Mouth Guards Prevent Dental Injuries But Require Frequent Replacement

Mouth guards prevent dental injuries, but can increase the number and intensity of mouth cuts and abrasions and chance of infection, so they should be sanitized daily and replaced every two weeks, or when they develop sharp or jagged edges, whichever occurs first.

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, studies 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 easily prevented had the athlete been wearing a mouth guard.

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.

 

Mouth guard types

A mouth guard is a piece of soft plastic shaped to fit inside the mouth, protecting the lips, cheeks, tongue and teeth and the jaw when they are hit by large object - like a ball, or someone's elbow or head.

There are 3 main types of mouth guards:

• Stock. The least expensive, stock type mouth guards cost about $2 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.
• 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.
• 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 mouth guards 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. mouth guard

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 told MomsTeam. "Any mouth guard is better than none," he says.

Do not protect against concussion

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. But there is no evidence that they protect against, or reduce the risk of, concussion.

In a January 2011 article in the journal Clinics in Sports Medicine researchers at Boston University and the Sports Legacy Institute, including MomsTeam's first concussion expert, Dr. Bob Cantu, Chris Nowinski, and Dr. Ann McKee ^[1] conducted a comprehensive review of the medical literature to date, and concluded that no studies existed to support a claim that mouth guards prevented concussions or reduced their severity.

Commenting on a 2005 study of National Hockey League players,^[2] which found that the concussion rate was 1.42 times greater in players who did not wear mouth guards compared with those who did, the authors concluded that the difference was not statistically significant. The same study, as later noted in a 2009 literature review in the British Journal of Sports Medicine, which counted among its authors two of the co-authors of the 2005 study,^[3] did note that symptom severity on a concussion evaluation post-concussion symptom scale was found to be significantly worse in athletes who were not wearing mouth guards than in those who were, but not that mouth guards reduced concussion risk.

Thus Dr. Cantu and his Boston University colleagues stated that "there is little evidence that mouth guards provide protection against concussion," and, in the process, criticizing a 2009 study of college athletes reported in Dental Traumotology^[3] as being marked by "several design flaws."  The study thus concludes with the following statement:

Although mouth guards have been shown to be effective in preventing dental and orofacial injury, there is currently no evidence that standard or fitted mouth guards decrease the rate or severity of concussions in athletes. The bulk of the evidence indicating a potential protective effect of mouth guards on concussion incidence has been based on a limited case series studies and retrospective, non-randomized, cross-sectional surveys. There is also evidence that mouth guard use does not result in any difference in neurocognitive test performance after concussion.

***

The preponderance of evidence seems to indicate that helmets and mouth guards provide a significant benefit in protecting against many catastrophic head, neck and orofacial injuries. However, there is not yet significant evidence to advocate their effectiveness in preventing concussion. ... Although newer equipment remains a promising potential tool in minimizing concussion severity and incidence, other methods such as rule changes, improved concussion education, and proper coaching and training may prove more effective in the immediate future.

Three studies released within weeks of each other in March 2013 ^[4-6] all reached the same conclusion as the 2011 study: there is no valid evidence that mouth guards reduce the risk of concussion.

Interestingly, an even more recent research paper^[8]  found that high school football players in Wisconsin who wore a generic mouth guard provided by the school actually had a lower rate of sport-related concussion  than players with more expensive mouth guards.

Require frequent replacement and sanitization

A study in Sports Health: A Multidisciplinary Approach⁷ found that mouth guards 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 mouth guards routinely collect.

Researchers stress that even with the increase in oral lesions,mouth guards 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 mouth guard is used and how often it is cleaned needs to be revised."

As a result, experts now recommend four safety steps:

1. Replace regularly or when mouth guard becomes sharp or jagged. A mouth guard 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 mouth guards may cause exercise-induced asthma and allergies, mouth guards should be replaced whenever an athlete develops any type of oral lesion (mouth sore) or respiratory distress;
3. Sanitize daily. Because mouth guards 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. Have regular oral exams. Athletes' mouths should be examined on an ongoing basis while they are using mouth guards.

"This study stresses the importance of informing athletes of the danger of not properly taking care of a mouth guard. A mouth guard 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:

Acrobatics	Football	Martial Arts	Skiing	Volleyball
Basketball	Gymnastics	Racquetball	Skydiving	Water Polo
Boxing	Handball	Rugby	Soccer	Weight Lifting
Discus Throwing	Ice Hockey	Shot Putting	Squash	Wrestling
Field Hockey	Lacrosse	Skateboarding	Surfing

Some athletic associations are getting the message. 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.

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1. Daneshvar DH, Baugh CM, Nowinski CJ, McKee AC, Stern RA, Cantu RC. Helmets and Mouth Guards: The Role of Personal Equipment in Preventing Sport-Related Concussions. Clin Sports Med 2011; 30: 145-163.

2. Benson BW, Meeuwisse WH. Ice Hockey injuries. Med Sport Sci 2005;49:86-119.

3. Benson BW, Hamilton GM, Meeuwisse WH, et al. Is protective equipment useful in preventing concussion? A systematic review of the literature. Br. J. Sports Med 2009;43(suppl 1):i56-67.

4. Giza C, Kutcher J, Ashwal S, et al. Summary of evidence-based guideline update: Evaluation and management of concussion in sports: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology2013;DOI:10.1212/WNL.0b013e31828d57dd (published online before print March 18, 2013)("There is no compelling evidence that mouth guards protect athletes from concussion.")

5. McCrory P, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med 2013;47:250-258 (There is no "good clinical evidence mouth guards will prevent concussions, although they have a "definite role in preventing dental and orofacial injury,")

6. Benson B, McIntosh A, Maddocks D, Herring S, Raftery M, Dvorak J. What are the most effective risk-reduction strategies in sport concussion. Br J Sports Med 2013;47:321-326 (characterizing studies that appeared to show mouth guards reduced concussion risk, including the 2009 study criticized in the 2011 study, as having "several limitations which threaten the validity of their results.")  

7. Glass RT, et. al, Protective Athletic Mouthguards: Do They Cause Harm? Sports Health: A Multidisciplinary Approach. 2009. 1 (5); 411-415.

8. McGuine T, Brooks A, Hetzel S, Rasmussen J, McCrea M. "The Association of the Type of Football Helmet and Mouth Guard With the Incidence of Sport-Related Concussion in High School Football Players." Presentation Paper AOSSM, July 13, 2013.

Revised and updated August 22, 2016