often in the form of dumbbells or barbells. People lift various kinds of weights for a variety of different reasons. These may include various types of competition; promo ...

and

. Mouthguard use during Gaelic football games and training is mandatory at all levels.

References

*Tribst, J. P. M., de Oliveira Dal Piva, A. M., Borges, A. L. S., & Bottino, M. A. (2018). Influence of custom‐made and stock mouthguard thickness on biomechanical response to a simulated impact. Dental Traumatology, 34(6), 429-437.
"Tooth surface loss; Part 3: Occlusion and splint therapy"
''British Dental Journal'', Vol. 186, No. 5, 1999-03-13, via nature.com. Retrieved on 2007-08-18. * Widmalm, Sven E
"Bite Splints in General Dental Practice"
(Website, lectures from author's homepage), University of Michigan, 2003-11-14. Retrieved on 2007-08-19. * Widmalm, Sven E
"Use and Abuse of Bite Splints"
(Website, lectures from author's homepage), University of Michigan, 2004-10-27. Retrieved on 2007-08-19.

Footnotes

{{Rugby union equipment Dental equipment Protective gear Rugby league equipment Rugby union equipment American football equipment Gaelic football equipment Martial arts equipment Lacrosse equipment