Myths and Facts About Intra-Oral Protectors
By Ed de la Vega, DDS
Fri, 30 Aug 2019
In response to the many inquiries regarding intra-oral protection (mouthguards) during sport activities, I am writing this article with the hope that once and for all, the myths and facts about intra-oral protection during the aforementioned activities are finally put to rest.
The said inquiries were directed to this writer from athletes, coaches and trainers as well as dentists who have not dealt with the design, fabrication and fitting of these intra-oral protectors and are thinking of getting into the art and science of making proper intra-oral protectors.
One inquiry that stood out was delivered via the social media. It was a direct to the point question - “What makes your mouthguards better than others?”
To begin with, I wish to state that there is a huge difference between what is commonly known as “mouthpiece” and custom dentist-designed, fabricated and fitted, heat and pressure laminated “mouthguards”.
To stress this point, one can look back at the video of the Casimiro-Ramirez fight held recently in Manila. Cesar Ramirez of Mexico lost his intra-oral protector during the heat of combat. We believe he was wearing a mouthpiece and not a dentist-designed, fabricated and fitted mouthguard. The same may have been true for Keith Thurman during his fight with the great Manny Pacquiao recently at Las Vegas (top photo).
Casimero (R) ejected Ramirez's mouthguard with a left to the jaw.
In contrast, check out all the fights of Donnie Nietes, the Filipino 4 weight division world champion. Nietes reigned as a continuous undefeated champion for many years and his achievements surpassed the 7-year record of the great boxing icon, Gabriel “Flash” Elorde. Nietes never lost his intra-oral protector in any of the fights he was involved in. Nietes wore custom designed, fabricated and fitted heat and pressure laminated mouthguards exclusively made for him.
Myth No 1: All mouthpieces are the same.
There is a huge difference. There are four kinds of intra-oral protectors.
A) dentist designed, fabricated, and fitted heat and pressure laminated devices
B) Vacuum formed
C) Boil and Bite
Each of these devices offers different levels of protection. The American Dental Association and the Academy of Sports Dentistry recommend the heat and pressure laminated dentist-designed and fitted devices because they conform with the requirements of what the devices should be, in terms of fit, thickness, proper border extensions, comfort, level of protection, and occlusion.
Vacuum formed devices are usually made by dentists or made for dentists by dental technicians. They have an average fit owing to the fact that they are formed using a vacuum former that sucks a heated and soften plastic material towards a dental cast to form the device.
One big disadvantage of these devices is their inability to be made in multiple layers because most dental vacuum formers do not have the power strong enough to laminate layers of the materials. Therefore, they don’t always have the proper recommended thickness for maximum protection.
Boil and bite devices are made from a thermoplastic material that an athlete will soak in hot water to soften. Then the soften material is placed in the mouth and the athlete forms it using finger pressure such as pushing the cheeks as well as tongue pressure.
Stock devices are ready made devices bought from sporting goods stores and via the internet. They are used as is, straight from the packaging. These should not be used particularly in combat sports, as they offer nothing but a false sense of security! But, in fairness some are really pretty particularly while viewed when they are on the palm of a hand. Their esthetic value highlighted by decals and décor does nothing to help protect the athlete.
Myth No. 2: Performance Enhancing Mouthguards (PEM) are the best mouthguards.
These mouthguards pushed by two commercial companies claim that their product can increases athlete’s core strength, enhance reaction time and focus , reduce stresses and tension throughout the body, stabilizes shoulder, neck, head, and jaw muscles, improves balance and flexibility, decelerate lactic acid buildup, and help muscles recover as the athlete sleep at night!
All the above is baseless and pure marketing ploy! There are no credible scientific and peer-reviewed researches to back the above statements!
Myth No. 3: Mouthguards should be removed between rounds.
The process of removing mouthguard between rounds started during the early days of boxing when mouthguards were merely pieces of rubber devices boxers put around their teeth to simulate protection.
These early generations of intra oral protectors needed to be removed between rounds because they were too uncomfortable for the boxers and they never fit right making breathing very difficult. Therefore, trainers removed them between rounds to give boxers an opportunity to breathe correctly even for just one minute.
Dentists designed, fabricated and fitted custom mouthguards need not be removed between rounds. Many of our clients state that their custom mouthguards are so comfortable and they keep them in for the duration of the whole fight. Often times they still have them on long after the fight is over when they parade around the ring after a victory.
However, some trainers still remove these mouthguards after each round, as it’s been a habit for them to do so thinking perhaps they have to do it to help their boxer.
Myth No. 4: Anyone with little training dental lab technology can make a mouthguard.
It may be true that anyone with such training can “make” a mouthguard. In fact, dentists with no in-house facilities often times delegate the fabrication of mouthguards they offer to their patients, to dental labs. There is a huge difference between “knowing to make them” and “knowing to fit them properly” taking into consideration knowledge in proper fit, border extensions, thickness, occlusion, oral anatomy and comfort of the athlete.
Myth No. 5: Mouthguards prevent concussions:
Mouthguards help reduce injuries to the teeth and surrounding oral structures but they will not prevent concussions. In fact there is no credible peer-reviewed published research to prove that they prevent concussions. This is because they have no effect on the movement of the brain and the cerebro-spinal fluid within the skull when forces are applied to the head.
Fact No 1: Mouthguards help reduce ortho-dental injuries during contact sports
Research by the American Dental Association (ADA) shows that athletes are 60 times less likely to damage their teeth when they are wearing a proper mouthguard while engaged in contact sports. More than 200 thousand injuries a year are prevented by the use of proper mouthguards.
Fact No. 2: Dentist-designed, fabricated and fitted custom heat and pressure laminated mouthguards offer better protection than the other kinds of mouthguards.
Dentist-designed, fabricated, and fitted custom made heat and pressure laminated mouthguards offer better protection because they fit snugly to the teeth. In addition, due to their proper thickness, achieved by multiple lamination of the mouthguard material, they dissipate forces of impact to the rest of the teeth rather than to just a few. More importantly, these types of mouthguards will seldom come off during heat of combat.
Studies published on the May/June 2014 Journal of the Academy of General Dentistry states that athletes that use over the counter mouthguards were more than twice as likely to suffer mild traumatic brain injures (MTBI)/concussions than those wearing custom-made, properly designed and fitted mouthguards.
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.
The ready-made (Stock) OTC mouthguards provide the least amount of protection because they do not properly fit the athlete’s mouth. To keep them in the mouth, athletes need to bite on them tight, therefore making breathing very difficult at best. A customized fit is essential to dissipating the force of an impact.
When cost is a factor, vacuum formed mouthguards are a better choice than boil and bite and stock mouthguards. They may not fit as snugly as heat and pressure laminated mouthguards but, they fit better than boil and bite and stock mouthguards.
But, there is no substitute for dentists-designed, fabricated and fitted pressure and heat laminated custom mouthguards.
It should be noted more concise research is needed to validate the protective values of these mouthguards. However, the benefits they offer in protecting the athlete far outweigh the costs associated with a dental or medical injury, which is likelier to occur with a store-bought model or self-made mouthguards.
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