Guest Blog: Mouthguard Manifesto

by barbaragarn

By Dr. Tracey Hysjulien (dentist, educator, hockey mom and JMS mega fan/skater)

First of all, I’d like to thank all of the non-mouth-guard-wearing hockey players who, over the years, have helped pay for my hockey habit and contributed to my children’s college funds. I have treated innumerable fellow adult hockey players and youth players who received dental injuries ranging from chipped front teeth and fractured molars to lacerated lips and concussions. And yes, I have treated injured players during various JMS sessions, too.

The AHA, WHAM and JMS do not require the use of dental mouth guards (and have varying policies on mouth-protecting cages and visors). The choice of whether or not to protect our smiles, eating and chewing ability, mental function and finances is completely our own.

Why should you wear a mouth guard during hockey?
Mouth guards protect against damage to teeth and dental work. When a blow is delivered to the mouth, the forces of the impact are absorbed by the structures the blow lands upon. In the case of hard oral tissues such as teeth, a forceful impact can easily cause tooth fracture, result in tooth dislodgement, or damage existing dental work (dental crowns, bridges, porcelain veneers, dental implants).

A sports mouth guard can help dissipate the total amount of energy that has to be absorbed by any one tooth or region of the mouth. This will lessen the total force load any one tooth is subjected to and therefore lessen the likelihood that chipping, breaking, or even tooth dislodgement.

How exactly do mouth guards protect?
Athletic mouth guards help prevent tooth damage that might be caused by tooth-to-tooth contact. Hard collisions or blows directed to the head or mouth can result in a motion in which the athlete’s jaws forcibly come together. The mouth guard’s resiliency can help to cushion the effects of this reaction and help prevent tooth damage. The spongy resiliency of a mouth guard can help to absorb some energy of a blow.

The stiffness of the mouth guard can help to distribute energy from a traumatic force over a greater surface area. Along these same lines, to some degree a mouth protector can help to prevent jaw bone fracture. A mouth guard can help minimize the amount of soft tissue damage that is caused by a traumatic event. A forceful blow can press a person’s lips or cheeks against teeth, dental work, or dental appliances in a fashion where they become pierced or torn.

The violent jaw movements created by a blow or collision can result in a biting laceration of the lips, cheeks, or tongue. Research has suggested that wearing a mouth guard can help to reduce the incidence or severity of concussion

What are the best mouth guards?
Two prime considerations for a mouth guard are that it has a good fit and that it is comfortable to wear. The BEST mouth guard is the one YOU like and will wear every time you play hockey!

From http://www.dental-picture-show.com/mouthguards/a1-sports-mouth-guards.html

Different types
Stock mouth guards
Cost: $1 to $15 (cheap)
Availability: Sporting and drug stores.

Stock mouth guards are pre-formed mouthpieces that are sold ready to use. No customization is expected on the wearer’s part. This type of guard usually only manufactured in just a few sizes.Stock mouth guards are typically the least expensive but they are also the least protective.

Because stock mouth guards come in limited sizes, fit and comfort are typically poor. So, to help to keep it in place, an athlete will often feel that they must perpetually clench their teeth together. This clenching action can create speech and breathing difficulties, creating a reason why the athlete will not wear the guard.

An athlete may try to improve the wearing comfort of a stock mouth guard by trimming it. Excessive trimming can compromise the level of protection the mouth guard can provide. Additionally, because so few sizes are usually available, a stock mouth guard may not cover over all of the wearer’s back teeth the way a properly fitted mouth guard should.
(Tracey’s note: I’ve tried these–they’re VILE! Better than nothing, though, and dirt cheap.)

“Boil and Bite” mouth guards.
Cost: $1 to $40 (also cheap, although newer “name-brand” models can be $100+)
Availability: Sporting and drug stores, online, mail-order.

A “boil and bite” mouth guard is bought off the shelf in one of a few standard sizes and then customized at home. Boil and bite mouth guards are the most used type of sports mouthpiece, made from a thermoplastic material. The guard is boiled to soften and then the athlete uses fingers, lips, tongue and biting pressure to seat the guard over their teeth and form its contours.

Because they are customized by the wearer, boil and bite mouth guards can be expected to fit somewhat better and be more comfortable than stock mouth guards. There is still some potential that an athlete will feel she or he must clench the teeth together to hold the guard in place, which can hinder breathing and speech activities. Additionally, boil and bite mouth guards are often considered to be bulky.

When choosing a boil and bite guard, athletes must select a size that extends over all of the back teeth. During the customization process, take care to make sure the plastic is still thick over the chewing and biting survaces, lest the level of protection be compromised.

(Tracey’s note: Even the fancy “name-brand” boil-n-bite guards are still stock guards that are only somewhat customized. These can be very expensive. I can’t recommend them over a custom-fit mouth guard from your friendly local dentist. And no, I am not soliciting business! I left clinical dentistry for academia and consulting several years ago. 😉 However, for those of you with orthodontia or other dental appliances, this MAY be the best option for you.)

Custom mouth guards
Cost: $40 +
Availability: Dentist offices.

Custom mouthpieces are the preferred type and considered to provide the greatest level of mouth protection. These guards can be customized, not only related to factors associated with the athlete’s oral anatomy, but also (in some cases) according to the type of sport that the wearer will be participating in.

The fit, comfort and retention of a custom mouth guard should be superior to any other type; a custom guard will be pleasant to wear and less likely to interfere with the wearer’s breathing and speech. Therefore, the custom mouth guard is more likely to be worn. Custom guards can cost several times the amount of a boil and bite or stock mouth guard but this should be considered money that has been well spent.

(Tracey’s note: I wear a custom guard I made for myself four years ago. My three little princes, one of which plays high school hockey, all wear custom guards. Mine is hot pink. Look for it on the ice at JMS!)

Taking care of your guard
A mouth guard really won’t require much care or attention, but some things will keep it looking new and extend its life span.

* When you are wearing your mouth guard, do not clench or chew on it. Doing so might rip, tear, pierce, or compress the guard’s plastic and compromise the level of protection.
* After you wear your mouth guard, wash it off. At least give it a good rinsing with cold water. Better yet, scrub it gently with your finger or, best of all, a toothbrush. Use a mild soap if you want–the plastic of a good mouth guard should not retain the soap’s taste.
* The plastic your mouth guard is made from will probably become distorted if it is exposed to elevated temperatures. Do not put your guard in hot water or a hot environment (like the car’s glove box) or on a hot surface (car dashboard).
* Store your mouth guard in a hard, perforated container. Doing so will both protect it from physical harm and also allow it to thoroughly dry out between uses. Most mouth guards will come with a plastic box included. If not, you can usually find this type of item at your local drugstore or pharmacy.

Mouth guards are supposed to wear out.
As you use your mouth guard, you can expect that it will gradually deteriorate and finally wear out. You can expect that as time goes by your guard will develop rips, tears and holes. The fit of a mouth guard will often become slack as it wears out. If you have noticed any, or even several, of these changes, it’s time to replace your mouth guard with a new one.

For further reading:
http://www.ada.org/public/topics/mouthguards_faq.asp

(BG note: Tracey will be reading the replies to this blog, so post questions here and she’s happy to answer. Thank you, Tracey!)