When playing contact sports the risk of dental injury is increased. Wearing a well fabricated mouthguard reduces the risk of dental injury by over 99%. However not all mouthguards provide the same protection.
You have three choices:

1. Stock mouthguard
2. Boil and bite mouthguard
3. Custom fit mouthguard

Numbers 1 and 2 cannot be advised, the Stock mouthguard lacks retention making it difficult to breath and talk and they exhibit significant overload (and risk of injury) for single prominent teeth.

The boil and bite mouthguards have been shown to provide a false sense of protection as a result of the dramatic decrease in occlusal thickness during the fitting and fabrication process. Park et al1 concluded that boil and bite mouthguards should not be recommended to patients.

The custom fit can be subdivided into:

1. Single layer thermoformed mouthguards
2. Custom laminated mouthguards that can be:
a. Vacuum formed
b. Pressure formed

The laminating process involves laying down 2 or more layers on the dental model. For a similar thickness the laminated mouthguard distributes power by 43% more and bends by 22.5% less than a single layer thermoformed mouthguard of the same thickness. The custom fit laminated mouthguard is able to distribute 4 times more force than the boil and bite.

The pressure formed mouthguard is a better fit around the teeth and gums and is retained in place better than the vacuum formed mouthguard.

Hodge stated in 20092 “The pressure formed custom laminated mouthguard provides more protection and better retention than any other method of mouthguard making. Consequently:

1. The use of single layer custom fit mouthguards is seriously questioned.
2. The use of standard vacuum-formed mouthguards is seriously questioned.”

There are two steps to the construction of a laminated custom fit mouthguard. The first step involves having an accurate impression taken by a dentist. The mouthguard is fabricated in layers on the resulting model. The second step involves fitting the mouthguard and customising the bite so the lower teeth meet evenly with the mouthguard. Mouthguards should be stored in a breathable container.

The laminated custom fit mouthguard is made from ethylene vinyl acetate (EVA). The EVA comes in many colours and club designs. Because the mouthguard is laid down in layers, the owners name can be included between layers.

From 10 years of age a laminated custom fit mouthguard offers the best protection against dental injury. The GAA has made the wearing of mouthguards compulsory for all players involved in Gaelic Football from January 1st 2014.

References
1. Park J, Scholl KL, Overton B, Darley KJ, Improving mouthguards. J Prosth Dent 1994;35(4):627-45
2. Hodges J, Mouthguard Mastery published by Good Innovations Pty Ltd. 2009

By Dr William Fenlon