I originally wrote this as a letter to the parents of my son's hockey teammates. However, it applies equally to all ages and all sports.
It's a bit long, but, I think you'll find it very informative. If you have a child in youth sports, this is really important.
Custom Athletic Mouth Guards vs. Over-the-counter
By Michael Barr, DDS
A few years ago, I became a "hockey dad." Previously, I knew very little about hockey other than it was a notoriously rough contact sport. Dental injuries traditionally top the list of hockey-related incidents. In fact, hockey is famous for producing toothless grins.
While my article may seem to be "hockey-centric," it bears mentioning that nearly ALL team sports can become "contact sports." That includes: baseball, basketball, soccer, lacrosse, football, rugby, volleyball, martial arts (karate, judo, taekwondo, ju-jitsu, mixed martial arts, etc.), and others I'm probably forgetting at the moment.
And protecting teeth isn't just for kids in sports. It's just as important for adults!
Naturally, as a dad, I'm concerned about my son's safety and well-being. As a dentist, I have an even more acute awareness about protecting his precious teeth. Teeth don't grow back if they're broken or knocked out.
As a trained and experienced restorative dentist, I'll tell you it's better to preserve what nature gave you. Furthermore, a single tooth traumatically lost may have a lifetime cost of over $15,000 in maintenance and replacements. One tooth!
Figure 1: Look familiar? The mouth guard isn't being worn properly. Almost every player with a store-bought guard is doing this...because he or she has no choice. He can't breathe or talk during play with it properly on his teeth. This is NOT acceptable, and it's dangerous. It does nothing to protect the player.
Athletic mouth guards are rightfully required by many sports league rules. But from my observations at practices and games, VERY few are actually WORN by the players. By "worn," I mean actually in the mouth, on the teeth, where they're supposed to be. Most of the players simply bite and chew on one side while the rest of the mouth guard hangs outside the mouth like a cigar.
They might as well not have them at all. I compare it to the motorcycle helmets you see strapped to the side of seat, as the rider goes down the road with nothing on his head. Pointless!
Look at your player's store-bought mouth guard. Is it all chewed up and flattened? See Figure 2.
Figure 2: Does your player's guard look like this? All chewed up? The yellow arrows indicate where the guard has split all the way through. This is a stock store-bought mouth guard I bought as a temporary for my son right after he got braces. He chewed through it in a WEEK. I've since made him another custom mouth guard. I believe these stock mouth guards are worthless.
Athletic mouth guards can prevent tooth fracture or loss, jaw fractures, and lacerations. While many of you have heard that a custom athletic mouth guards may prevent concussion injuries, there is no current scientific evidence supporting this notion. It is still a controversial issue not yet proven with repeatable scientific data. The primary purpose of athletic guards remains the protection of teeth, jaws, and related soft tissues.
Athletes don't wear store-bought guards properly, because they can't!
I submit it's not a matter of the players simply not wanting to wear them. The fact of the matter is that they CAN'T wear them properly AND function as a sports team member simultaneously.
Here's the real issue: The majority (if not all) the mouth guards that aren't being worn properly are over-the-counter, boil-and-bite mouth variety. That type of mouth guard is nearly, if not completely, worthless... Because they don't fit (and stay put). The fit is so poor, the player can only keep it on his/her upper teeth by forcibly biting down on it. And if they do that, it restricts breathing significantly and prevents communications with other players.
Because they are so bulky, the players can't:
And that's exactly the problem: The boil-and-bite guards are IN THE WAY. And, when they're in the way of breathing, it's a big problem to the athlete. So, he or she spits it out...or holds it sideways like a cigar out the side of the mouth to appease the refs who want them to "wear" the guards. The refs are too busy to strictly enforce this rule.
You should try to do a few hot-laps around the rink, court, or field and BREATHE while holding a store-bought guard in place. You won't like it! And, you'll want to spit the guard out just like your young players do.
You may have also noticed the store-bought guards don't seem to last very long. Many parents have told me they're buying a new guard every few weeks or every month. This is especially true if your player is chewing on it (see figures 1 and 2 above).
The answer is...
A professionally fitted CUSTOM mouth guard. A custom mouth guard fits over the teeth and gums very intimately and comfortably. When it goes in, it STAYS in. It will not fall off. It won't get in the way. See Figure 3.
Figure 3: Custom laminated athletic mouth guard.
My son puts his custom mouth guard in when he gets dressed for practice or the game. And it stays in his mouth, on his teeth, until he returns to the locker room. He can talk with it and call for a pass. He can drink water and stay hydrated with it in place. He can BREATHE on a breakaway without having to spit it out.
Figure 4: A custom guard is very comfortable. It can also be made in a number of colors.
How are custom mouth guards different than store-bought?
A store-bought athletic guard is a pre-fabricated plastic guard. Some of them are "boil-and-bite," which means you place them in hot water, softening the guard, and then molding it in the player's mouth. And even those do not fit well...at all.
A custom guard can be made in one of two ways, and it's important to note the differences between them.
The first type is a single layer of material that is adapted to a model of your player's teeth by heat and vacuum/suction. Many dentists have the equipment to make vacuum-formed guards right in their offices. So, some default to this as their "custom athletic mouth guard." It is better than an over-the-counter, boil-and-bite guard. But it's not the best.
The second type of custom guard is the BEST protection you can get for your player's teeth. It's a laminated, multi-layer guard that is adapted to the model by heat and PRESSURE. The reason I emphasized "pressure" is because it's a far superior method of adapting "thermo-formed" materials to a dental model.
This method uses special (and more expensive) equipment. Pressure-forming creates a much more accurate (and snug) fit. It also allows us to make a multi-layer, laminated guard, which protects teeth more effectively. When we add layers, we can add increased thickness to areas that need extra protection. This method takes more time and more materials. Of course, it costs more, too.
Figure 5: Pressure-formed mouth guards fit the teeth and gums like a tight glove. It will stay put until the player intentionally removes it.
Many dentists do not have the special pressure-forming equipment. If they don't, they'll have to send the case to a commercial lab that does. Some dentists may not be aware of the significant advantages to laminated, multi-layer, pressure-formed guards if they are not up to date on the latest sports-dentistry information.
Be sure to ask your dentist which type of guard he offers (vacuum vs. pressure or single vs. multiple laminated layers). The differences are significant enough to be worth asking.
How do I get a custom mouth guard?
Making a professional custom mouth guard requires an accurate impression (mold) of the player's teeth. This means you'll have to bring him or her to a dentist's office for the impression. If you've had braces, a dental crown, denture, or retainer made, you are probably familiar with the impression process.
Figure 6: Dental impression.
A model is made and then sent to the lab for the mouth guard to be made. Or they may be made right in the dental office if they have the proper lab equipment. The player will then need to return to the office to finish the fitting process. It's a two-appointment procedure.
If your player is growing or losing baby teeth, the guard will probably need to be remade as necessary to accommodate those changes.
What if the player has braces?
If your player is currently in braces, custom guards can be unfortunately difficult to fit, depending on what kind of hardware is on the teeth. And, because the braces hardware can change during the course of orthodontic treatment, a custom guard may only fit for a short time. A boil-and-bite designed for braces may be your best bet in some cases until the braces come off. But, you can count on having to buy many of them per season as your child will probably chew through them in a short time.
Shouldn't the guard have a strap (to attach to the helmet)?
While straps can be added to a custom guard, they are simply not necessary. Straps are popular with store-bought guards because they are often spit out by necessity (for reasons already mentioned). On the other hand, a custom guard stays put. It's not removed for talking, breathing, or even drinking water. Accordingly, a strap is not needed.
Straps can even be dangerous with a custom mouth guard. In football, a "face-mask" violation becomes even more worrisome if the strap is grabbed along with the face-mask. In hockey, I've seen helmets come off in collisions. A strap could cause trauma to the teeth. I recommend not using a strap.
Do mouth guards reduce concussions?
The short answer is: No. Despite advertising claims and "urban legend," there is no scientific evidence that mouth guards reduce the incidence of concussions. The primary reason to wear a mouth guard is to protect the teeth and surrounding tissues.
What is the cost?
A pressure-formed, laminated custom mouth guard costs about the same as or less than what you'd spend on multiple boil-and-bite guards. So, yes...the price is higher than a single guard bought at a sporting goods store. But, regardless of the low price of a store-bought guard, it's worth nothing if it DOES nothing. A stock store-bought guard may last a few weeks to a month (doing nothing, mind you). A custom made guard will easily last a whole season (or more), effectively protecting a player's teeth. And, since a mouth injury can cause life-long and costly issues, I believe custom mouth guards are an excellent investment and value.
There are few guarantees in life.
Of course, we know that hockey and other contact sports have risks. And, no piece of equipment can guarantee an injury-free season. Using the best equipment available certainly helps. But a chewed-up store-bought mouth guard with half of it (or all of it) hanging outside the player's mouth is useless and will not help prevent any injuries.
As a dentist and a hockey dad, I would urge you to consider obtaining a properly fitted, pressure-formed athletic mouth guard for your child athlete or for yourself, if you're an adult playing sports.