A mouthguard, also known as a gumshield, mouth protector or sports guard is an appliance that covers the teeth and surrounding mucosa with the aim of preventing or reducing trauma to the teeth, gingival tissue, lips and jaws. The device is usually worn on the maxillary arch and works by separating the maxillary and mandibular dentition, protecting the teeth from the surrounding soft tissue, absorbing or redistributing shock and/or stabilising the mandible during traumatic jaw closure. They may also play a role in preventing and reducing concussion by absorbing impact forces that would otherwise be transmitted through the base of the skull to the brain, although the evidence for this is less conclusive.
A mouthguard will usually fall into one of three categories: stock mouthguards (which are made ready to use and are believed to give the least protection), the mouth-formed or 'boil and bite’ type (which are heated in hot water, placed in the mouth and moulded to the teeth) and custom-made mouthguards (which are usually made on a stone model of the maxillary teeth and surrounding tissue and are thought to give the most protection).
These devices can be made from various materials but ethylene-vinyl acetate is by far the most popular material, probably because of the ease with which it can be used for the production of custom-made mouthguards.
This paper gives a review of the role of mouthguards in preventing and reducing sports-related trauma and examines the materials that are used to fabricate them.
American Society for Testing and Materials.Standard practice for care and use of athletic mouth protectors. West Conshohocken (PA): American Society for Testing and Materials, 2000. Technical report no. F697–00.
2.
TakedaT, KajimaT, NakajimaK, NarimatsuK, KonnoM, HasegawaK, SekiguchiC, OzawaT, NohK, IshigamiK.Paired maxillary and smaller mandibular mouthguard for rugby player with malalignment.Dent Traumatol2014;30(1):76–80.
3.
ChapmanP.Communication: the bimaxillary mouthguard: increased protection against orofacial and head injuries in sport.Aust J Sci Med Sport1985;17:25–29.
4.
MilwardPJ, JaggerRG.A bimaxillary sports mouthguard: a modified technique.J Prosthodont1997;6(4):292–295.
5.
AndradeRA, EvansPL, AlmeidaAL, da SilvaJde J, GuedesAM, GuedesFR, RanalliDN, ModestoA, TinocoEM.Prevalence of dental trauma in Pan American games athletes.Dent Traumatol2010;26(3):248–253.
American Dental Association.For the dental patient. The importance of using mouthguards. Tips for keeping your smile safe. J Am Dent Assoc. 2004;135(7):1061.
8.
MaestrelloCL, MourinoAP, FarringtonFH.Dentists’ attitudes towards mouthguard protection.Pediatr Dent1999;21 (6):340–346.
9.
DavisGT, KnottSC.Dental trauma in Australia.Aust Dent J1984;29:217–221.
10.
JaggerRG, AbbasbhaiA, PatelD, JaggerDC, GriffithsA.The prevalence of dental, facial and head injuries sustained by schoolboy rugby players.A pilot study. Prim Dent Care.2010;17(3):143–146.
11.
GelbierS.The use and construction of mouth and tooth protectors for contact sports.Br Dent J1966;120(11):533–537.
12.
HickeyJC, MorrisAL, CarlsonLD, SewardTE.The relation of mouth protectors to cranial pressure and deformation.J Am Dent Assoc1967;74(4):735–740.
13.
WoodAW.Head protection-cranial, facial and dental in contact sports.Oral Health1972;62(4):23–33.
14.
WeiSH.Prevention of injuries to anterior teeth.Int Dent J1974;24(1):30–49.
15.
HeintzWD.The case for mandatory mouth protectors. Phys Sportsmed1975;April:61–63.
16.
ChapmanP.Concussion in contact sports and importance of mouthguards in protection.Aust J Sci Med Sport1985;17:23–27.
17.
ChapmanPJ.The pattern and use of mouthguards in Rugby League (a study of the 1986 Australian Rugby League Team).Br J Sports Med1988;22(3):98–100.
18.
GaronM, MerkleA, WrightJ.Mouth protectors and oral trauma: a study of adolescent football players.J Am Dent Assoc1986;112(5):663–665.
19.
Maestrello-deMoyaMG, PrimoschRE.Orofacial trauma and mouth-protector wear among high school varsity basketball players.ASDC J Dent Child1989;56(1):36–39.
20.
MastrangeloF.Eye and face injuries in high school hockey: cutting down the risks. In: CastaldiC, HoernerE, eds. Safety in ice hockey, ASTM STP 1050. Philadelphia: American Society for Testing and Materials, 1989:52–54.
21.
McNuttT, ShannonSWJr, WrightJT, FeinsteinRA.Oral trauma in adolescent athletes: a study of mouth protectors.Pediatr Dent1989;11(3):209–213.
22.
CumminsNK, SpearsIR.The effect of mouthguard design on stresses in the tooth-bone complex.Med Sci Sports Exerc2002;34(6):942–947.
23.
LabellaC, SmithB, SigurdssonA.Effect of mouthguards on dental injuries and concussions in college basketball.Med Sci Sports Exerc2002;34:(1):41–44.
24.
RanalliDN, DemasPN.Orofacial injuries from sport: preventive measures for sports medicine.Sports Med2002;32(7):409–418.
25.
FinchC, BrahamR, McintoshA, McCroryP, WolfeR.Should football players wear custom fitted mouthguards?Results from a group randomised controlled trial. Inj Prev2005;11(4):242–246.
26.
MarshallSW, LoomisDP, WallerAE, ChalmersDJ, BirdYN, QuarrieKL, FeehanM.Evaluation of protective equipment for prevention of injuries in rugby union.Int J Epidemiol2005;34(1):113–118.
27.
ADA Council on Access, Prevention and Interprofessional Relations, ADA Council on Scientific Affairs.Using mouthguards to reduce the incidence and severity of sports-related oral injuries. J Am Dent Assoc2006;137(12):1712–1720.
28.
CohencaN, RogesRA, RodesR.The incidence and severity of dental trauma in intercollegiate athletes.J Am Dent Assoc2007;138(8):1121–1126.
29.
KnapikJJ, MarshallSW, LeeRB, DarakjySS, JonesSB, MitchenerTA, delaCruzGG, JonesBH.Mouthguards in sport activities: history, physical properties, and injury prevention effectiveness. Sports Med2007:37(2):117–144.
30.
BlignautJ, CarstensI, LombardC.Injuries sustained in rugby by wearers and nonwearers of mouthguards.Br J Sports Med1987;21(2):5–7.
31.
AubryM, CantuR, DvorakJ, Graf-BaumannT, JohnstonK, KellyJ, LovellM, McCroryP, MeeuwisseW, SchamaschP.Summary and agreement statement of the First International Conference on Concussion in Sport, Vienna 2001. Recommendations for the improvement of safety and health of athletes who may suffer concussive injuries. Br J Sports Med. 2002;36(1):6–10.
32.
RamptonJ, LeachT, TherrienSA, BotaGW, RoweBH.Head, neck, and facial injuries in ice hockey: the effect of protective equipment.Clin J Sport Med1997;7(3):162–167.
33.
BensonB, MohtadiNG, RoseMS, MeeuwisseWH.Head and neck injuries among ice hockey players wearing full face shields vs half face shields.JAMA.1999;282(24):2328–2332.
WintersJESr.Commentary: Role of Properly Fitted Mouthguards in Prevention of Sport-Related Concussion.J Athl Train2001;36(3):339–341.
37.
WisniewskiJ, GuskiewiczK, TropeM, SigurdssonA.Incidence of cerebral concussions associated with type of mouthguard used in college football.Dent Traumatol2004;20(3):143–149.
38.
TakedaT, IshigamiK, HoshinaS, OgawaT, HandaJ, NakajimaK, ShimadaA, NakajimaT, RegnerCW.Can mouthguards prevent mandibular bone fractures and concussions?A laboratory study with an artificial skull model. Dent Traumatol2005;21 (3):134–140.
39.
HasegawaK, TakedaT, NakajimaK, OzawaT, IshigamiK, NarimatsuK, NohK.Does clenching reduce indirect head acceleration during rugby contact?Dent Traumatol2014;30(4):259–264.
40.
NarimatsuK, TakedaT, NakajimaK, KonnoM, OzawaT, IshigamiK.Effect of clenching with a mouthguard on head acceleration during heading of a soccer ball.Gen Dent.2015;63(6):41–46.
41.
StengerJM, LawtonEA, WrightJM, RickettsJ.Mouthguards: protection against shock to head, neck and teeth.J Am Dent Assoc1964;69(3):273–281.
DorneyB.Mouthguard protection in sports injury: case report.Aust Dent J1994;39(6):372.
44.
MihalikJP, McCaffreyMA, RiveraEM, PardiniJE, GuskiewiczKM, CollinsMW, LovellMR.Effectiveness of mouthguards in reducing neurocognitive deficits following sports-related cerebral concussion.Dent Traumatol2007;23(1):14–20.
45.
Fitted mouthguards afford key protection.J Am Dent Assoc1972;84(3):531.
46.
BensonB, RoseM, MeeuwisseW.The impact of face shield use on concussions in ice hockey: a multivariate analysis.Br J Sports Med2002;36(1):27–32.
47.
BensonBW, MeeuwisseWH.Ice hockey injuries.Med Sport Sci2005;49:86–119.
48.
DelaneyJS, Al-KashmiriA, DrummondR, CorreaJA.The effect of protective headgear on head injuries and concussions in adolescent football (soccer) players.Br J Sports Med.2008;42(2):110–115.
49.
IfkovitsT, KühlS, ConnertT, KrastlG, Dagassan-BerndtD, FilippiA.Prevention of dental accidents in Swiss boxing clubs.Swiss Dent J2015;125(12):1322–1335.
50.
GueirózAF, de BritoRBJr, RamacciatoJC, MottaRH, FlórioFM.Influence of mouthguards on the physical performance of soccer players. Dent Traumatol. 2013;29(6):450–454.
51.
LiewAK, AbdullahD, Wan NoorinaWA, KhooS.Factors associated with mouthguard use and discontinuation among rugby players in Malaysia.Dent Traumatol2014;30(6):461–467.
52.
MurakamiS, MaedaY, GhanemA, UchiyamaY, KreiborgS.Influence of mouthguard on temporomandibular joint.Scand J Med Sci Sports2008;18(5):591–595.
53.
D'ErcoleS, MartinelliD, TripodiD.Influence of sport mouthguards on the ecological factors of the children oral cavity.BMC Oral Health2014;14:97.
54.
MaedaY, YangTC, MiyanagaH, TanakaY, IkebeK, AkimotoN.Mouthguard and sports drinks on tooth surface pH.Int J Sports Med.2014;35(10):871–873.
55.
GlassRT, ConradRS, WoodCR, WarrenAJ, KohlerGA, BullardJW, BensonG, GuldenJM.Protective athletic mouthguards: do they cause harm?Sports Health2009;1(5):411–415.
56.
CraigRG, GodwinWC.Physical properties of materials for custommade mouth protectors.J Mich State Dent Assoc1967;49(2):34–40.
57.
GoingRE, LoehmanRE, ChanMS.Mouthguard materials: their physical and mechanical properties.J Am Dent Assoc1974;89(1):132–138.
58.
CraigRG, GodwinWC.Properties of athletic mouth protectors and materials.J Oral Rehab2002;29(2):146–150.
59.
GreenJIJ.Prevention and management of tooth wear: the role of the dental technology.Prim Dent J2016;5:(3)30–33.
BishopBM, DaviesEH, von FraunhoferJA.Materials for mouth protectors.J Prosthet Den1985;53(2):256–261.
62.
LoehmanRE, ChanMS, GoingRE.Optimization of materials for a user-formed mouthguard.Ann Biomed Eng1975;3(2):199–208.
63.
FontellesJB, ClarkeC.Directive 2005/84/EC of the European Parliament and of the Council of 14 December 2005 amending for the 22nd time Council Directive 76/769/EEC on the approximation of the laws, regulations and administrative provisions of the Member States relating to restrictions on the marketing and use of certain dangerous substances and preparations (phthalates in toys and childcare articles).Off J Eur Union2005;48:40–43.
64.
AuroyP, DuchatelardP, ZmantarNE, HennequinM.Hardness and shock absorption of silicon rubber for mouth guards.J Prosthet Dent1996;75(4):463–471.
65.
JaggerR, MilwardP, WatersM.Properties of an experimental mouthguard material.Int J Prosthodontics2000;13(5):416–419.
66.
ScottJ, BurkeFJ, WattsDC.A review of dental injuries and the use of mouthguards in contact team sports.BrDentJ1994;176(8):310–314.
67.
PatrickDG, van NoortR, FoundMS.Scale of protection and the various types of sports mouthguard.Br J Sports Med.2005;39(5):278–281.
68.
WidmerRP.The normal development of teeth.Aust Fam Physician1992;21(9):1251–1261.
DeYoungAK, RobinsonE, GodwinWC.Comparing comfort and wearability: custom-made vs self-adapted mouthguards.J Am Dent Assoc1994;125(8):1112–1117.
71.
GreasleyA, ImlachG, KaretB.Application of a standard test to the in vitro performance of mouthguards.Br J Sports Med1998;32(1):17–19.
72.
HoffmannJ, AlfterG, RudolphNK, GözG.Experimental comparative study of various mouthguards.Endod Den Traumatol1999;15(4):157–163.
73.
BemelmannsP, PfeifferP.Shock absorption capacities of mouthguards in different types and thicknesses.Int J Sports Med2001;22(2):149–153.
74.
GuevaraPH, HondrumSO, ReichlRB.A comparison of commercially available mouthguards and a custom mouthguard.Gen Dent2001;49(4):402–406.
75.
WarnetL, GreasleyA.Transient forces generated by projectiles on variable quality mouthguards monitored by instrumented impact testing.Br J Sports Med2001;35(4):257–262.
76.
GebauerDP, WilliamsonRA, WallmanKE, DawsonBT.The effect of mouthguard design on respiratory function in athletes.Clin J Sport Med2011;21(2):95–100.
77.
PieroM, SimoneU, JonathanM, MariaS, GiulioG, FrancescoT, GabriellaC, LauraA, EvaB, GianniM, FrancescoC, GiovanniG.Influence of a custom-made maxillary mouthguard on gas exchange parameters during incremental exercise in amateur road cyclists.J Strength Cond Res2015;29(3):672–677.
78.
WintersJ, DeMontR.Role of mouthguards in reducing mild traumatic brain injury/concussion incidence in high school football athletes.Gen Dent2014;62(3):34–38.
79.
BussellMA, BarretoLS.The recommendation and provision of mouthguards: a survey of consultant orthodontists in the UK.J Orthod2014;41(2):141–146.
80.
OikarinenKS, SalonenMAM, KorhonenJ.Comparison of the guarding capacities of mouth protectors.Endod Den Traumatol1993;9(3):115–119.
81.
WestermanB, StringfellowPM, EcclestonJA.Forces transmitted through EVA mouthguard materials of different types and thickness.Aust Dent J1995;40(6):389–391.
82.
BulsaraYR, MatthewIR.Forces transmitted through a laminated mouthguard material with a sorbothane insert.Endod Den Traumatol1998;14(1):45–47.
83.
WestermanB, StringfellowPM, EcclestonJA.EVA mouthguards: how thick should they be?Dent Traumatol2002;18(1):24–27.
84.
MizuhashiF, KoideK, TakahashiM.Assessing change in mouthguard thickness according to the thickness of the original mouthguard sheet. Dent Traumatol2014 Dec;30(6):468–471.
85.
FarringtonT, CowardT, Onambele-PearsonG, TaylorRL, EarlP, WinwoodK.The effect of model inclination during fabrication on mouthguard calliper-measured and CT scan-assessed thickness.Dent Traumatol.2016;32(3):192–200.
86.
WakedEJ, CaputoAA.Thickness and stiffness characteristics of custom-made mouthguard material.Quintessence Int2005;36(6):462–466.
87.
TuncES, OzdemirTE, AriciS.Postfabrication thickness of single-and double-layered pressure-formed mouthguards.Dent Traumatol2013;29(5):378–382.
TakahashiM, KoideK, SatohY, IwasakiS.Shape change in mouthguard sheets during thermoforming.Dent Traumatol2016;32(5):379–384.
90.
FarringtonT, CowardT, Onambele-PearsonG, TaylorRL, EarlP, WinwoodK.An investigation into the relationship between thickness variations and manufacturing techniques of mouthguards.Dent Traumatol2016;32(1):14–21.
91.
TakahashiM, KoideK, MizuhashiF.Influence of color difference of mouthguard sheet on thickness after forming.J Prosthodont Res2012;56(3):194–203.
92.
Del RossiG, LismanP, SignorileJ.Fabricating a better mouthguard.Part II: the effect of color on adaptation and fit. Dent Traumatol.2008;24(2):197–200.
93.
TakahashiM, KoideK, SuzukiH, IwasakiS.Optimal heating condition of ethylene-vinyl acetate co-polymer mouthguard sheet in vacuum-pressure formation.Dent Traumatol2016;32(4):311–315.
94.
MizuhashiF, KoideK, TakahashiM.Difference in pressure-formed mouthguard thickness according to heating condition.Dent Traumatol2016;32(1):22–26.
95.
GearyJL, CliffordTJ, KinironsMJ.Occlusal accommodation and mouthguards for prevention of orofacial trauma.Oral Health Prev Dent2009;7(1):55–59.
96.
WestermanB, StringfellowPM, EcclestonJA.The effect on energy absorption of hard inserts in laminated EVA mouthguards.Aust Dent J2000;45(1):21–23.
97.
KataokaSH, SetzerFC, GondimEJr, CaldeiraCL.Impact absorption and force dissipation of protective mouth guards with or without titanium reinforcement.J Am Dent Assoc.2014;145(9):956–959.
98.
WatermeyerGJ, ThomasCJ, JoosteCH.The protective potential of mouthguards.J Dent Assoc S Afr.1985;40(4):173–177.
99.
WestermanB, StringfellowPM, EcclestonJA.Beneficial effects of air inclusions on the performance of ethylene vinyl acetate (EVA) mouthguard material.Br J Sports Med2002;36(1):51–53.
100.
WestermanB, StringfellowPM, EcclestonJA, HarbrowDJ.Effect of ethylene vinyl acetate (EVA) closed cell foam on transmitted forces in mouthguard material.Br J Sports Med.2002;36(3):205–208.
