Mouthguards: Important Safety Equipment

What youth sports have the most mouth injuries?

If you answered football or hockey, you would be wrong! Because the use of mouth guards in youth and high school football, lacrosse, and ice hockey has been mandatory since the early 1970's, these sports have experienced a dramatic decline in the number of dental and jaw injuries. Instead, published reports show that the majority of mouth injuries occur in such popular youth sports as baseball, basketball, soccer, field hockey, softball and gymnastics, which lag far behind in injury protection. Recent studies also report that oral and facial injuries to female athletes exceed those in males. According to a study published in the Journal of Pediatric Dentistry, roughly three times as many mouth injuries occur on the basketball court as on the football field. Most of these injuries could have been prevented with the simple use of a mouth guard.

Are mouth injuries serious?

You bet they are. Injuries to the mouth and jaw - broken, cracked and lost teeth, jaw and joint fractures - are painful and hard to treat:

• Severe jaw and joint injuries may require surgery and general anesthesia, which requires hospitalization and wiring the jaw shut for 30 days to let the injury heal.

• A lost tooth must be re-implanted or false teeth made and fitted. Although easier to treat than a broken or fractured jaw, lost teeth are just as painful.

• Players wearing braces can sustain serious mouth lacerations if the braces are hit with a ball or by another player. These types of injuries may call for extensive repair and lengthen orthodontic treatment time.

There are 3 main types of mouth guards:

1. Stock. The least expensive, stock type mouth guards cost about $2.00 and come in three sizes: small, medium and large. You get what you pay for in terms of fit. Some users complain that they are too wide in the back, making it harder to talk.

2. Boil and Bite. A semi-custom fit can be made using a "boil and bite" model mouth guard. Hot water is used to soften the plastic and your child then bites into the guard, molding it to his or her teeth. This type of mouth guard sells for between $5 and $15 and offers very good protection.

3. Custom. A dentist or orthodontist makes the best fitting mouth guards in a dental office. Not surprisingly, this kind of mouth guard is the most expensive of the three, costing between $35 and $65. Custom mouth guards are the best option if your child plays a number of sports each year or plays sports with continuous activity, like basketball or soccer, and is advised for a child with braces so that the mouth guard won't interfere with treatment (for more on mouthguards for children with braces, click here). Once a child reaches age 13 or 14, a custom fitted mouth guard should generally continue to fit for as long as needed.

No one type of mouth guard is recognized as providing more protection. "The key point is to play it safe," says Dr. Hugh R. Phillis, a trustee of the American Association of Orthodontists and orthodontist in Nashua, New Hampshire. "Any mouth guard is better than none," he says.

What kinds of injuries do mouth guards prevent? 

Mouth guards, regardless of type, help prevent injury to the mouth, teeth, lips, cheeks and tongue.   Mouth guards worn by players with braces may even prevent injury to another player caused by contact with the braces. They also cushion blows that might cause jaw fractures.

Whether they also protect against concussion is unclear. According to the National Association of Athletic Trainers' 2004 Position Statement on the Management of Sport-Related Concussion, the "wearing of a mouth guard is thought by some to provide additional protection for the athlete against concussion by either reducing the risk of injury or reducing the severity of the injury itself." The NATA notes, however, that there the absence of biomechanical studies to support the theory that mouth guards result in less force being delivered to the brain at the point of head contact.

Even though a mouth protector is worn, it is still, however, possible for a tooth to be knocked out; however, the wearing of a protector will reduce tooth injuries to a minimum

Require frequent replacement.

A new study published in the September/October issue of Sports Health: A Multidisciplinary Approach found that mouthguards may increase the number and intensity of mouth cuts and abrasions, exposing an athlete to an increased chance of infection due to the bacteria, yeast, and fungi that mouthguards routinely collect.

Researchers stress that even with the increase in oral lesions, mouthguards are still an important piece of safety equipment for contact sports. "By no means should the value of a mouth guard be discounted," Glass emphasizes. "The protection they do offer teeth during contact sports is important. However, the length of time that a mouthguard is used and how often it is cleaned needs to be revised."

As a result, they now recommend four safety steps:

1. Replace reguarly or when mouthguard becomes sharp or jagged.   A mouthguard should be replaced as soon as it becomes distorted or develops sharp jagged edges or after 14 days of regular use, whichever comes first; 

2. Replace if oral irritation or ulcer. Because  the molds from mouthguards may cause exercise-induced asthma and allergies, mouthguards should be replaced whenever an athlete develops any type of oral lesion (mouth sore) or respiratory distress;

3. Sanitize daily. Because mouthguards have a natural ability to become a breeding ground for bacteria, fungi, and mold, they should be sanitized on a daily basis using a commercially available antimicrobial denture-cleansing solution; and

4. Ongoing oral exams.  Athletes' mouths should be examined on an ongoing basis while they are using mouthguards. 

"This study stresses the importance of informing athletes of the danger of not properly taking care of a mouthguard. A mouthguard will do your mouth good only if you keep it in good shape," adds Glass.

In what sports should mouth guards be worn? 

The American Academy of Pediatric Dentistry recommends a sports mouth guard for all youth competition, regardless of age. The American Dental Association recommends mouth guards for the following sports:

Some athletic associations are getting the message. In the fall of 1999, for instance, the Massachusetts Interscholastic Athletic Association, the governing body in the state for high school athletics, made mouth guards mandatory for junior varsity and varsity soccer players for the first time. Mouth guards may soon become mandatory in other sports as well.