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Mouthguards in Sport Activities History, Physical Properties and Injury Prevention Effectiveness

  • Review Article
  • Mouthguards in Sport Activities History, Physical Properties and Injury Prevention Effectiveness
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Abstract

Three systematic reviews were conducted on: (i) the history of mouthguard use in sports; (ii) mouthguard material and construction; and (iii) the effectiveness of mouthguards in preventing orofacial injuries and concussions. Retrieval databases and bibliographies were explored to find studies using specific key words for each topic. The first recorded use of mouthguards was by boxers, and in the 1920s professional boxing became the first sport to require mouthguards. Advocacy by the American Dental Association led to the mandating of mouthguards for US high school football in the 1962 season. Currently, the US National Collegiate Athletic Association requires mouthguards for four sports (ice hockey, lacrosse, field hockey and football). However, the American Dental Association recommends the use of mouthguards in 29 sports/exercise activities.

Mouthguard properties measured in various studies included shock-absorbing capability, hardness, stiffness (indicative of protective capability), tensile strength, tear strength (indicative of durability) and water absorption. Materials used for mouthguards included: (i) polyvinylacetate-polyethylene or ethylene vinyl acetate (EVA) copolymer; (ii) polyvinylchloride; (iii) latex rubber; (iv) acrylic resin; and (v) polyurethane. Latex rubber was a popular material used in early mouthguards but it has lower shock absorbency, lower hardness and less tear and tensile strength than EVA or polyurethane. Among the more modern materials, none seems to stand out as superior to another since the characteristics of all the modern materials can be manipulated to provide a range of favourable characteristics. Impact studies have shown that compared with no mouthguard, mouthguards composed of many types of materials reduce the number of fractured teeth and head acceleration. In mouthguard design, consideration must be given to the nature of the collision (hard or soft objects) and characteristics of the mouth (e.g. brittle incisors, more rugged occusal surfaces of molars, soft gingiva). Laminates with different shock absorbing and stress distributing (stiffness) capability may be one way to accommodate these factors.

Studies comparing mouthguard users with nonusers have examined different sports, employed a variety of study designs and used widely-varying injury case definitions. Prior to the 1980s, most studies exhibited relatively low methodological quality. Despite these issues, meta-analyses indicated that the risk of an orofacial sports injury was 1.61.9 times higher when a mouthguard was not worn. However, the evidence that mouthguards protect against concussion was inconsistent, and no conclusion regarding the effectiveness of mouthguards in preventing concussion can be drawn at present. Mouthguards should continue to be used in sport activities where there is significant risk of orofacial injury.

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References

  1. Burt CW, Overpeck MD. Emergency visits for sports-related injuries. Ann Emerg Med 2001; 37: 301–8

    Article  PubMed  CAS  Google Scholar 

  2. Nicholas NK. Dental injuries in primary and intermediate school children. N Z Dent J 1980; 76: 8–11

    PubMed  CAS  Google Scholar 

  3. Kvittem B, Hardie NA, Roettger M, et al. Incidence of orofacial injuries in high school sports. J Pub Health Den 1998; 58:288–93

    Article  CAS  Google Scholar 

  4. Sane J. Comparison of maxillofacial and dental injuries in four contact team sports: American football, bandy, basketball, and handball. Am J Sports Med 1988; 16: 647–52

    Article  PubMed  CAS  Google Scholar 

  5. Sim FH, Simonet WT, Melton LJ, et al. Ice hockey injuries. Am J Sports Med 1987; 15: 30–40

    Article  PubMed  CAS  Google Scholar 

  6. Kumamoto DP, Maeda Y. A literature review of sports-related orofacial trauma. Gen Dent 2004; 52: 270–80

    PubMed  Google Scholar 

  7. Tuli T, Hachl O, Hohlrieder M, et al. Dentofacial trauma in sport accidents. Gen Dent 2002; 50: 274–9

    PubMed  Google Scholar 

  8. Onyeaso CO. Oro-facial trauma in amateur secondary school footballers in Ibadan, Nigeria: a study of mouth guards. Odontostomatol Trop 2004; 27: 32–6

    Google Scholar 

  9. Onyeaso CO. Secondary school athletes: a study of mouthguards. J Nat Med Assoc 2004; 96: 240–5

    Google Scholar 

  10. Onyeaso CO, Adegbesan OA. Oro-facial injury and mouthguard usage by athletes in Nigeria. Int Dent J 2003; 58: 231–6

    Article  Google Scholar 

  11. Levin L, Friedlander LD, Geiger SB. Dental and oral trauma and mouthguard use during sport activities in Israel. Dent Traumatol 2003; 19: 23742

    Article  Google Scholar 

  12. Cornwell H, Messer LB, Speed H. Use of mouthguards by basketball players in Victoria, Australia. Dent Traumatol 2003; 19: 193–203

    Article  PubMed  Google Scholar 

  13. Chapman PI. Attitudes to mouthguards and prevalence of orofacial injuries in international rugby: a study of the 1990 Wallabies. Aust J Sci Med Sports 1991; 23: 113–5

    Google Scholar 

  14. Chapman PJ. Orofacial injuries and international rugby players’ attitudes to mouthguards. Br J Sports Med 1990; 24: 156–8

    Article  PubMed  CAS  Google Scholar 

  15. Chapman PJ. Players’ attitudes to mouthguards and the prevalence of orofacial injuries in the 1987 U.S. Rugby Football Team. Am J Sports Med 1989; 17: 690–1

    Article  PubMed  CAS  Google Scholar 

  16. Chapman PJ. The pattern of use of mouthguards in rugby league (a study of the 1986 Australian Rugby league touring team). Br J Sports Med 1988; 22: 98–100

    Article  PubMed  CAS  Google Scholar 

  17. Chapman PJ. Orofacial injuries and the use of mouthguards by the 1984 Great Britain Rugby League touring team. Br J Sports Med 1985; 19: 34–6

    Article  PubMed  CAS  Google Scholar 

  18. Chapman PJ. Orofacial injuries and mouthguards: a study of the 1984 Wallabies. Br J Sports Med 1985; 19: 93–5

    Article  PubMed  CAS  Google Scholar 

  19. Chapman PJ, Nasser BP. Attitudes to mouthguards and prevalence of orofacial injuries in four teams competing at the second Rugby World Cup. Br J Sports Med 1993; 27: 197–9

    Article  PubMed  CAS  Google Scholar 

  20. Stokes AN, Chapman PJ. Mouthguards, dental trauma and the 1990 All Blacks. N Z J Sports Med 1991; 19: 66–7

    Google Scholar 

  21. Perunski S, Lang B, Pohl Y, et al. Level of information concerning dental injuries and their prevention in Swiss basketball: a survey among players and coaches. Dent Traumatol 2005; 21:195–200

    Article  PubMed  Google Scholar 

  22. Godwin WC, Bagramian RA, Robinson E. The utilization of mouth-protectors by freshman football players. J Pub Health Den 1972; 32: 22–4

    Article  CAS  Google Scholar 

  23. Jennings CC. Injuries sustained by users and non-users of gum shields in local rugby union. Br J Sports Med 1990; 24: 159–65

    Article  PubMed  CAS  Google Scholar 

  24. Yamada T, Sawaki Y, Tohnai S, et al. Oral injury and mouthguard usage by athletes in Japan. Endod Den Traumatol 1998; 14: 84–7

    Article  CAS  Google Scholar 

  25. Upson N. Dental injuries and the attitudes of rugby players to mouthguards. Br J Sports Med 1982; 16: 241–4

    Article  PubMed  CAS  Google Scholar 

  26. Jolly KA, Messer LB, Manton D. Promotion of mouthguards among amateur football players in Victoria. Aust N Z J Public Health 1996; 20: 630–9

    Article  PubMed  CAS  Google Scholar 

  27. Muller-Bolla M, Lupi-Pegurier L, Pedeutour P, et al. Orofacial trauma and rugby in France: epidemiological survey. Dent Traumatol 2003; 19: 183–92

    Article  PubMed  Google Scholar 

  28. Hawke JE, Nicholas NK. Dental injuries in rugby football. N Z Dent J 1969; 65: 173–5

    PubMed  CAS  Google Scholar 

  29. Davies RM, Bradley D, Hale RW, et al. The prevalence of dental injuries in rugby players and their attitude to mouthguards. Br J Sports Med 1977; 11: 72–4

    Article  PubMed  CAS  Google Scholar 

  30. Caglar E, Kargul B, Tanboga I. Dental trauma and mouthguard usage among ice hockey players in Turkey premier league. Dent Traumatol 2005; 21: 29–31

    Article  PubMed  Google Scholar 

  31. Garon MW, Merkle A, Wright IT. Mouth protectors and oral trauma: a study of adolescent football players. JADA 1986;112: 663–5

    PubMed  CAS  Google Scholar 

  32. Marshall SW, Spencer RJ. Concussion in rugby: the hidden epidemic. J Athlet Training 2001; 36: 334–8

    Google Scholar 

  33. Koh JO, Cassidy D, Watkinson EJ. Incidence of concussion in contact sports: a systematic review of the evidence. Brain Inj 2003; 17: 901–17

    Article  PubMed  Google Scholar 

  34. Powell JW, Barber-Foss KD. Traumatic brain injury in high school athletics. JAMA 1999; 282: 958–63

    Article  PubMed  CAS  Google Scholar 

  35. Goodman D, Gaetz M, Meichenbaum D. Concussion in hockey: there is cause for concern. Med Sci Sports Exerc 2001; 33:2004–9

    Article  PubMed  CAS  Google Scholar 

  36. Baker RJ, Patel DR. Sports related mild traumatic brain injury in adolescents. Indian J Pediatr 2000; 67: 317–21

    Article  PubMed  CAS  Google Scholar 

  37. Schulz MR, Marshall SW, Mueller FO, et al. Incidence and risk factors for concussion in high school athletes, North Carolina,1996–1999. Am J Epidemiol 2004; 160: 937–44

    Article  PubMed  Google Scholar 

  38. Mayer C. Tooth protectors for boxers. Oral Hyg 1930; 20: 298–9

    Google Scholar 

  39. Watts G, Woolard A, Singer CE. Functional mouth protectors for contact sports. JADA 1954; 49: 7–11

    PubMed  CAS  Google Scholar 

  40. Report of the Joint Committee on Mouth Protectors of the American Association for Health, Physical Education and Recreation and the American Dental Association. Washington DC, 1960

  41. Vanet R. Gridiron challenge. Dental Survey 1951; 27: 1258–9

    Google Scholar 

  42. American Society for Testing and Materials. Standard practice for care and use of athletic mouth protectors. West Conshohocken(PA): American Society for Testing and Materials, 2000. Technical report no. F697–00

  43. Chandler NP, Wilson NHF, Daber BS. A modified maxillary mouthguard. Br J Sports Med 1987; 21: 27–8

    Article  PubMed  CAS  Google Scholar 

  44. Watermeyer GJJ, Thomas CJ, Jooste CH. The protective potential of mouthguards. J Dent Assoc S Afr 1985; 40: 173–7

    PubMed  CAS  Google Scholar 

  45. Takeda T, Ishigami K, Hoshina S, et al. Can mouthguards prevent mandibular bone fractures and concussions? A laboratory study with an artificial skull model. Dent Traumatol 2005;21: 134–40

    Article  PubMed  Google Scholar 

  46. Waked EJ, Caputo AA. Thickness and stiffness characteristics of custom-made mouthguard material. Quintessence Int 2005;36: 462–36

    PubMed  Google Scholar 

  47. Heintz WD. The case for mandatory mouth protectors. Phys Sportsmed 1975; 3 (4): 61–3

    Google Scholar 

  48. Hughston JC. Prevention of dental injuries in sports. Am J Sports Med 1980; 8: 61–2

    Article  PubMed  CAS  Google Scholar 

  49. Duda M. Which athletes should wear mouthguards? Phys Sportsmed. XI 1987; 15 (9): 179–83

    Google Scholar 

  50. American Dental Association. The importance of using mouthguards: tips for keeping your smile safe. JADA 2004;135: 1061

    Google Scholar 

  51. Bureau of Dental Health Education, Council on Dental Materials and Devices, American Dental Association. Mouth protectors: 11 years later. JADA 1973; 86: 1365–6

    Google Scholar 

  52. Duffy PI. Ice Hockey: rules and interpretations. Indianapolis (IN): National Collegiate Athletic Association, 2005

    Google Scholar 

  53. Winters CW. LaCrosse: men’s rules. Indianapolis (IN): National Collegiate Athletic Association, 2005

    Google Scholar 

  54. Adams JR. Football: rules and interpretation. Indianapolis (IN): National Collegiate Athletic Association, 2004

    Google Scholar 

  55. Quarrie KL, Gianotti SM, Chalmers DJ, et al. An evaluation of mouthguard requirements and dental injuries in New Zealand rugby union. Br J Sports Med 2005; 39: 650–4

    Article  PubMed  CAS  Google Scholar 

  56. Scott J, Burke FIT, Watts DC. A review of dental injuries and the use of mouth guards in contact team sports. Br Dent J 1994;176: 310–4

    Article  PubMed  CAS  Google Scholar 

  57. Chalmers DJ. Mouthguards: protection for the mouth in rugby union. Sports Med 1998; 25: 339–49

    Article  PubMed  CAS  Google Scholar 

  58. Kerr IL. Mouth guards for the prevention of injuries in contact sports. Sports Med 1986; 3: 415–27

    Article  PubMed  CAS  Google Scholar 

  59. Newsome PR, Tran DC, Cooke MS. The role of the mouthguard in the prevention of sports-related dental injuries: a review. IntJ Paed Dent 2001; 11: 396–404

    Article  CAS  Google Scholar 

  60. Lee-Knight CR. Protective mouthguards and sports injuries. J Can Dent Assoc 1991; 57: 39–41

    PubMed  CAS  Google Scholar 

  61. Woodmansey KF. Athletic mouth guards prevent orofacial injuries: a review. Gen Dent 1999; 47: 64–9

    PubMed  CAS  Google Scholar 

  62. Ranalli DN. Prevention of sports-related traumatic dental injuries. Dent Clin North Am 2000; 44: 35–51

    PubMed  CAS  Google Scholar 

  63. Marshall SW, Loomis DP, Waller AE, et al. Evaluation of protective equipment for prevention of injuries in rugby union. Int J Epidemiology 2005; 34: 113–8

    Article  Google Scholar 

  64. Kahn HA, Sempos CR. Statistical Methods in Epidemiology. New York: Oxford University Press, 1989

    Google Scholar 

  65. Thacker SB, Gilcrest J, Stollap DF, et al. The prevention of shin splints in sports: a systematic review of the literature. Med Sci Sports Exerc 2002; 34: 32–40

    PubMed  Google Scholar 

  66. Thacker SB, Gilcrest J, Stroup DF, et al. The impact of stretching on sports injury risk: a systematic review of the literature. Med Sci Sports Exerc 2004; 36: 371–8

    Article  PubMed  Google Scholar 

  67. Petitti DB. Meta-analysis, decision analysis, and cost-effectiveness. New York: Oxford University Press, 2000

    Google Scholar 

  68. Jacobs WH. Dentistry gave boxing the mouthpiece. Oral Hyg 1938; 28: 1148–53

    Google Scholar 

  69. Jacobs WH. Boxer’s appliance. Dent Dig 1930; 36: 201

    Google Scholar 

  70. Garfield S. Teeth, teeth, teeth: a treatise on teeth and related parts of man, land and water animals from the earth’s beginning to the future of time. New York: Simon and Schuster,

  71. Reed RV. Origin and early history of the dental mouthpiece. Br Dent J 1994; 176: 478–80

    Article  PubMed  Google Scholar 

  72. Carlos T A. The mouthguard in use. Oral Hyg 1938; 28: 1580–1

    Google Scholar 

  73. Hagey JW. Boxer’s appliance. Dent Dig 1930; 36: 201–2

    Google Scholar 

  74. Abrams AM. Boxer’s appliance. Dent Dig 1930; 36: 200–1

    Google Scholar 

  75. Kerpel E. Measures to protect jaws and teeth from fractures in sport injuries. J Dent Res 1937; 16: 338

    Google Scholar 

  76. Kramer LR. Accidents occurring in high school athletics with special reference to dental injuries. JADA 1941; 28: 1351–2

    Google Scholar 

  77. Cathcart JF. Mouth protectors for contact sports. Dent Dig 1951; 64: 338–41

    Google Scholar 

  78. Dukes HR. Football mouthpieces reduce tooth injuries to zero. J Kans State Dent Assoc 1955; 39: 65–6

    Google Scholar 

  79. Dukes HR. Latex football mouthpieces. JADA 1954; 49: 445–8

    PubMed  CAS  Google Scholar 

  80. Dukes HR. ‘Gridiron challenge’ accepted by two dental societies. J Kans State Dent Assoc 1954; 38: 121–32

    Google Scholar 

  81. The fighting Irish look tough again. Life Magazine 1952; 33: 60–63

    Google Scholar 

  82. Winters LR, Schmitt LC. Tooth preservation in contact sports. J Calif Dent Assoc 1961; 37: 368–70

    Google Scholar 

  83. Stevens OO. Mouth protectors: evaluation of eleven types. JADA 1963; 67: 521–8

    PubMed  CAS  Google Scholar 

  84. Bureau of Dental Education, American Dental Association. Evaluation of mouth protectors used by high school football players. JADA 1964; 68: 430–42

    Google Scholar 

  85. Powers JM, Godwin WC, Heintz WD. Mouth protectors and sports team dentists. JADA 1984; 109: 84–7

    PubMed  CAS  Google Scholar 

  86. Cohen A, Borish AL. A four year comparative study of various mouth protectors. Bul Nat Ass Secondary School Principals 1961; 45: 145–8

    Google Scholar 

  87. McCarthy MF. Sports and mouth protection. Gen Dent 1990; 38: 343–6

    PubMed  CAS  Google Scholar 

  88. Ranalli DN. Prevention of craniofacial injuries in football. Dent Clin North Am 1991; 35: 627–45

    PubMed  CAS  Google Scholar 

  89. Castaldi CR. Prevention of craniofacial injuries in ice hockey. Dent Clin North Am 1991; 35: 647–57

    PubMed  CAS  Google Scholar 

  90. Hawn KL, Visser MF, Sexton PJ. Enforcement of mouthguard use and athletic compliance in National Collegiate Athletic Association Men’s Collegiate ice hockey competition. J Athlete Training 2002; 37: 204–8

    Google Scholar 

  91. Craig RG, Godwin WC. Physical properties of materials for custom-made mouth protectors. J Mich State Dent Assoc1967; 49: 3440

    Google Scholar 

  92. Going RE, Loehman RE, Chan MS. Mouthguard materials: their physical and mechanical properties. JADA 1974; 89: 132–8

    PubMed  CAS  Google Scholar 

  93. Bishop BM, Davies EH, von Fraunhofer JA. Materials for mouth protectors. J Prosthet Den 1985; 53: 256–61

    Article  CAS  Google Scholar 

  94. Craig RG, Godwin WC. Properties of athletic mouth protectors and materials. J Oral Rehab 2002; 29: 146–50

    Article  CAS  Google Scholar 

  95. Guevara PH, Hondrum SO, Reichl RB. A comparison of commercially available mouthguards and a custom mouthguard. Gen Dent 2001; 49: 402–6

    PubMed  CAS  Google Scholar 

  96. Auroy P, Duchatelard P, Zmantar NE, et al. Hardness and shock absorption of silicon rubber for mouth guards. J Prosthet Den1996; 75: 463–71

    Article  CAS  Google Scholar 

  97. Park JB, Shaull KL, Overton B, et al. Improving mouthguards. J Prosthet Den 1994; 72: 373–80

    Article  CAS  Google Scholar 

  98. Westerman B, Stringfellow PM, Eccleston JA. The effect on energy absorption of hard inserts in laminated EVA mouthguards. Aust Den J 2000; 45: 21–3

    Article  CAS  Google Scholar 

  99. Westerman B, Stringfellow PM, Eccleston JA, et al. Effect of ethylene vinyl acetate (EVA) closed cell foam on transmitted forces in mouthguard material. Br J Sports Med 2002; 36: 205.

    Article  PubMed  CAS  Google Scholar 

  100. Takeda T, Ishigami K, Shintaro K, et al. The influence of impact object characteristics on impact force and force absorption by mouthguard material. Dent Traumatol 2004; 20: 12–20

    Article  PubMed  Google Scholar 

  101. Takeda T, Ishigami K, Jun H, et al. The influence of the sensor type on the measured impact absorption of mouthguard material. Dent Traumatol 2004; 20: 29–35

    Article  PubMed  Google Scholar 

  102. Westennan B, Stringfellow PM. Forces transmitted through EVA mouthguard materials of different types and thickness. Aust Den J 1995; 40: 389–91

    Article  Google Scholar 

  103. Westennan B, Stringfellow PM, Eccleston JA. An improved mouthguard material. Aust Den J 1997; 42: 189–91

    Article  Google Scholar 

  104. Westennan B, Stringfellow PM, Eccleston JA. Beneficial effects of air inclusion on the performance of ethylene vinylacetate (EVA) mouthguard material. Br J Sports Med 2002;36: 51–3

    Article  Google Scholar 

  105. Takeda T, Ishigami K, Handa J, et al. Does hard insertion and space improve shock absorption ability of mouthguard. Dent Traumatol 2006; 22: 77–82

    Article  PubMed  Google Scholar 

  106. Jagger R, Milward P, Waters M. Properties of an experimental mouthguard material. Int J Prosthodontics 2000; 13: 416–9

    CAS  Google Scholar 

  107. Low D, Sumii T, Swain MV, et al. Instrumented indentation characterization of mouth-guard materials. Dent Mater 2002;18: 211–5

    Article  PubMed  CAS  Google Scholar 

  108. Wilkinson EE, Powers IM. Properties of custom-made mouth protector materials. Phys Sportsmed 1986; 14 (6): 77–84

    Google Scholar 

  109. Chaconas SJ, Caputo AA, Bakke NK. A comparison of athletic mouthguard materials. Am J Sports Med 1985; 13: 193–7

    Article  PubMed  CAS  Google Scholar 

  110. Padilla R, Dorney B, Balikov S. Prevention of oral injuries. J Calif Dent Assoc 1996; 24: 30–6

    PubMed  CAS  Google Scholar 

  111. Fontelles JB, Clarke C. Directive 2005/84/EC of the European Parliament and of the Council of 14 December 2005 amending for the 22nd time Council Directive 76/69/EEC on the approximation of the laws, regulations and administrative provisions of the Men Der States relating to restrictions on the marketing and use of certain dangerous substances and preparations (phthalates in toys and childcare articles). Official Journal of the European Union 2005 Dec 27; 48: 40–3

    Google Scholar 

  112. Patrick DG, van Noort R, Found MS. Scale of protection and the various types of sports mouthguard. Br J Sports Med 2005; 39:278–81

    Article  PubMed  CAS  Google Scholar 

  113. Loehman RE, Chan MS, Going RE. Optimization of materials for a user-formed mouthguard. Ann Biomed Eng 1975; 3: 199

    Article  PubMed  CAS  Google Scholar 

  114. Bulsara YR, Matthew IR. Forces transmitted through a laminated mouthguard material with a sorbothane insert. Endod Den Traumatol 1998; 14: 45–7

    Article  CAS  Google Scholar 

  115. Westennan B, Stringfellow PM, Eccleston JA. EVA mouthguards: how thick shouk! they be? Dent Traumatol 2002; 18: 24–7

    Article  Google Scholar 

  116. Tran D, Cooke MS, Newsome PRH. Laboratory evaluation of mouthguard material. Dent Traumatol 2001; 17: 260–5

    Article  PubMed  CAS  Google Scholar 

  117. Bureau of Dental Health Education, Council on Dental Materials and Devices, American Dental Association. Mouth protectors for football players: the dentist’s role. JADA 1962; 64:419–21

    Google Scholar 

  118. Lim D, Robinovitch S, Goodman D. Effect of mouthguards on the transmission of force across the human jaw. Clin J Sports Med 2005; 15: 313–9

    Article  Google Scholar 

  119. Hickey JC, Morris AL, Carlson LD, et al. The relation of mouth protectors to cranial pressure and deformation. JADA 1967;74: 735–40

    PubMed  CAS  Google Scholar 

  120. Greasley A, Karet B. Towards the development of a standard test procedure for mouthguard assessment. Br J Sports Med1997; 31: 31–5

    Article  PubMed  CAS  Google Scholar 

  121. Greasley A, Imlach G, Karet B. Application of a standard test to the in vitro performance of mouthguards. Br J Sports Med1998; 32: 17–9

    Article  PubMed  CAS  Google Scholar 

  122. Johnson T, Messer LB. An in vitro study of the efficacy of mouthguard protection for den to a veolar injuries in deciduous and mixed dentitions. Endod Den Traumatol 1996; 12: 277–85

    Article  Google Scholar 

  123. Oikarinen KS, Salonen MAM, Korhonen J. Commision of the guarding capacities of mouth protectors. Endod Den Traumatol 1993;9: 115–9

    Article  CAS  Google Scholar 

  124. Hoffman J, Alfter G, Rudolph NK. Experimental comparative study of various mouthguards. Endod Den Traumatol 1999;15: 157–63

    Article  Google Scholar 

  125. de Wet FA, Dent M, Heyna M, et al. Shock absorption potential of different mouthguard materials. J Prosthet Den 1999; 82:301–6

    Article  Google Scholar 

  126. Morikawa M, Taniguchi H, Ohyama T. Evaluation of athletic mouthguards through vibration test on maxillary teeth of human dry skull. J Med Dent Sci 1998; 45: 9–18

    PubMed  CAS  Google Scholar 

  127. Godwin WC, Craig RG. Stress transmitted through mouth protectors. JADA 1968; 77: 1316–20

    PubMed  CAS  Google Scholar 

  128. Bemelmanns P, Pfeiffer P. Shock absorption capabilities of mouthguards in different types and thicknesses. Int J Sports Med 2001; 22: 149–53

    Article  PubMed  CAS  Google Scholar 

  129. Warnet L, Greasley A. Transient forces generated by projectiles on variable quality mouthguards monitored by instrumented impact testing. Br J Sports Med 2001; 35: 257–62

    Article  PubMed  CAS  Google Scholar 

  130. Cummins NK, Spears IR. The effect of mouthguard design on stresses in the tooth-bone complex. Med Sci Sports Exerc 2002; 34: 942–7

    Article  PubMed  Google Scholar 

  131. Takeda T, Ishigami K, Ogawa T, et al. Are all mouthguards the same and safe to use? The influence of occlusal supporting mouthguards in decreasing bone distortion and fractures. Dent Traumatol 2004; 20: 150–6

    Article  PubMed  Google Scholar 

  132. Padilla RR. A technique for fabricating modern athletic mouthguards. J Calif Dent Assoc 2005; 33: 399–408

    PubMed  Google Scholar 

  133. Yamanaka T, Ueno T, Oki M, et al. Studies on the effects of shortening the distal end of a mouthguard using modal analysis. J Med Dent Sci 2002; 49: 129–33

    PubMed  Google Scholar 

  134. Kim HS, Mathieu K. Application of laminates to mouthguards: finite element analysis. J Mater Sci Mater Med 1998; 9: 457–62

    Article  PubMed  CAS  Google Scholar 

  135. Oikarinen KS, Salonen MAM. Introduction to four custom made mouth protectors constructed of single and double layers for activists in contact sports. Endod Den TraumatoI1993; 9:19–24

    Article  CAS  Google Scholar 

  136. Cohen A. A five year comparative study of various mouth protectors. Pa Den J 1962; 29 (7): 6–12

    Google Scholar 

  137. Cohen A, Borish AL. Mouth protector project for football players in Philadelphia high schools. JADA 1958; 56: 863–4

    PubMed  CAS  Google Scholar 

  138. Schoen GH. Report of committee on mouth protector project. Bul Naussau County Dent Soc 1956; 30: 12–4

    Google Scholar 

  139. Moon DG, Mitchell DF. An evaluation of a commercial mouthpiece for football players. JADA 1961; 62: 568–72

    PubMed  CAS  Google Scholar 

  140. Dunbar DM. Report on reduction in mouth injuries. J Mass Dent Soc 1962; 11: 31, 34–5

    Google Scholar 

  141. Bureau of Dental Health Education, American Dental Association. Mouth protectors: 1962 and the future. JADA 1963; 66:539–43

    Google Scholar 

  142. Blignaut JB, Carstens IL, Lombard CJ. Injuries sustained in rugby by wearers and non-wearers of mouth guards. Br J Sports Med 1987; 21: 5–7

    Article  PubMed  CAS  Google Scholar 

  143. McNutt T, Shannon SW, Wright IT, et al. Oral trauma in adolescent athletes: a study of mouth protectors. Pediatr Dent 1989; 11: 209–13

    PubMed  CAS  Google Scholar 

  144. Maestrello-de Moya MG, Primosch RE. Orofacial trauma and mouth-protector wear among high school varsity basketball players. J Dent Child 1989; 56: 36–9

    CAS  Google Scholar 

  145. LaBella CR, Smith BW, Sigurdsson A. Effect of mouthguards on dental injuries and concussions in college basketball. Med Sci Sports Exerc 2002; 34: 41–4

    PubMed  Google Scholar 

  146. Finch C, Braham R, McIntosh A, et al. Should football players wear custom fitted mouthguards? Results from a group randomised controlled study. Inj Prev 2005; 11: 242–6

    Article  PubMed  CAS  Google Scholar 

  147. Fleiss JL. Statistical methods for rates and proportions. New York: John Wiley and Sons, 1981

    Google Scholar 

  148. Poole C. Low p-values or narrow confidence intervals: which are more durable? Epidemiology 2001; 12: 291–4

    Article  PubMed  CAS  Google Scholar 

  149. Gunn N. Follow-up on mouth and tooth protector program. Arkansas Dent J 1963; 34: 13–5

    Google Scholar 

  150. Brebner RTS, Marshall DW. Mouthguards: a community project in Hawke’s Bay. N Z Dent J 1977; 73: 61–3

    PubMed  CAS  Google Scholar 

  151. Lee-Knight CR, Harrison EL. Dental injuries at the 1989 Canadian Games: an epidemiological study. J Can Dent Assoc 1992; 58: 810–5

    PubMed  CAS  Google Scholar 

  152. Soporowski NJ, Tesini DA, Weiss AI. Survey of orofacial sports-related injuries. J Mass Dent Soc 1994; 43: 16–20

    PubMed  CAS  Google Scholar 

  153. Benson BW, Rose MS, Meeuwisse WH. The impact of face shield use on concussions in ice hockey: a multivariate analysis. Br J Sports Med 2002; 36: 27–32

    Article  PubMed  CAS  Google Scholar 

  154. Amy E. Oro-facial injuries in Central American and Caribbean sports games: a 20-year experience. Dent Traumatol 2005; 21:127–30

    Article  PubMed  Google Scholar 

  155. Seals RR, Morrow RM. An evaluation of mouthguard programs in Texas high school football. JADA 1985; 110: 904–9

    PubMed  Google Scholar 

  156. Gee IM. Use of mouth guards in Texas high school. Texas Den J 1962; 80 (6): 13–5

    Google Scholar 

  157. Heintz WD. Mouth protectors: a progress report. JADA 1968; 77: 632–6

    PubMed  CAS  Google Scholar 

  158. Alexander D, Walker J, Floyd K, et al. A survey on the use of mouthguards and associated oral injuries in athletics. Iowa Dent J 1995; 40: 41–4

    Google Scholar 

  159. deWet FA, Badenhorst M, Rossouw LM. Mouthguards for rugby players at primary school level. J Dent Assoc S Afr 1981; 36: 249–53

    CAS  Google Scholar 

  160. Stenger IM, Lawson EA, Wright JM, et al. Mouthguards: protection against shock to head, neck and teeth. JADA 1964; 69:273–81

    PubMed  CAS  Google Scholar 

  161. Morton JG, Burton IF. An evaluation of the effectiveness of mouthguards in high-school rugby players. N Z Dent J 1979;75: 151–3

    PubMed  CAS  Google Scholar 

  162. Lahti H, Sane J, Ylipaavalniemi P. Dental injuries in ice hockey games and training. Med Sci Sports Exerc 2002; 34: 400–2

    Article  PubMed  Google Scholar 

  163. Rodd HD, Chesham DJ. Sports-related oral injury and mouthguard use among Sheffield school children. Community Dent Health 1996; 14: 25–30

    Google Scholar 

  164. Morrow RM, Bonci T. A survey of oral injuries in female college and university athletics. Athl Training 1989; 24: 236–7

    Google Scholar 

  165. Banky J, McCrory PR. Mouthguard use in Australian football. J Sci Med Sport 1999; 2: 20–9

    Article  PubMed  CAS  Google Scholar 

  166. Delaney JS, Lacroix VJ, Leclerc S, et al. Concussions among university football and soccer players. Clin J Sports Med 2002;12: 331–8

    Article  Google Scholar 

  167. Kececi AD, Soglu E, Baydar ML. Dental trauma incidence and mouthguard use in elite athletes in Turkey. Dent Traumatol 2005; 21: 76–9

    Article  PubMed  Google Scholar 

  168. Bolhuis JHA, Leurs JMM, Flogel GE. Dental and facial injuries in international field hockey. Br J Sports Med 1987; 21: 174–7

    Article  PubMed  CAS  Google Scholar 

  169. Kay EJ, Kalarla P, MacCleod DAD, et al. Oro-facial and dental injuries in club rugby union players. Br J Sports Med 1990; 24:271–3

    Article  PubMed  CAS  Google Scholar 

  170. Teo CS, Stokes AN, Lob T, et al. A survey of tooth injury experience and attitudes to prevention in a group of Singapore school boys. Ann Acad Med Singapore 1995; 24: 23–5

    PubMed  CAS  Google Scholar 

  171. Lieger O, Arx TV. Orofacial/cerebral injuries and the use of mouthguards by professional athletes in Switzerland. Dent Traumatal 2006; 22: 1–6

    Article  Google Scholar 

  172. Lang B, Pohl Y, Pilippi A. Knowledge and prevention of dental trauma in team handball in Switzerland and Germany. Dent Traumatal 2002; 18: 329–34

    Article  Google Scholar 

  173. Stokes ANS, Croft GC, Gee D. Comparison of laboratory and intraorally formed mouth protectors. Endod Den Traumatal 1987; 3: 255–8

    Article  CAS  Google Scholar 

  174. Wisniewski JF, Guskiewicz K, Trope M, et al. Incidence of cerebral concussions associated with type of mouthguard usedin college football. Dent Traumatol 2004; 20: 143–9

    Article  PubMed  Google Scholar 

  175. Upson N. Mouthguards: an evaluation of two types for rugby players. Br I Sports Med 1985; 19: 89–92

    Article  CAS  Google Scholar 

  176. Barbic B, Pater I, Brison RI. Comparison of mouth guard designs and concussion prevention in contact sports. Clin J Sports Med 2005; 15: 294–8

    Article  Google Scholar 

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Acknowledgements

We would like to thank Ms Ann Marie Gibson for her editorial comments and Ms Stephanie Morrison for her technical review. Mr Kristin Goel and Ms Claudia Coleman assisted us in obtaining many of the references cited in this paper, especially those more difficult to obtain.

The views, opinions and/or findings contained in this report are those of the authors and should not be construed as official Department of the Army position, policy or decision, unless so designated by other official documentation.

Citations of commercial organisations and trade names in this report do not constitute an official Department of the Army endorsement or approval of the products or services of this organisation.

No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the contents of this review.

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Knapik, J.J., Marshall, S.W., Lee, R.B. et al. Mouthguards in Sport Activities History, Physical Properties and Injury Prevention Effectiveness. Sports Med 37, 117–144 (2007). https://doi.org/10.2165/00007256-200737020-00003

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