Oral Health Care Professionals, LLC
2033 Ogden Avenue
Downers Grove, IL 60515
Phone: (630) 963-6750

Oral Health Care Professionals, LLC
2033 Ogden Avenue
Downers Grove, IL 60515
P: (630) 963-6750
F: (630) 963-6761

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Dental Mouthguards

Eric G. Jackson, DDS, MAGD, FICOI, FICD, FADI

                Your teeth are a lifelong investment.  Multiple times per day you brush and floss to help them perform at the highest possible level.  By practicing good dental hygiene you protect your oral investment over the long term.  In the dental world however, much like in the investment world, long term success requires a different technique than the short term.  So what measures can you take to address the short term?  Trauma is undoubtedly the leading cause of catastrophic short term dental issues, so mitigating this risk is a good place to focus protection.  No one can predict when they might suffer dental trauma as countless different situations can cause injury to teeth and gums.  While trauma cases are not an everyday occurrence, they do unfortunately happen fairly regularly.  In the last year alone, I’ve helped fix patients’ teeth that have tripped and fallen into doors, been hit in the face at a Cubs game, passed out and fractured teeth lifting weights at XSport, fallen off their scooter, and even chipped their teeth kissing their significant other!  Obviously no one can prepare for these types of trauma since the activities they were performing were not terribly injury prone.  But what would you do if you knew injury was a possibility when performing an activity.  Wouldn’t you take steps to protect your dental investment and hopefully prevent additional dental issues and expenses?

Participation in athletics is a common situation that increases the possibility for head and neck trauma.  Such injuries frequently occur in sports across in all levels of athletics and many of them could be minimized or prevented by the use of a mouthguard.  Studies show that “athletes are 60 times more likely to suffer harm to the teeth if they’re not wearing a mouthguard.”[i]  Mouthguards help cushion a 004.JPGblow to the face, minimizing injuries to a person’s lips, teeth, tongue, jaw, face, and head as a whole.  They help you avoid chipped or broken teeth, nerve damage to a tooth, or even tooth loss.  While collision/contact sports such as boxing/MMA, football, soccer, ice hockey, basketball, lacrosse, and field hockey  pose the highest risk for dental injury, there is also risk of injury  in non-contact sports (gymnastics or skating) and even recreational activities (mountain biking, lifting weights at the gym).  Unfortunately, many of these sports injuries occur in young children.  According to the Centers for Disease Control, “more than half of the 7 million sports and recreation related injuries that occur each year are sustained by youth as young as 5 years-old.”[ii]

In a recent survey commissioned by the American Academy of Orthodontics (AAO), 67% of parents admitted that their children do not wear a mouthguard during organized sports.[iii]  The AAO Survey also found that 84% of children do not wear mouthguards while playing organized sports because they are not required to wear them, even though they may be required to wear other protective materials, such as helmets and shoulder pads.[iv]  The National Youth Sports Safety Foundation (NYSSF) says that athletes who do not wear mouth guards are 60 times more likely to sustain damage to their teeth.[v]  This raises a question: if mouthguards offer a simple and relatively inexpensive solution to help dramatically decrease the risk of oral-facial injuries, why aren’t more kids wearing them?

how mouthguards protect athletes.jpgAthletic mouthguards are not a new concept in either the sporting or the dental world.  In 1964, Dr. John Stenger worked with the Notre Dame football team and delivered one of the earliest landmark mouthguard studies.  Players were observed during both practices and games over an entire football season and recorded when each suffered an injury.  The study clearly demonstrated that impact forces to the jaw/face were diminished and thereby resulted in fewer injuries.  Players that wore mouthguards had fewer injuries and missed less playing time than those who did not wear them.[vi]  In 1967, another landmark study was conducted by Dr. Judson C. Hickey and showed that mouthguards reduce pressure changes and bone deformation within the skull in a cadaver model.  The study demonstrated a whopping 50% reduction in forces applied to the head when an individual is struck on the chin.[vii]  These early studies showed that a mouthguard could decrease the likelihood of trauma to not only the teeth/mouth but possibly even the brain injuries/ concussions.   More on that in a bit…

 

 

There are three primary types of mouthguards available to the public:

Mouthguard comparisons.jpg[viii]

Certainly any of the three mouthguard options are better than not wearing one at all, but is there a big difference between them?  The answer is ABSOLUTELY and cannot be stressed enough!  Custom mouthguards are vastly superior to the other two options.  Logically, the more intimate the mouthguard material fits against the teeth, the more the incoming force can be dispersed.  The same logic holds true with thickness of material.

A landmark study published in the May/June 2014 issue of General Dentistry, the peer-reviewed clinical journal of the Academy of General Dentistry (AGD), compared the performance of over-the-counter (OTC) mouthguards vs. custom mouthguards.  That study revealed that high school football players wearing store-bought, over-the-counter (OTC) mouthguards were more than twice as likely to suffer mild traumatic brain injures (MTBI)/concussions than those wearing custom-made, properly fitted mouthguards.[ix]  Mouthguard thickness also has been shown to be a factor that contributes to the level of protection. The average thickness of the custom-made mouthguards in this study was 3.50 millimeters, while the average thickness of the OTC mouthguards was only 1.65 millimeters.[x]  Custom-made mouthguards also can last longer than store-bought models and may be less prone to damage by the athletes, said AGD Spokesperson Eugene Antenucci, DDS, FAGD. “Over-the- counter mouthguards are not fitted to the athlete’s mouth, making them less comfortable than custom guards made by a dentist,” said Dr. Antenucci. “When a mouthguard is not comfortable, the athlete is likely to chew it, reducing its thickness and resulting in less protection.”[xi]  “Although more research on this topic is needed, our study shows the value of a custom-made mouthguard,” said lead author Jackson Winters, DDS, a pediatric dentist who also served as a high school and collegiate football official for 28 years.  “The benefits of protecting your child far outweigh the costs associated with a dental or medical injury, which is likelier to occur with a store-bought model.”[xii]

Here are just a few of the benefits to a custom-made mouthguard made to fit your teeth and only your teeth:

  • The fit is precise, with very little distortion, and also covers teeth at the back of your mouth • Custom mouthguards have the greatest durability and allow you to sustain the hardest impacts with lower risk of damage, and they'll be the most comfortable for you
  • Your mouthguard will fit snugly, protecting your teeth, gum tissue and supporting bone, and won't fall out
  • Your dentist can ensure that your mouthguard is the correct thickness, unlike "boil-and-bite" products off the shelf
  • There is almost no interference with speech or breathing[xiii]

 If a custom mouthguard is not an option for you or your child, the Boil & Bite style is the second best of the three styles because they are loosely molded in the mouth, but still fall far short of the custom.  Think about the drawbacks of off-the-shelf mouthguards before finalizing your decision:

  • The fit is not exact and not as comfortable
  • The material used is normally thinner than the 3-4mm recommended to provide the best protection
  • Off-the-shelf products offer minimal protection for the gums and supporting bone
  • They often fall out if you open your mouth and keeping your mouth closed makes it more difficult to breathe or speak
  • Non-custom products are typically less durable[xiv]

Concussions have become one of the hottest topics in modern sports, primarily in football.  From the NFL down to Pop Warner, the issue is on the forefront of research and discussion.  It should be mentioned that the definition of a concussion according to the Illinois High School Association (IHASA) Concussion Protocol is defined as: “A concussion is a traumatic brain injury that interferes with normal brain function. An athlete does not have to lose consciousness (be “knocked out”) to have suffered a concussion.”[xv]  In May 2015 the Illinois High School Association (IHASA) announced new measures to protect student-athletes on the field by creating a Concussion Advisory Council.  This group of individuals has been tasked with reviewing student athletic programs and making recommendations for safety improvements.  The IHSA also created a website dedicated to concussion education and has called for better partnerships with the medical community when it comes to understanding the effect of concussions.[xvi]  Among those on the advisory panel is Tregg Duerson, son of former Chicago Bears safety Dave Duerson, who took his own life in 2011.  Dave suffered multiple concussions during his playing career and donated his brain to concussion research.  Neurologists confirmed he had Chronic Traumatic Encephalopathy, a progressive degenerative disease caused by head injuries.[xvii]  Without question, athletes of all skill levels are bigger, stronger, and faster than ever before.  Although the technology behind protective equipment is always evolving and improving, it must be used to be effective!!! 

It should be noted that all concussion research with regards to dental mouthguards is still theoretical and not proven in the medical/dental literature.  The brain is a very difficult organ to study, and one must realize that concussions will likely always occur in collision and contact sports, such as football. Many factors are involved in reducing athletes' vulnerability to concussion, including genetics, anatomy, force of the blows, mass of the players, other equipment and rule changes, playing surfaces, coaching techniques, players being in harm's way when a force is present, and increasing knowledge about what constitutes a concussion.[xviii]  Though anecdotal, there are three possible theories on the potential benefits of properly-fitting athletic mouthguards and the reduction of the incidence or severity of concussions.

  1. Direct Dissipation and/or absorption of force of an upward blow to the jaw
  2. Increased separation of the head of the condyle and glenoid fossa
  3. Increased head stabilization by activating and strengthening neck muscles

A mouthguard must dance the delicate dance of being strong and durable while being soft enough to absorb impact energy and reduce force transmitted to the jaw.  Concussions result from the sudden acceleration or deceleration of the brain because of either direct or indirect (e.g. rotational) forces.  The strength of this force and its effect on the brain are directly related to the absolute value of the acceleration.  Without turning this into a physics lesson, some of you may remember the Newtonian formula: F = ma where “F” signifies the force applied, “m” signifies the mass of the object involved in the contact, and “a” the acceleration.  When broken down, acceleration is really a function of initial velocity, final velocity, and the distance traveled during the acceleration.[xix]  In other words, acceleration is Vin Diesel’s car in The Fast & The Furious racing from 0mph to 100mph over a quarter mile stretch of street.  If you’d like to be formal, you could list it as: a = (v2-v02)/2s.  Combining the two yields the final equation:

F = m(v2-v02)/2s.

Let’s turn this equation into real world dental physics.  When Jay Cutler takes a hit to the chin (let’s all hope that happens a lot less this season…Go Bears!), his properly fitting custom-made mouthguard disperses the impact by spreading the force to as wide an area as possible because it intimately contacts all the teeth and gums.  Being custom made, his mouthguard has the proper desired thickness and therefore creates a cushioned space between the head of the mandibular condyle (top part of the bottom jaw) and the glenoid fossa (bottom of the skull).  The Academy for Sports Dentistry has several great illustrations of this cushioned space included below.  Note the extra space between the lines illustrating the cushioned space.  The mouthguard compresses before the total force reaches the base of the skull.  It acts like a shock absorber on your car and ideally prevents the head of the lower jaw from “bottoming out” and striking the skull thereby transferring the force into the brain increasing the chance of concussion.

 

TMJ without mouthguard - edited.JPG

TMJ with mouthguard - edited.JPG

According to prominent Canadian concussion researcher Dr. Karen Johnston “The force required to concuss a fixed head is almost twice that required to concuss a mobile head.”  What the heck is a mobile head you might ask?!?  Dr. Johnston is referring to the third theory of how a mouthguard might reduce the incidence or severity of concussions.  Back to good ol’ Jay Cutler again (sorry Jay).  Let’s hypothesize that one of Jay’s offensive linemen gets beat by his man and the defenseman puts a solid hit on our quarterback.  Some researchers have begun to show that by being able to clench down harder on a mouthguard, Jay’s head and neck muscles might “super-activate” and serve to stabilize the head by tensing the muscles.  Increased head stabilization would hypothetically better absorb the force of impact and protect his brain from concussion.  Even more interesting, some have further suggested that this effect might be in place whether or not Jay sees the impact coming.  If any of these three mouthguard/concussion theories are ever empirically proven to be true, the constant requirement amongst all of them would be the fact that the athlete is wearing a custom-made mouthguard.  Until then, my opinion is that they seem quite logical and plausible.  We should always remember that the primary role of a dental mouthguard is to protect the teeth and gums.  Unlike concussion protection, the role a custom mouthguard plays in protecting various dental structures is certain and scientifically proven.  In my opinion any additional protection of the brain, theoretical or not, is a welcome possibility.

                I’m quite proud of the wide variety of mouthguard options available to my patients.  There’s a mouthguard to fit every budget, sport, and cosmetic desire.  I truly desire to see EVERY patient-athlete protected.  Patients can select from:

  • Shock Doctor Ultra Double Braces mouthguard

Shock Doctor.jpg

  • Under Armour mouthguards

Original Authorized Provider of Under Armour mouthguards.jpg

 

  • Custom-fitted regular or orthodontic mouthguard made by Dr. Jackson
    • Classic, Decal, & Wrap

Eric Jackson DDS - Classic Mouthguards.jpg

Downers Grove North 1.jpg

Downers Grove South 1.jpg

Downers Grove North 3.jpg

Eric Jackson DDS - Wrap Mouthguards.jpg

                Let’s discuss the differences between the different types of custom-made mouthguards I make here at the office:

Classic: The tried and true mouthguard that typically comes to mind when discussing custom-made options.  It, like all my custom mouthguards, is fabricated on my Biostar machine.  It is a positive pressure machine as opposed to a more traditional and simple negative pressure machine.  In my opinion, this style of fabrication machine is essential to proper mouthguard fabrication.  It yields are far more predictable fabrication quality than any other method of mouthguard creating.  Cosmetically, the classic mouthguard is more limited than the other two.  One solid color, two solid colors, Red/White/Blue, and Clear are the predominant design choices to patients.  Since it is slightly thinner than my other two styles of custom mouthguards, the Classic is an excellent option for non-contact sports and all patients wearing braces.  Although thinner, the Classic is still a good choice for contact sports.

Decal & Wrap:  Last year I started investigating how to improve upon my Classic design.  I wanted a thicker, more resilient, and more customizable option.  Over several months I personally developed and honed the fabrication technique that I now use to create my Decal and Wrap style custom-made mouthguards.  I am proud to say that I am unaware of any other dental professional in the area that makes or offers a similar product.  They are thicker and more resilient than any custom mouthguard I have ever seen.  The Decal and Wrap mouthguards are structurally identical and made with essentially the same technique.  Their only difference is cosmetic as both offer a limitless combination of design options.  Appropriately named, the Decal mouthguard has two logo/picture decals on the bite surface of the molars and the Wrap is completely covered in the patient’s chosen design.  Fees for the Wrap are higher due to the additional artistic work required during fabrication.

                I’m proud to say that patient response to the newly developed Decal and Wrap mouthguards has been phenomenally positive.  One the first Wrap mouthguards I made was for my cousin Joseph, who plays travel hockey.  Hockey players are notorious for chewing and mashing their mouthguards throughout practice and games.  According to Joseph it’s not uncommon for him and his teammates to chew/destroy several mouthguards per season.  This is something I’ve heard throughout levels of hockey for quite some time.  Don’t ask me why hockey players are so rough on their mouthguards, I don’t know.  It’s just a hockey thing I guess.  I figured if anyone could give my new Wrap mouthguard a quality torture test it would be him, so I brought him in, took the impressions of his teeth, and made his a sweet looking Wrap with his Hockey team logo on it.  After multiple practices and games the verdict was in and I was quite pleased.  “This is the best mouthguard I’ve ever had.  It was so snug and fit great.  I really like the design too.  I think it’s going to hold up really well” he texts me not long thereafter (he IS a teenager after all, do they even make voice calls anymore??  haha)   Joseph may have been the first but he certainly hasn’t been the last to love the design of both the Decal and Wrap mouthguards.  They’ve received praises from local high school athletes to players on the Chicago Bandits and I couldn’t be more pleased.  

So far I’ve primarily written about the physiological benefits and additional safety a custom-made mouthguard provides, but let’s not forget the age old saying “you gotta look and feel good to play good!”  Proper grammar notwithstanding, I agree with the saying to some extent.  My Decal and Wrap mouthguards are completely customizable and offer limitless fun design options to patients.  As you can see in the photos, I’ve made some quite creative Wraps!  Add that to the classic single or dual color mouthguard and you’ve got an amazing piece of customizable artwork protecting your face and mouth. 

A question I often get asked is “Dr. Jackson, can I have wear a mouthguard if I have braces?”  ABSOLUTELY and just like the non-orthodontic patients, it’s highly encouraged!  Patients in braces have two main options during their treatment:

  • A custom-made orthodontic mouth guard
  • An over-the-counter stock orthodontic mouthguard

I’m going to stress this point by underlining it: DO NOT use a Boil & Bite mouth guard if you wear braces!!  The Boil & Bite mouthguards will get stuck on your brackets and pull them off your teeth when you remove the mouthguard!  Not a good way to celebrate a big win on the field and DEFINITELY not the way to make your parents &/or orthodontist happy.  Mouthguards designed for orthodontic patients are quite similar to their non-orthodontic counterparts except for a few unique attributes.  Orthodontic mouthguards must account for the fact that an athlete’s teeth are moving daily!  OTC stock orthodontic mouthguards use a free space or channel that provides retention while allowing ample room for the teeth to move into their new position.  Unfortunately, these stock orthodontic mouthguards often demonstrate many of the same negative attributes their non-orthodontic counterparts, the most significant of which is they often require an athlete to keep his/her mouth closed to keep the mouthguard in place due to its non-custom and non-mouth molded design.  Again, this can negatively impact ability to breathe and speak.  Fortunately custom-made orthodontic mouthguards are a second and far superior option for all the same reasons as the non-orthodontic style.

Often I’ll get asked if I recommend both top and bottom custom orthodontic mouthguards be made for an athlete.  My answer is almost always no, with one small exception.  Braces or not, when a custom-made mouthguard on the upper teeth fits correctly, a lower mouthguard is unnecessary.  This is because a blow to the face typically makes contact with the most protruding point.  When a player with braces wears a custom-made mouthguard, the mouthguard protrudes slightly more than usual and protects the lower teeth.  The exception can be in wrestling, where it is sometimes required by the law/rules.  In cases where a lower guard is mandatory, or insisted upon, I will typically make a normal thickness mouthguard to cover the upper teeth and a thinner one across the lower to minimize bulk and maximize comfort.

Remember, an average orthodontic patient may have his/her braces on for an average of 2 years.  The teeth are constantly moving so a custom fit mouthguard that properly fits today may not do so in 3,6, 12+ months.  Each case is different and there’s no exact way to predict how long each custom mouthguard will fit.  When the fit becomes poor we simply take a new impression and fabricate a new mouthguard.  Sure you might require multiple custom mouthguards during your orthodontic treatment, but as I always say, it’ll only motivate you to follow your orthodontists’ instructions and WEAR THOSE RUBBER BANDS so you can finish treatment sooner!  By the way, consistently wearing rubber bands and following your orthodontists’ instructions is a GREAT way to make your parents and orthodontist happy!  Trust me; I know this fact firsthand since my orthodontist also happened to be my father!  Once the braces are off and retainers are made a traditional custom-made mouthguard is typically made and since the teeth are no longer moving, its fit should not change.  One final note: if you have an orthodontic retainer, or any other removable dental appliance other than a mouthguard, do not wear it during any contact sports.  It simply does not belong there and can cause harm.

Lastly, how about some tips to properly care for your mouthguard:

  • Rinse your mouth before and after each use or better yet, brush your teeth
  • Rinse the mouthguard in cool water after each use.  Occasionally clean it in cool, soapy water.  Rinse thoroughly afterwards.
  • Transport the mouthguard in a sturdy case that has air holes/vents
  • Protect the mouthguard from high temperatures (hot water, direct sunlight, hot surfaces, etc) to minimize distorting its shape
  • Periodically check the mouthguard for general wear.  If you find holes or tears in it, if it becomes too loose, or if it causes discomfort, replace it.
  • Bring the mouthguard to each dental hygiene appointment to have it examined

Every athlete knows that with sports participation comes the possibility of injury.  Unfortunately, the mouth, face, and head are often overlooked as likely recipients of trauma.  Without a doubt, one of the most effective and least expensive means of orofacial injury is a dental mouthguard.  If you would like to speak about mouthguards, or any other sports dentistry topic, please feel free to call the office and schedule a complimentary appointment with me.  Email and Twitter are also available options.  I am extremely passionate about modern dentistry and love discussing it with patients, so don’t hesitate to contact me. 

Sincerely,

Eric G. Jackson, DDS, MAGD, FICOI, FICD, FADI

[email protected]

Twitter: @EjacksonDDS

Dr. Eric Jackson is passionate about sports dentistry and injury prevention through use of dental mouthguards.  In addition to being a member of the organization he is a Mentor Dentist of the Academy for Sports Dentistry (ASD), one of the world’s foremost organizations for sports dentistry.  In 2013 Dr. Jackson became the inaugural team dentist for the &