What Are Mouth Guards?
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Custom Fit Mouth Guards

Published on Oct 26, 2021 and last reviewed on Aug 03, 2023   -  4 min read


Read this article to know the features, types, and fabrication of mouth guards and overall management of oral injuries by the dentist.

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?

  • 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.

  • 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.

  • 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.

  • 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:

  1. 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.

  2. The impression is poured with high-strength dental stone to produce a model of the patient’s dentition and other oral structures.

  3. The mouth guard is formed using one or more sheets of thermoplastic material (most commonly ethylene vinyl acetate) on the stone model.

  4. The mouth guard is then seated with proper occlusal balance and with correct equilibration.

  5. 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.

  6. 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?

  • Do not chew or alter the mouth guard as this will affect the fit and possibly damage or decrease its effectiveness.

  • The mouth guard after removal should be stored in only cold water as hot water can dimensionally alter its fit in the oral cavity.

  • 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.

  • 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.

  • Do not share your mouth guards with others.

  • Avoid high temperature or direct sunlight to minimize distortion.

  • 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.

  • It is recommended to avoid the use of removable orthodontic appliances simultaneously with the mouth guard.

  • Mouth guards wear out over time. Replacement is recommended every two to three years, earlier if torn, cracked, or significantly worn out.


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.

Frequently Asked Questions


Is Getting a Custom Mouthguard Helpful?

Wearing a mouthguard or night guard can prevent the teeth from grinding against each other, thereby preventing attrition of teeth (loss of tooth structure by constant friction against each other). If an individual is prone to stress, tooth attrition, grinding, and teeth clenching, it is worth getting a custom-made mouthguard or night guard to protect the teeth from damage. 


Do Dentists Make Customized Mouthguards?

Yes, dentists can fabricate custom-made mouthguards and night guards that fit into one’s mouth properly. Every individual has a different jaw size and different anatomy of the teeth. Unlike the readymade, easily available mouthguards, custom-made ones are specially made for the patient’s mouth. These are more convenient and comfortable to wear. The dentist takes impressions of the teeth and jaws with alginate materials, after which the mouthguards or night guards are fabricated in the laboratories.


How Long Can Custom Mouthguard Be Used?

Depending on the patient's habits and other factors, mouthguards may last three to five years. A night guard has an average lifespan of five years, but depending on the wear, it can need replacement in just one year. Night guards may also get torn or get broken if not handled properly. They can also turn yellow and stink if not cleaned properly. 


Can Night Guards Affect the Temporomandibular Joint?

Night guards are usually prescribed as a treatment or solution for nighttime bruxism (teeth clenching or grinding). Unfortunately, most individuals use night guards incorrectly or, for the first time, experience worsening pain in their jaw joint, also called the temporomandibular joint (TMJ), after wearing the appliances. Over-the-counter ready-made or prefabricated night guards may or may not fit properly, causing severe pain in the jaw joint. This may affect the TMJ over a while. Hence. It is always advised to wear night guards fabricated by dentists (custom-made).


How Many Times Can One Wear a Mouthguard?

There is no specific number of times a person could wear a mouthguard or a nightguard. However, dentists recommend replacing the mouthguard after every six months or when the mouthguard becomes thin or yellow. Research shows that mouthguards become less effective when their thickness reduces. This is because there is less protective material to absorb the masticatory forces or external impact and protect the teeth.


Can a General Dentist Make Mouthguards?

Yes. A general dentist can make a mouthguard or night guard. The process involves taking impressions of the patient’s mouth and sending the impressions made from alginate material to the laboratory. The lab technician uses these impressions to make plaster models over which the nightguard or mouthguard is fabricated. The nightguard is then fit into the patient's mouth and checked for any fitting issues or problems.


Do Night Guards Cause the Teeth to Shift?

Over-the-counter or ready-made and prefabricated night guards can cause the teeth to shift from their original positions over time in case they do not fit properly. This shifting can also cause other side effects like attrition, malalignment of the teeth, poor aesthetics, altered smile and mouth sores from the material rubbing against the gums and soft tissue, and soreness of the jaw joint (temporomandibular joint).


Can a Mouthguard Realign Teeth?

No, mouthguards nor night guards can realign your teeth. Clear and invisible braces called clear aligners are used to realign and straighten the teeth out of alignment to improve the smile. Mouthguards and night guards are fabricated over the already existing teeth positions, whereas clear aligners are fabricated on the desired and altered teeth positions.


Does One Have to Wear a Nightguard Forever?

Whether short-term or long-term, dentists prescribe or recommend the duration of nightguards depending on the severity, the existing condition of the teeth, the severity of attrition, and the intensity of clenching and grinding habits. Wearing the night guard protects teeth from further damage. One can stop wearing night guards if the habits no longer exist and continue to show damaging effects. However, these habits may also occur subconsciously at night, so it is best to continue wearing them as a preventive measure.


Which Is Better Upper or Lower, the Night Guard?

Both upper and lower night guards are capable of preventing dental disorders. However, the best results are achieved by wearing the lower nightguard. Most people find night guards for lower teeth more comfortable than upper ones. Lower night guards also fit better and are less likely to shift or become loose at night. They are also less likely to trigger a gag reflex.


Which Dental Problems Are Prevented With a Night Guard?

The night guard effectively protects the teeth against disorders like teeth grinding and clenching that lead to severe tooth attrition and consequences. Teeth grinding (bruxism) is a condition where the patient grinds their upper and lower teeth against each other. This leads to loss of tooth structure due to constant friction between the teeth. This can also cause severe teeth sensitivity and pain. It could also lead to other problems, such as jaw pain, pain in the jaw joint (TMJ), tooth pain, and sore gums.


How to Stop Teeth From Clenching at Night?

Clenching of teeth and teeth grinding at night is a result of severe and chronic stress. Reducing stress levels can help prevent clenching habits while asleep. Here are some ways to stop teeth clenching at night–
- Try relaxation techniques to calm down before bed.
- Listen to relaxing and soothing music.
- Practice facial yoga. 
- Wear custom-made night guards fabricated by dentists.


Are Custom-Fitted Mouthguards Expensive?

Custom-made mouthguards are a bit more costly than the ready-made ones available in the market, especially the ones made by dentists. It involves a more precise fit and better benefits. However, the price range also depends on the dentist and the condition of the teeth, and their alignment.

Article Resources

Last reviewed at:
03 Aug 2023  -  4 min read




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