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The term “mouthguard” has been widely written about within the dental profession. However, the product comes in many different configurations — varying in thickness, extensions, the EVA material used, colours, embedded inclusions, constructed with or without a bite, and made with different equipment and different construction methods.

These variables influence the overall predictability, quality, durability, safety, comfort and cost. They also significantly confound the ability to compare the results of research into mouthguards. It would be safe to say that not all mouthguards are created equally.

To overcome these inconsistent parameters and as part of a much wider R&D program, here is a brief outline of mouthguard research with professional rugby and Australian football players. Using a specified design, material(s) and construction method, more than 300 professional players were issued mouthguards for analysis.

The study spanned a total of 12 years — annually for seven consecutive years, followed by a two-year break to review the findings, then a further five consecutive years. All mouthguards were produced using clear materials only.

During the football playing season, the players were questioned by club doctors, trainers and coaches, and they reported back to the R&D leader. The R&D leader visited each player twice in the playing season and reviewed the products, gained first-class technical feedback, and gathered much information including oral-facial injury patterns, concussion details and product feedback.

All players paid for the products and were insured with a one-year warranty against tooth injury to encourage feedback for the products. The majority of the mouthguards were constructed on upper models, a few were made on lower models, and all mouthguards were balanced for maximum tooth contact against their antagonist arch in the dental laboratory.

In phase 1 year 4, one player received a catastrophic mouth injury from a head clash, losing several anterior teeth (upper and lower) and small fragments of bone. In this case, the polycarbonate shield was completely shattered from the strength of the impact.

Due to feedback on players’ wants and needs, in year 8 a modified and refined product was issued. Over the course of the official playing season for this group, the incidence of mandibular jaw fractures was significantly reduced when the only item that had changed was the mouthguard itself.

That season’s review revealed another fact, that the nature of jaw fracture had also changed — upper Le Fort fractures through the buttress were higher among the jaw fracture injuries reported. But the total number of jaw fractures had reduced by around 50 percent from year 1 to year 12.

Over years 8 to 12 (phase 2 of the study), three genuine insurance claims and two bogus claims (where teeth injuries were sustained without using the specified mouthguard) were received. No teeth were lost in phase 2, though one anterior upper tooth was chipped and two posterior teeth (one upper and one lower molar) were also chipped — the teeth remained vital and required minimal treatment to restore.

The three injuries prompted small but important modifications to the product’s construction specifications, including to the posterior extensions and to the fully embedded anti-penetration polycarbonate shield. Note: No hard helmets are used in rugby or Australian football.

Unfortunately, in Australia around this time, concussion was not seen as a major problem. Many players (and officials) reportedly stated that concussion was a sign of hard play and toughness in a player. Compared to today, the medical profession’s understanding of brain injury was limited, along with the ability to diagnose or treat it. Attitudes were different then with a concussive event only being considered when a player was carried off the field on a stretcher.

Nonetheless, over the course of the study, officials and players constantly reported that “concussions” were reducing. Also in phase 2 of the study, rule changes to attacking the head were introduced. Player interviews in the last three years of the study revealed that player attitude to concussion had changed, and the number who reported concussions during that time reduced by around 30 percent in years 5 through 7.

Concussive events can be best measured by “intelligent” mouthguards using this same specified design, and the first steps to achieve that end have been taken in our current R&D program. This includes the construction of a proof-of-concept tool and the production of mouthguards that have fully embedded electronic components. The goal of this R&D project is to bring together a team of experts in electronics, neuroscience and medicine and to fund the next steps by marketing to orthodontists and general practice dentists worldwide.

The original study also raised many questions that have dominated the development of our products and ongoing research studies.

Questions about the cost to produce specified mouthguards including anti-penetration varieties have been solved, without the need to dispense with existing equipment (standard vacuum or pressure machines), or the need for highly trained technicians or time-poor dentists to apply the new user friendly construction method. If a dental office makes bleaching trays, the same office can make these specified mouthguards, too.

In summary, these specified mouthguards are playing a significant role in making sports safer. In contrast, U.S. football and ice hockey use hard helmets and anti-penetration face protection, which should be connected to the mouthguard. These two sports require different approaches and modified specifications to the mouthguards appropriate for these sports.

About the Author

Peter's article June '16 photo imageAs a registered dental technician, Peter Burns was an opinion leader in crown and bridgework, general prosthetics and implant dentistry in his own full-service dental laboratory, which he built into a 50-person laboratory until he retired from it in 2009. He presented technical lectures, table clinics and demonstrations worldwide. As the Founder and CEO of Signature Mouthguards Pty Ltd, a research and development company focused on mouthguards, Peter led many R&D studies and reviews into mouthguards, which have set the benchmark from which many other mouthguards have been built worldwide. Peter is an active member of the British Standards Institute (BSI) and is certified in ISO 9001 Quality Management Systems. Peter is the inventor of nine international patents related to mouthguards and currently has three further international cases pending.

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