MOUTHGUARDS: DO THEY REALLY MATTER?
By Ed de la Vega, DDS
Mon, 05 Feb 2018
Almost without exceptions, a great majority of Filipino boxers that come to my offices in Canoga Park, California present sub-standard mouthguards. They come not only because they get a free custom made mouthguard, but also to experience the novelty of using a mouthguard “similar to what Manny Pacquaio has used” for more than a decade. Sadly, except for a few, they know nothing of its protective values, the importance of the appliance and the reasons behind its design and fabrication. The same goes for the managers that accompany them.
It is for this reason that I wrote this article. I want to change the pathetic situation these boxers endure. I want them respected and provided with proper protective appliances. After all they are humans, not fighting cocks!
As a start, I reached out to the Games and Amusement Board. I had a few exchanges with the Honorable Chairman, Abraham Mitra. He was very receptive but had reservations mainly due to economics. I asked if they have a position statement on Mouthguards. From what I got, I believe GAB has none. Therefore I sent him some information that he readily referred to the “Boxing Division”. I have yet to hear from them.
Then I reached out to certain respected referees and boxing judges and boxing personalities in the country. They too did not have the answers I needed, reinforcing my belief that indeed GAB has no written position on the use of proper intra-oral protection in contact sports.
With the storm I hope to generate from exposing the issue through this article, I hope change will come …. and soon!
Yes, it may cost people some money to affect these changes, particularly the “managers” and perhaps even the “promoters”. But in the end, the boxers who earns the money, sometimes at the expense of their health, for the aforementioned managers and promoters, are protected from undue injuries, injuries that are totally preventable by a simple device called a mouthguard.
I know there will be people out there who would readily say that I am pushing for changes for personal gains because I design, fabricate and fit mouthguards at my offices, including at my office at Parañaque City. Nothing can be so far from the truth. Thank you, but modesty aside, I don’t make my primary living from mouthguards. In fact, many times I give them away for free particularly to Filipino boxers that visit my Canoga Park office.
I can totally understand resistance against my proposed changes principally from managers and promoters; and even from GAB. In fact, I can almost hear both groups of stakeholders saying: - “Managers are poor, they can’t afford to provide their boxers with expensive mouthguards”. That tells me they lack information of the values of proper mouthguards. And, the attitude is a total cop out!
“Expensive” is relative particularly when compared to the cost of health care services to treat and manage sports related injuries. Certainly, custom mouthguards cost less than the cost of treatment for sports related injuries. I know for I had been involved with both sides of the issue.
From my perspective, the only reason these managers and promoters are refusing to provide proper mouthguards for their fighters is because they can do it. There are no rules and regulations telling them to do what is right for their boxers. If rules and regulations are in the books stating that boxers and MMA fighters must wear proper mouthguards, then everybody follows. They will find ways to afford the mouthguards otherwise, their fighters don’t get in the ring. Will this affect the “poor managers” who allegedly can’t afford proper mouthguards? Maybe, but the issue is not totally unsolvable. They are many ways to comply. As they say:- “If there is a will, there is a way”.
In addition, if rules and regulations exist and all stakeholders are properly informed, more local dentists will be interested in providing them because of the potential business. With more providers, the prices become competitive and invariably will drop to where everyone can afford them. That is true in any business- the law of supply and demand. The only reason why custom mouthguards are expensive now is because they are still “boutique items”. Only few dentists routinely make them and they charge a premium.
My proposals to affect these changes are simple. And, they are reasonable. We should start from the very top… at the Games and Amusement Board (GAB).
With present Chairman of the GAB, the Honorable Abraham Mitra “so open minded to changes”, I see no reason why these cannot be done. It’s all about attitude...the willingness to make changes!
To start with, the GAB should formulate a position paper regarding mouthguards. We have great minds at the GAB that can easily do this. The statement should include among others, the stance of GAB and the definition of what a proper mouthguard should be. Following this, comes its distribution to all stakeholders to create awareness. The best way to do this is post the information on the GAB website and through regional seminars.
One important aspect of the proposed changes is “time element”. Stake holders must be given adequate time to digest the information, familiarize themselves with the issues, and allow them time to ask questions and receive answers as the changes are gradually implemented. A two-year window will be ideal. This will also allow local dentists time to gradually equip themselves with the proper equipment and attend seminars to upgrade their skills in making proper mouthguards so they can deliver the mouthguards the fighters need and truly deserve.
With due respect to the GAB, I wrote the below written unsolicited draft for the proposed “GAB Position Paper on Mouthguards” and useful information about mouthguards. It is purely for information purposes.
Please know I am not telling any one what to do. Hopefully it will serve as their basis in the formulation of the guidelines they may wish to make. This information is fluid. More maybe added as the science of mouthguards evolve. It may not be complete either. More experts maybe needed to improve it further. But, it is a beginning.
Intra-oral Protectors- The Use of Proper Mouthguards
A Position Paper of the Games and Amusement Board
With the unabated popularity of contact sports in the Philippines, boxing and MMA in particular, comes the need to provide information and establish guidelines to protect participants from intra-oral injuries .
Therefore, this position paper was written. It is an effort to inform participants of contact sport about intra-oral injuries and a method to prevent and minimize them.
The Position Statements of the Games and Amusement Board (GAB )on Mouthguards
The GAB recognizes the prevalent and inherent intra-oral injury risks common in contact sports and the preventive value of intra-oral protectors. The GAB endorses the use of intra-oral protectors by those who engage in contact sports; and encourages their widespread use specifically, those that are dentist-designed, fabricated and fitted mouthguards.
The GAB advocates the importance of good oral health and the safety in contact sports and the use of a custom mouthguard as the most reasonable available protective device for the reduction of the incidence and severity of sports-related dental injuries; it is committed to promote oral health issues and injury prevention for contact sports participants.
The GAB understands that in order to maximize protection from injuries, custom mouthguards are necessary. Therefore, GAB is committed to improve awareness to them and requires their use in combat sports.
What is a Mouthguard?
(For the purpose of this paper, the term “mouthguard” implies “Custom Mouthguards”)
A mouthguard is a resilient appliance molded of a specialized plastic material on an athlete’s dental model. It is placed inside the mouth and fitted over the teeth to minimize injuries to the teeth and surrounding structures during sports activities.
Types of Mouthguards
a. Stock Mouthguard : These plastic devises are usually sold at sporting goods stores and via the internet. They are designed to be “one-size fits all”. They are taken out of their wrapping and then immediately placed in the mouth without the benefit of adjustments to assure comfort and function. These mouthguards requires that the teeth be constantly clenched to stay in place impeding the athlete’s breathing and ability to speak. Due to these, athletes discontinue their use and are left unprotected.. All these mouthguards provide is a false sense of security and their use is not recommended.
b. Boil and Bite: These are made of a thermoplastic pre-shaped materials sold at sporting goods store and via the internet. These are soaked in boiling water to soften and then placed in the mouth and molded with the fingers, lips and tongue. During such process, more often than not, the thickness in the biting surface will be affected causing lack of posterior support and proper thickness to assure adequate protection. In many cases athletes also reshape them with scissors in an attempt to improve fit and reduce bulk that triggers gagging. This further reduces thickness and adequate support. The use of this mouthguards is not recommended.
C. Custom Mouthguards: These mouthguards are designed, fabricated and fitted by a dentist or under the direct supervision of a dentist who has the ability to address issues related to the proper design, fit and function of the appliance. These mouthguards fulfill all the necessary criteria associated with adaptation, retention, comfort, and material stability. Due to the process in which they are fabricated, they fit snugly that breathing is not impeded allowing the athlete to receive adequate protection and focus on his game
There are two kinds of Custom Mouthguards:
1. Vacuum Formed. These mouthguards are made using heat and a vacuum-forming machine . When done by a dentist or under the direct supervision of a dentist, these mouthguards can be acceptable. Their only draw back is that it is difficult to layer different materials to attain the recommended adequate thickness of 3mm due to functional limitation of the vacuum-forming machine. But they are superior over stock and boil and bite mouthguards as they are made over an athlete’s dental cast.
2. Heat and Pressure Laminated: These mouthguards are made using high heat and high-pressure lamination. This procedure allows more accurate adherence of the material to the details of the dental cast, which in turn enhances retention.
Heat and pressure lamination also allows layering of different materials to achieve the adequate recommended thickness of 3 mm., as well as the use of multiple colors and the inclusion of decals to enhance the esthetic design. In the hands of a professional with the ability to address issues like design, fit, function, extensions and occlusion, mouthguards fabricated through this process are the best mouthguards an athlete can have. These mouthguards are highly recommended for use during contact sports and are mandated by GAB for use in combat sports.
The Qualities of a Mouthguard:
1. It should allow speaking and does not limit breathing
2. It should stay firmly in place during combat and not easily pushed out by the tongue
3. It should provide a high degree of comfort and fit
4. It should be durable and easy to clean
5. It should be resilient, tear-resistant, odorless and tasteless
6. It should allow proper occlusion of the teeth and have proper border extensions to prevent irritations of the surrounding oral tissues.
How do Mouthguards Protect Athletes?
Mouthguards protect athletes by absorbing and distributing forces of impact received while participating in athletic activities particularly, contact sports
They protect soft tissues of the lip, cheeks, gums, and tongue by covering the sharp surfaces of the teeth and from damages to the teeth as a result of sudden impact. They may also protect the jaws from fractures and the temporo-mandibular joint from displacement. However, there is no direct proof to show that they protect against concussion.
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