Mouthguard

Last updated

Mouthguard worn in handball, a contact sport Franck Junillon 04.jpg
Mouthguard worn in handball, a contact sport
An example of a mouthguard used in the treatment of bruxism Knirscherschiene.jpg
An example of a mouthguard used in the treatment of bruxism

A mouthguard is a protective device for the mouth that covers the teeth and gums to prevent and reduce injury to the teeth, arches, lips 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. [1] A mouthguard is most often used to prevent injury in contact sports, as a treatment for bruxism or TMD, or as part of certain dental procedures, such as tooth bleaching or sleep apnea treatment. Depending on the 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.

Contents

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. [2]

Custom-made

Vacuum form mouthguard made from an impression using dental alginate. Vacuum-form mouth guard.jpg
Vacuum form mouthguard made from an impression using dental alginate.

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 material. In the EU, the guard must be sold with a CE mark and the guard must have passed an EC Type-Examination test, performed by an accredited European Notified Body.

Dentistry

Occlusal splint Aufbissschiene.jpg
Occlusal splint

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. [3]

They are used to protect tooth and restoration surfaces, manage mandibular (jaw) dysfunction TMD, and stabilize the jaw joints during occlusion or create space prior to restoration procedures. People prone to nocturnal bruxism, or nighttime clenching, as well as morsicatio buccarum 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." [4]

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. [5]

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. [6]

Usage

History

The exact origins of the mouthguard are unclear. Most evidence indicates that the concept of a mouthguard was initiated in the sport of boxing. 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. [17] 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, over the maxillary incisors of boxers before they entered the ring. [18] 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. [19]

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. [20] 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. [19] 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. [21] 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, described how custom mouthguards could be manufactured from impressions using wax and rubber. Steel springs were even recommended to reinforce soft materials. [21]

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. [22] He immediately received nationwide recognition as the father of the modern mouthguard for athletes. [23] 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.

American Football mouthguard Football mouthguard.jpg
American Football mouthguard

In the 1940s and 1950s, dental injuries were responsible for 24-50% of all injuries in American football. [21] In 1952, Life magazine did a report on Notre Dame football players without incisors. [24] 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. [25] 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. [26]

Mouthguards have become a standard in many sports. In addition to football, the NCAA currently requires mouthguards in ice hockey, field hockey, and lacrosse. 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, basketball, bicycling, boxing, equestrian, football, gymnastics, handball, ice hockey, inline skating, lacrosse, martial arts, racquetball, rugby football, shot putting, skateboarding, skiing, skydiving, soccer, softball, squash, surfing, volleyball, water polo, weightlifting and wrestling. [26] Mouthguard use during Gaelic football games and training is mandatory at all levels. [27]

See also

Related Research Articles

<span class="mw-page-title-main">Temporomandibular joint dysfunction</span> Medical condition

Temporomandibular joint dysfunction is an umbrella term covering pain and dysfunction of the muscles of mastication and the temporomandibular joints. The most important feature is pain, followed by restricted mandibular movement, and noises from the temporomandibular joints (TMJ) during jaw movement. Although TMD is not life-threatening, it can be detrimental to quality of life; this is because the symptoms can become chronic and difficult to manage.

<span class="mw-page-title-main">Bruxism</span> Disorder that involves involuntarily grinding or clenching of the teeth

Bruxism is excessive teeth grinding or jaw clenching. It is an oral parafunctional activity; i.e., it is unrelated to normal function such as eating or talking. Bruxism is a common behavior; reports of prevalence range from 8% to 31% in the general population. Several symptoms are commonly associated with bruxism, including aching jaw muscles, headaches, hypersensitive teeth, tooth wear, and damage to dental restorations. Symptoms may be minimal, without patient awareness of the condition. If nothing is done, after a while many teeth start wearing down until the whole tooth is gone.

<span class="mw-page-title-main">Dental braces</span> Form of orthodontics

Dental braces are devices used in orthodontics that align and straighten teeth and help position them with regard to a person's bite, while also aiming to improve dental health. They are often used to correct underbites, as well as malocclusions, overbites, open bites, gaps, deep bites, cross bites, crooked teeth, and various other flaws of the teeth and jaw. Braces can be either cosmetic or structural. Dental braces are often used in conjunction with other orthodontic appliances to help widen the palate or jaws and to otherwise assist in shaping the teeth and jaws.

Prosthodontics, also known as dental prosthetics or prosthetic dentistry, is the area of dentistry that focuses on dental prostheses. It is one of 12 dental specialties recognized by the American Dental Association (ADA), Royal College of Surgeons of England, Royal College of Surgeons of Edinburgh, Royal College of Surgeons of Ireland, Royal College of Surgeons of Glasgow, Royal College of Dentists of Canada, and Royal Australasian College of Dental Surgeons. The ADA defines it as "the dental specialty pertaining to the diagnosis, treatment planning, rehabilitation and maintenance of the oral function, comfort, appearance and health of patients with clinical conditions associated with missing or deficient teeth or oral and maxillofacial tissues using biocompatible substitutes."

The Nociceptive trigeminal inhibition tension suppression system, is a type of occlusal splint that is claimed to prevent headache and migraine by reducing sleep bruxism. Sleep bruxism is purported to lead to a hyperactivity of the trigeminal nerve, often triggering typical migraine events. The hyperactivity of trigeminal neurons during trigemino-nociceptive stimulation is a proposed cause of migraine and is correlated with imaging of migraine sufferers. The objective of the NTI-TSS is to relax the muscles involved in clenching and bruxing, thus supposedly diminishing the chances for migraines and tension headaches to develop through the reduction in nociceptive stimulation normally caused by parafunctional activity. It is sometimes used for temporomandibular joint dysfunction (TMD).

<span class="mw-page-title-main">Articulator</span>

An articulator is a mechanical hinged device used in dentistry to which plaster casts of the maxillary (upper) and mandibular (lower) jaw are fixed, reproducing some or all the movements of the mandible in relation to the maxilla. The human maxilla is fixed and the scope of movement of the mandible is dictated by the position and movements of the bilateral temperomandibular joints, which sit in the glenoid fossae in the base of the skull. The temperomandibular joints are not a simple hinge but rotate and translate forward when the mouth is opened.

<span class="mw-page-title-main">Dental attrition</span>

Dental attrition is a type of tooth wear caused by tooth-to-tooth contact, resulting in loss of tooth tissue, usually starting at the incisal or occlusal surfaces. Tooth wear is a physiological process and is commonly seen as a normal part of aging. Advanced and excessive wear and tooth surface loss can be defined as pathological in nature, requiring intervention by a dental practitioner. The pathological wear of the tooth surface can be caused by bruxism, which is clenching and grinding of the teeth. If the attrition is severe, the enamel can be completely worn away leaving underlying dentin exposed, resulting in an increased risk of dental caries and dentin hypersensitivity. It is best to identify pathological attrition at an early stage to prevent unnecessary loss of tooth structure as enamel does not regenerate.

Occlusion, in a dental context, means simply the contact between teeth. More technically, it is the relationship between the maxillary (upper) and mandibular (lower) teeth when they approach each other, as occurs during chewing or at rest.

<span class="mw-page-title-main">Crossbite</span> Medical condition

Crossbite is a form of malocclusion where a tooth has a more buccal or lingual position than its corresponding antagonist tooth in the upper or lower dental arch. In other words, crossbite is a lateral misalignment of the dental arches.

Dental pertains to the teeth, including dentistry. Topics related to the dentistry, the human mouth and teeth include:

<span class="mw-page-title-main">Cracked tooth syndrome</span> Medical condition

Cracked tooth syndrome (CTS) is where a tooth has incompletely cracked but no part of the tooth has yet broken off. Sometimes it is described as a greenstick fracture. The symptoms are very variable, making it a notoriously difficult condition to diagnose.

<span class="mw-page-title-main">Dental trauma</span> Medical condition

Dental trauma refers to trauma (injury) to the teeth and/or periodontium, and nearby soft tissues such as the lips, tongue, etc. The study of dental trauma is called dental traumatology.

<span class="mw-page-title-main">Dislocation of jaw</span> Medical condition

Dislocations occur when two bones that originally met at the joint detach. Dislocations should not be confused with subluxation. Subluxation is when the joint is still partially attached to the bone.

<span class="mw-page-title-main">Dental avulsion</span> Medical condition

Dental avulsion is the complete displacement of a tooth from its socket in alveolar bone owing to trauma, such as can be caused by a fall, road traffic accident, assault, sports, or occupational injury. Typically, a tooth is held in place by the periodontal ligament, which becomes torn when the tooth is knocked out.

Dentomandibular sensorimotor dysfunction (DMSD) is a medical condition involving the mandible, upper three cervical (neck) vertebrae, and the surrounding muscle and nerve areas.

<span class="mw-page-title-main">Bite registration</span>

Bite registration is a technique carried out in dental procedures, by taking an impression of the teeth, to capture the way the teeth meet together. This is then used to accurately make restorations which will not change the position the teeth meet in.

<span class="mw-page-title-main">Tooth mobility</span> Medical condition

Tooth mobility is the horizontal or vertical displacement of a tooth beyond its normal physiological boundaries around the gingival (gum) area, i.e. the medical term for a loose tooth.

A complete denture is a removable appliance used when all teeth within a jaw have been lost and need to be prosthetically replaced. In contrast to a partial denture, a complete denture is constructed when there are no more teeth left in an arch; hence, it is an exclusively tissue-supported prosthesis. A complete denture can be opposed by natural dentition, a partial or complete denture, fixed appliances or, sometimes, soft tissues.

<span class="mw-page-title-main">Posselt's envelope of motion</span> The range of movement of the mandible

Posselt's envelope of motion or Posselt's envelope of movement refers to the range of motion of the lower jaw bone, or mandible.

References

Footnotes

  1. ↑ "The Importance Of A Mouthguard When Playing Sport". Orthodontics Australia. 21 February 2020. Retrieved 24 September 2020.
  2. ↑ Zadik Y, Levin L (February 2009). "Does a free-of-charge distribution of boil-and-bite mouthguards to young adult amateur sportsmen affect oral and facial trauma?". Dent Traumatol. 25 (1): 69–72. doi:10.1111/j.1600-9657.2008.00708.x. PMID   19208013.
  3. ↑ "Read This Before You Buy a Night Guard Online | JS Dental Lab". jsdentallab.com. Retrieved 9 February 2023.
  4. ↑ Jagger, R (2008). "The effectiveness of occlusal splints for sleep bruxism". Evid-Based Dent. 9 (1): 23. doi: 10.1038/sj.ebd.6400569 . PMID   18364692.
  5. ↑ Leib, A. M. (November 1996). "The occlusal bite splint--a noninvasive therapy for occlusal habits and temporomandibular disorders". Compendium of Continuing Education in Dentistry (Jamesburg, N.J.: 1995). 17 (11): 1081–1084, 1086, 1088. ISSN   1548-8578. PMID   9161143.
  6. ↑ Srivastava, Rahul; Jyoti, Bhuvan; Devi, Parvathi (2013). "Oral splint for temporomandibular joint disorders with revolutionary fluid system". Dental Research Journal. 10 (3): 307–313. ISSN   1735-3327. PMC   3760352 . PMID   24019797.
  7. ↑ NZ Dental Association advice Archived 2007-06-29 at the Wayback Machine
  8. ↑ "Do mouthguards prevent concussion?"
  9. ↑ "...mouthguards became compulsory in 1997..." Archived 2005-12-02 at archive.today
  10. ↑ Zadik Y, Jeffet U, Levin L (December 2010). "Prevention of dental trauma in a high-risk military population: the discrepancy between knowledge and willingness to comply". Mil Med. 175 (12): 1000–1003. doi: 10.7205/MILMED-D-10-00150 . PMID   21265309.
  11. ↑ Zadik Y, Levin L (December 2008). "Orofacial injuries and mouth guard use in elite commando fighters". Mil Med. 173 (12): 1185–1187. doi: 10.7205/milmed.173.12.1185 . PMID   19149336.
  12. 1 2 Teeth grinding. Bruxism. https://www.nhs.uk/
  13. ↑ Brad W. Neville; Douglas D. Damm; Carl M. Allen; Jerry E. Bouquot (2002). Oral & maxillofacial pathology (2nd ed.). Philadelphia: W.B. Saunders. pp. 253–254. ISBN   0721690033.
  14. ↑ Various scientific articles on NCBI on the use of transparent aligners
  15. ↑ Quinnell, Timothy G.; et al. (17 July 2014). "A crossover randomised controlled trial of oral mandibular advancement devices for obstructive sleep apnoea-hypopnoea (TOMADO)". Thorax. 2014 (69): 938–945. doi: 10.1136/thoraxjnl-2014-205464 . PMID   25035126.
  16. ↑ Deane, S. A.; Cistulli, P. A.; Ng, A. T.; Zeng, B.; Petocz, P.; Darendeliler, M. A. (2009). "Comparison of Mandibular Advancement Splint and Tongue Stabilizing Device in Obstructive Sleep Apnea: A Randomized Controlled Trial". Sleep. 32 (5): 648–653. doi:10.1093/sleep/32.5.648. PMC   2675900 . PMID   19480232.
  17. ↑ Knapik JJ, Marshall SW, Lee RB, Darakjy SS, Jones SB, Mitchener TA, Jones BH (2007). "Mouthguards in Sport Activities". Sports Medicine. 37 (2): 117–44. doi:10.2165/00007256-200737020-00003. PMID   17241103. S2CID   35006939.
  18. ↑ Reed RV (1994). "Origin and early history of the dental mouthpiece". British Dental Journal. 176 (12): 478–80. doi:10.1038/sj.bdj.4808485. PMID   8031630. S2CID   6215999.
  19. 1 2 Knapik et al., 2007, p. 120.
  20. ↑ Pontsa, Peter T. (2008). Mouth Guards Prevent Dental Trauma in Sports. The Dent-Liner 12 (3).
  21. 1 2 3 Knapik et al., 2007, p. 121.
  22. ↑ "Acrylic Splints for Athletes: Transparent Slip Casings for the Teeth as a Protection From Blows". Journal of the American Dental Association. 36 (1): 109–110. 1948.
  23. ↑ "Protecting Athletes' Teeth." Pittsburgh Post-Gazette 21.162 (Feb. 6, 1948) 18.
  24. ↑ The fighting Irish look tough again. Life Magazine 1952; 33: 60-63.
  25. ↑ Ada Council On Access, Prevention Interprofessional Relations; ADA Council on Scientific Affairs (2006). "Using Mouthguards to Reduce the Incidence and Severity of Sports-related Oral Injuries". Journal of the American Dental Association. 137 (12): 1712–1720. doi:10.14219/jada.archive.2006.0118. PMID   17138717.
  26. 1 2 Knapik, et al., 2007, p. 121.
  27. ↑ "Former Meath goalie highlights importance of wearing mouthguard after suffering gruesome lip injury". Hogan Stand. 6 February 2021.
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