What Is Mouth Guard?
Mouth guards (also called gum shields or mouth protectors) are defined as resilient devices or appliances placed inside the mouth to reduce oral injuries, particularly to the teeth and surrounding structures. Mouth guards cover the teeth as well as the gingival structure forming a shield for the oral cavity. They not only reduce the severity but also prevent the occurrence of injuries.
Children and adolescents frequently take part in various contact sports, physical exercises, and unsupervised recreational activities, which pose an increased risk of minor to extremely complex dental injuries in these individuals. Sporting accidents are reported to be accountable for 10 to 39% of dental injuries in children. Dental concussion Injuries need to be avoided as much as possible for sports players and athletes.
Concussion injuries usually occur either after a fall or impact directly or indirectly to the face or the facial muscles affecting the jaws and dentition. This can lead to discoloration of the tooth structure if there is a nerve-related injury (that is, to the tooth pulp) or, in severe cases, can be a leading cause of dentoalveolar fractures and injuries. By protection with the mouth guard (preferably fabricated and customized by the dental surgeon), the incidence of these kinds of jaw-related or tooth concussion injuries can certainly be avoidable.
What Are the Salient Features of a Mouth Guard?
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To provide adequate protection, a mouth guard should be properly fitted to the wearer’s mouth and accurately adapted to his or her oral structures, and should importantly be physiologically comfortable to suit the patient’s teeth suiting his or her oral needs.
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It should be relatively easy to fabricate and clean with high-impact energy absorption. The necessity of high-impact absorptive forces by the mouth guard is, in turn, to reduce transmitted forces upon impact from any external force, especially in sports players.
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The mouth guard should fundamentally have the four ideal characteristics of being tear-resistant, odorless, being tasteless, and, lastly, should not interfere with the speech.
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The mouth guard should also not interfere with the patient’s original occlusion or bite; for this purpose, a dentist suggested, and dental lab-made custom-fit mouth guards are usually preferable for professional sports players and athletes. Current research in sports medicine supports not only the usage of pressure laminated custom-fit mouth guards but also the reinforcement by sports players will spread awareness on why its usage is crucial to the prevention of concussion injuries, jaw fractures, and dentoalveolar or facial injuries.
The American society for testing and materials designated three categories for athletic mouth guards:
A. Prefabricated, ready-made, or stock mouth guard.
B. Mouth-formed, “boil-and-bite “protector.
C. Custom-made, either vacuum-formed or pressure-laminated, usually based on the instructions given by the dental surgeon.
The two categories of custom mouth guards are the vacuum mouth guard and the pressure-laminated mouth guard. Although custom mouth guards can be the most expensive option, they generally offer better retention and comfort, less interference with speech and breathing, and more adaptability to orthodontic appliances as they are individually designed and form-fitted under the dentist’s supervision.
How Are Custom-Fitted Mouth Guards Fabricated?
Fabrication of custom-fitted mouth guards requires five standard steps:
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An alginate impression, which includes all teeth (except erupting third molars), the gingiva (till the mucolabial fold), the labial frenum, the palatal portion including the full vestibular extensions and borders are made. If a wax bite is required by the dental laboratory, it is recommended to be taken with the teeth approximately 1.5 mm distance apart.
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The impression is poured with high-strength dental stone to produce a model of the patient’s dentition and other oral structures.
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The mouth guard is formed using one or more sheets of thermoplastic material (most commonly ethylene vinyl acetate) on the stone model.
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The mouth guard is then seated with proper occlusal balance and with correct equilibration.
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Excess material is trimmed from the mouth guard wherein the labial flange should ideally extend to within 2 mm of the vestibular reflection and have rounded edges, and the palatal flange should extend to within 10 mm of the palatal gingival margins and have a tapered edge.
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If any orthodontic tooth movements are to be undertaken, the laboratory should be informed of the proposed movements so that the mouth guards can be fabricated to accommodate them. Depending on the extent of the tooth movements, the mouth guard may need to be remade as treatment progresses.
Vacuum-Formed Mouth Guards: A vacuum-formed mouth guard is constructed using a conventional vacuum machine that applies low heat and vacuum (equivalent to approximately one atmosphere of pressure) to soften a single layer of thermoplastic material.
Pressure-Laminated Mouth Guards: The pressure lamination technique utilizes a combination of heat and pressure which facilitates proper lamination and precise adaptation of the mouth guard within the specifications of the copolymer material, technique, and machinery used. Up to 10 atmospheres of positive pressure is applied using the pressure lamination machine.
How Should Mouth Guards Be Taken Care of?
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Do not chew or alter the mouth guard as this will affect the fit and possibly damage or decrease its effectiveness.
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The mouth guard after removal should be stored in only cold water as hot water can dimensionally alter its fit in the oral cavity.
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Proper oral hygiene like mouthwash twice a day will also help achieve plaque control in the oral cavity. Since the mouth contains bacteria and plaque, it is important to clean your mouth guard after each use. Clean with toothpaste or toothbrush or clean it in cool, soapy water and rinse thoroughly.
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Store and transport the mouth guard in a firm, perforated container to prevent damage and permit air circulation. Do not close the mouth guard container until the freshly washed mouth guard is dry.
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Do not share your mouth guards with others.
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Avoid high temperature or direct sunlight to minimize distortion.
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Check the condition of the mouth guard occasionally and replace it if it has holes or tears, becomes loose, or irritates the teeth or gums.
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It is recommended to avoid the use of removable orthodontic appliances simultaneously with the mouth guard.
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Mouth guards wear out over time. Replacement is recommended every two to three years, earlier if torn, cracked, or significantly worn out.
Conclusion:
To conclude, custom-fabricated protective mouthguards for people participating in sports and certain recreational activities can minimize or eliminate mouth injuries. However, the maintenance and fabrication of a mouth guard play an equally important role in not only protecting the player from oro-facial injury but also in providing physiological comfort to suit the wearer’s needs. Awareness of the players about the usage and dental approach to mouth guards will be beneficial in the prevention of physical injuries to the orofacial cavity.
