Why wear a mouth guard?

Why Wear a Mouth Guard?

Each year approximately 10,000 primary school children in Ireland damage one or more of their front permanent teeth. This figure, taken from recent research carried out by HSE West, is consistent with international research and previous epidemiological research on children’s dental health in Ireland. The extent of the damage can range from a small chip fracture to a front tooth, to a fracture of the root of the tooth and in some cases, a tooth knocked out of the mouth completely. The cost of treatment can be substantial for the initial emergency visit and for the follow up long-term care that is eventually required in most cases. Most chip fractures are treated by tooth-coloured fillings initially but eventually a crown or permanent cap is required. In more complicated cases a root treatment, a bridge, an implant or even orthodontic treatment may be required to correct the damage caused by a sports injury. This treatment can take several years to complete and cost several thousand euro. All of this could be prevented in the first place if mouth guards were worn when playing contact sports.

What is current practice in Ireland?

Up to recently, wearing of mouth guards was optional for children in many sports varying from 5% usage in soccer to a high of 60% in rugby. The recent decision of the GAA to make wearing of mouth guards compulsory for children playing Gaelic from January 2013 is a welcome development. However, with over two thirds of schools and sports clubs reported as not having a policy on mouth guard use, it is obvious that parents will need to become much more vocal in advocating for change on this important oral health issue.

How effective are mouthguards at preventing dental injuries?

Ice hockey is the most dangerous sport in the world when it comes to dental injuries. In Ireland anecdotal evidence would indicate that gaelic football, hurling, rugby, hockey, soccer, basketball and boxing are all high risk for dental injuries. Other pursuits like skate boarding and rollerblading also carry significant risk of facial and dental injury. In Canada the introduction of compulsory wearing of mouth guards in professional ice hockey resulted in a decrease in the annual rate of dental injuries from 8% to 1%. In the USA over a 14 year period there has been a dramatic reduction in the annual incidence of dental injuries following the introduction of face masks and later mouth guards. Similar reductions were achieved in basketball over the same period following the introduction of mouth guards.

Which type of mouth guard is the most effective?

There are three types of mouth guard

1. Stock mouth guard
These are the cheapest. They are made of latex rubber or polyvinyl chloride and come in three sizes. They are of little or no value and may in fact be unsafe as they interfere with breathing and speech and do not redistribute forces on impact.

2. Boil to fit mouth guard
These are the most widely available type of mouth guard and can be bought in most sports stores. This mouth guard comes in a kit of the ‘do it yourself’ variety consisting of a fairly rigid outer shell and a soft but resilient heat or self cured lining. Once the
lining is softened in boiling water, the person bites down to help it take the shape of their mouth. However, by biting down the thickness of the mouth guard is reduced therefore reducing effectiveness. Because of their bulkiness, these mouthguards can be uncomfortable to wear. On the positive side they are relatively inexpensive and do provide a basic level of protection.

3. Custom made mouth guard
These provide the highest level of protection. A randomised controlled trial in Australia concluded that there was a significant protective effect of custom made mouth guards relative to all other types of mouth protectors. This effect was enhanced when custom made mouth guards were worn during both practice and play sessions. A recommendation that all Australian football players should wear custom made mouth guards has been accepted by sporting authorities in Australia. Custom fitted mouth guards are constructed and fitted to the shape of the mouth. The essential difference between this and other varieties is that the guard is constructed on a plaster model replica of the teeth made from an impression of the teeth taken by a dental professional. This results in a mouth guard that is comfortable and fits more snugly on the teeth. Because of the better fit, breathing and swallowing is easier and speech is less affected. Because of the laboratory construction technique a minimum of 4mm thickness is guaranteed enabling the redistribution of forces when there is an impact or trauma to the face.
These mouth guards are more expensive because of the additional steps taken during construction. However, this additional expense is more than compensated for by the additional advantages and effectiveness associated with wearing this type of mouth guard.

It is worth noting that for children under the age of 12 where the dentition is changing rapidly a custom made mouthguard is unlikely to last for more than 12 months and boil to fit gumshields will be a more cost effective option. Our dentists will discuss with you whether your child is suitable for a custom made mouth guard.

How to care for your mouth guard

- Rinse in cold water before use
- After use, dry and store in a plastic container with air vents to allow the air to circulate
- Once in a while, clean with a mild detergent and rinse thoroughly
- Store in a cool place as mouth guards can distort if left in the sun or hot water
- Bring along when visiting the dentist to ensure that it still fits properly

Mouth guards and orthodontic treatment

An Orthodontist will advise on the correct type of mouth guard for people wearing braces while playing contact sports. Separate upper and lower custom made mouth guards may be required. Removable orthodontic appliances should be removed when playing any type of contact sports. Custom made mouth guards should be an essential part of the kit of every child and adult playing contact sports in Ireland. Much unnecessary and avoidable permanent injury to the face and teeth costing families thousands of euros could be prevented if wearing of custom made mouth guards was made compulsory for all contact sports in this country.