Mouth Guards

Sport-related injuries

• injuries to the lip

• avulsion

• displacement

• cracks

• fracture of the teeth

• pulp exposure

What is the mouthguard used for?

It is used for protecting the teeth and mouth, reducing the likelihood of jaw fractures, neck injuries, concussions, or even brain damage/ cerebral hemorrhage

A quality athletic mouthguard should absorb/distribute force while resisting the deformation that can be caused during impact of contact sport, such as

football, rugby, hockey, boxing, soccer, squash, gymnastics, skateboarding, taekwondo

The ideal mouthguard is

• durable/ able to last and be used for a long time

• resilient

• comfortable

• should fit properly

• be easy to clean

• should not affect your ability to breathe and speak

Stock athletic mouthguard/ Type 1

• the least expensive

• they offer some protection, but they do not grip the teeth

• can be difficult to keep them in place unless you bite down on them constantly

• over-the-counter devices, ill fitting, minimal protection

boil and bite mouthguard

• fit more closely around the teeth / this makes it easier to keep them in place

• when you bite into the hot mouthguard - you reduce the thickness of the device/may reduce the level of protection

• Thermoplastic sports mouth guards are placed in boiling water until they are softened / 132°F temperature when inserted into the mouth

• soft-lined Type II sports mouth guards are also available and offer a more rigid mouthguard shell lined with ethyl methacrylate

custom-made mouthguards

• the most expensive

• have a better fit - better protection

• the most comfortable

• interfere least with breathing and speech

• fabricated over a dental cast using vacuum-formed, thermoplastic material

• heat/pressure laminated sport mouth guards are fabricated by layering several sheets of ethyl vinyl acetate over a mold to achieve a uniform thickness of material

Custom-made mouthguards can be subdivided into categories

1. performance mouthpieces

2. boxer-type mouthguard

Performance Mouthpieces

• prevents your teeth from clenching, pivots your jaw forward to relieve pressure on the TMJ

boxer type mouth guard

• provide safety for the anatomy and physiology of the jaw joint and related structures

• these jaw joint protectors lock and reposition the mandibular jaw in a down and forward position to create a safety space in the jaw joint complex between the mandibular condyle, glenoid fossae, and related basal structures

• it prevents the mandibular condyle from impacting the basal surface of the skull following impact to the mandibular jaw region which protects the basal surface of the brain from explosive head impact energy and subsequent concussions

What is vacuum forming

Vacuum forming is a technique that is used to shape a variety of thermoplastics

1. Begin by fixing a sheet of thermoplastic of uniform thickness onto a sturdy frame

2. Then the frame is heated and lowered over the cast

3. Next, the vacuum is turned on, drawing the thermoplastic template down and forming it to the cast surface

4. The thermoplastic is allowed to cool and then is carefully removed from the object

This technique is an excellent way to fabricate a custom fitted sport mouthguard and bleaching trays

Biostar technique

• this machine uses a vacuum to push the material from the top down onto the cast, ensuring that the material is well adapted to the cast surface

• uses an automated process dictated by a specific code that coordinates to the thermoplastic material being used

• this code has specified heating and cooling times that have been calibrated to the thermoplastic material

Gum laceration

a cut

Fabrication procedure for vacuum forming mouth guard

1. The dentist must furnish/provide with a maxillary impression /cast that must be an accurate duplication of the teeth and tissue surfaces

2. At least 10 mm of tissue below the gingival margin must be present on the labial, buccal, and palatal areas

3. A sufficient undercut is required to ensure that the vacuum-formed and thermos-formed material may be adequately adapted

4. Begin by mapping the buccal and labial surfaces of your cast by measuring 5 mm above the gingival margin

5. In the lingual - measure 10 mm

6. the mouth guard will terminate at the gingival margin distal of the most posterior tooth

7. fully relieve the labial frenum

continued

• drill a hole through the palate from the tissue side to the base/ this allows to draw the template sheet tight for good adaptation

• trim the cast so that no undercuts are present beyond your mapped design on the buccal and labial surfaces

• soak the cast in the bowl of water for 5-10 mins

• place the sheet of thermoplastic into a clamp, position under the heating element

• once it has been thoroughly heated, pull the frame down and turn on the vacuum

• wait 30 sec, then use a wet paper towel to push and adapt the thermoplastic material onto the cast

• cool it down by running cold water over the incisal and occlusal surfaces

Trimming step

1. transfer your design onto the thermoplastic material

2. use a carbide bur, silicone trimmer, soft-liner bur to trim the mouth guard at right angles to mapped design

3. smooth and slightly round all peripheral extensions using a butane torch

Fabrication procedure for biostar mouthguard

1. begin by mapping the buccal and labial surfaces of your cast by measuring 3-5 mm above the gingival margins on a printed model.

2. in the lingual surface, measure 10 mm below the gingival margins

3. The mouth guard will terminate at the gingival margin of the most posterior tooth

4. ensure you fully relieve the labial frenum

5. drill a hole trough the palate using a stone bur

6. trim the cast so that no undercuts are present beyond your mapped design

7. soak the cast in a bowl of water for 5-10 mins

Delivery instructions to the patient for care of the mouth guard

1. should be washed with cold, lukewarm water after every use to remove saliva buildup, bacteria, debris, to minimize discoloration

2. hot water should not be used because of the possible distortion of the mouth guard

3. Using toothpaste on a soft-bristle brush and rinsing with mouthwash is permissible

4. should be stored in a protective, ventilated appliance container

5. a periodic check of the mouthguard is recommended. This is to ensure that there are no distortions. tears, bite-throughs