A Technique for Fabricating Modern Athletic Mouthguards

Department of Pediatric Dentistry

Lutheran Medical Center

Date: 11/13/2009

Article title: A Technique for Fabricating Modern Athletic Mouthguards

Author(s): Ray R Padilla, DDS

Journal: CDA Journal

Volume (number): Vol. 33, No 5

Month, Year: May 2005

Major topic: Mouthguard fabrication

Minor topics: Althletic Mouthguards

Type of Article: Technique article

Main Purpose: Instruct general dentists on the proper fabrication of a pressure laminated mouthguard

Overview of method of research: Review of literature included as preface to fabrication instructions.

Findings:

As more dental patients become active in athletic endeavors, oral-facial injuries are on the rise. Proper mouthguard use can significantly reduce injury and general dentists must be able to educate patients on the need for mouthgaurds as well as provide means to obtain such.

Key points/Summary :

There are 3 major types of mouthguards

Type I: store bought, one size fits all. Research does not support their use.

Type II: store bought boil-and-bite. May fit better than type I, but there is some “research” suggesting that they may be worthless.

Type II: professionally made, custom fitted. The holy grail of mouthguards. The standard are 3-4mm thick pressure laminates.

The literature only supports the professional recommendation of custom mouthguards.

A quality mouthguard should have 3mm labial thickness, 2mm palatal and 3mm occlusally.

The material of choice is ethylene vinyl acetate with shore hardness of 80.

As with any appliance, a great impression is imperative; the author recommends Accu-Dent multicolloid.

After pouring model, mark the highest level of the vestibule with a pencil and trim to that point.

Lube the model

Use 2 layers of 3mm ethylene vinyl acetate in two steps. One step will not allow for proper thickness in all areas needed.

Make sure that the lingual area is not bulky.

Trim areas of muscle attachment well and equilibrate occlusion by gently heating the mouthguard and having the patient bite together until all teeth are in contact.

Assessment of article: I with we had a pressure laminate system. I’ve made a few of these using our vacum system and if this author’s sources are right, they may have been as useful as not having a mouthguard at all. Still, this is a great service and can be a great practice builder. Good article for practical application.

Policy on Prevention of Sports-related Orofacial Injuries

Resident: Adam J. Bottrill
Date: 13NOV09
Region: Providence
Article title: Policy on Prevention of Sports-related Orofacial Injuries
Author(s): AAPD council on Clinical Affairs
Journal: Oral Health Policies Reference Manual
Page #s: p. 45
Year: 2005-2006
Major topic: Prevention of Sports-related Orofacial Injuries
Minor topic(s): Official Recommendations
Type of Article: Policy Statement




Main Purpose: Disseminate the AAPD’s Official Recommendations Regarding Sports-related Injuries.
Overview of method of research: NA

Key points in the article discussion:
A. Purpose:
1. The AAPD is concerned…. (I sure hope so)
2. Increased competitiveness has resulted in a large increase in orofacial and dental injuries.
a. represent a high percentage of the total injuries experienced in sports.

B. Background:
1. Mandatory protective equipment:
a. college football, lacrosse and ice hockey have demonstrated significant reduction of dental and facial injuries with the use of mouthguards.
2. Other sports lag behind significantly in this area.
a. baseball, basketball, soccer, field hockey, softball, wrestling, volleyball and gymnastics.
3. Leisure activities can also benefit from this type of protection.
a. skateboarding, inline or roller skating and bicycling
4. Mouth guards distribute forces of impact, reducing risk of severe orofacial injury and concussion.
a. must be fitted and worn properly.
5. 3 types
a. stock, mouth formed, custom fit (listed in reverse order of protectiveness)

C. Policy Statement:
1. Dentists play an active role in educating the public in the use of protective equipment. (prevent injuries AND reduce health care costs)
2. Continuation of preventive practices instituted by the previously mentioned sports organizations.
3. For baseball and softball, ASTM-certified face protector should be required.
4. Mandating mouthguards will help protect against orofacial injuries in many other sports.
5. Coaches and administrators of sports should consult with a dentist for recommendations for immediate management of sports-related injuries (eg, avulsed teeth).
6. Continuation of R&D for a more comfortable and efficacious mouthguard is needed to facilitate more widespread usage of the devices.
7. The International Academy of Sports Dentistry should be recognized as a valuable resource for the professions and the public.

Assessment of article: No shenanigans here. Just the straight scoop.

Compliance of children and youngsters in the use of mouthguards 11/13/09

LUTHERAN MEDICAL CENTER
Dental Residency Program
Literature Review Form

Resident: Murphy Date: 11/12/09 Region: Prov.
Article title: Compliance of Children and youngsters in the use of mouthguards
Author(s): Matalon, Vered. Ilana Brin, et al
Journal: Dental Traumatology
Volume #; Number; Page #s): 24. 462-467
Year: 2008
Major topic: Children’s compliance wearing mouthguards during sports
Minor topic(s): Parents understanding of why a mouthguard is necessary
Type of Article: Clinical Study, Survey
Main Purpose: Assess why children do or do not wear their mouthguards.
Overview of method of research: Originally, 80 children were chosen for the study. The only criteria were that they have fully erupted incisors(they did not specify which incisors). The mean age was of the children was 12.7. There were 42 boys, 27 girls, and 21 of the children were siblings. A year later, 69 children and their parents completed a survey to gain information on terms of compliance regarding the appliance.

Findings: A mouthguard can be defined as a resilient appliance placed inside the mouth to protect against injuries to the teeth, lacerations to the mouth, fractures, and dislocations of the jaw. There is also evidence that they can protect against concussion and injury to the cervical spine. 26% of all oral injuries are a result of sports. According to the study, only 27% of athletes are aware that mouthguards should be worn, and only 3% reported using a mouthguard. In terms of compliance, 29% said they never wore it, 32 percent said they wore it sometimes, 23 percent said when they first got it they wore it all the time, but not so much anymore, and 16% wore it all the time. Reasons for not wearing the appliance were numerous, with the three most common being, ‘I forget to wear it’, it’s not comfortable’(55% said this), and ‘I’m embarrassed to wear it because none of my friends wear one’. 32% of the children lost their appliance. 4.5% lost the appliance after one week, 36.4% after a month, and 59.1% more than a month. With regards to the parents, 46% stated that using a mouthguard is essential, 40% didn’t know if it was helpful, and 6.3% said it was unnecessary. Additionally, 37.5% of parents thought that asking the child to use it was unrealistic. 77% said that their children did not previously have a mouthguard because they didn’t know it was available. Also, 47.9% said their dentist never offered them one.

Summary of conclusions: There are three predictors that the study focused on. Gender, boys are more likely to wear the appliance, age, younger children are less likely to wear the appliance, and sibling position, children that were born later in the sibling order were less likely to comply. Most children who didn’t use their mouthguards did so because of forgetfulness(45%) or discomfort(42%). History of family oral trauma did not increase parent’s awareness of mouthguard importance. More than half of the parents said that their child did not have a mouth guard because their dentist or physician never told them about it. After one year, 68% of the children still had their mouthguard, but a third of them never used it.

Assessment of article: Overall a very good article with relevant facts regarding the use and compliance of mouthguards with respect to children. The take home message is offer mouthguards to your patients, and the younger they are, the lower they are on the sibling tree, and whether they’re a boy or a girl will give you a fairly good idea if they’re going to wear it….or “lose it" before they reach the parking lot.