Mouthguards

The ADA has taken an active stance since the mid-1990s recognizing the preventive value of orofacial protectors, endorsing their use by those who engage in recreational and sports activities; and encouraging widespread use of orofacial protectors with proper fit, including mouthguards.¹

Both the ADA Council of Scientific Affairs and the Council on Advocacy for Access and Prevention (CAAP; formerly the Council on Access, Prevention and Interprofessional Relations) recognize that dental injuries are common in collision or contact sports and recreational activities.² Numerous surveys of sports-related dental injuries have documented that participants of all ages, genders and skill levels are at risk of sustaining dental injuries in sporting activities, including organized and unorganized sports at both recreational and competitive levels. While collision and contact sports, such as boxing, have inherent injury risks, dental injuries are also prevalent in non-contact activities and exercises, such as gymnastics and skating.^3-5

The Councils promote the importance of safety in maintaining oral health and the use of a properly fitted mouthguard as the best available protective device for reducing the incidence and severity of sports-related dental injuries. The Councils are committed to oral health promotion and injury prevention for sports participants.

It is necessary that mouthguards actually perform as required, i.e. to keep teeth safe.  An important step was therefore the work of the ADA with ANSI in developing a standard for Athletic Mouth Protectors and Materials.  However, as recently as 2009, a study of commercially available products found none that met current ANSI and ADA standards for impact attenuation.⁶

It is important for mouthguards to be safe however to be effective, they also have to be used.  Reasons given for why mouthguards are not used include awareness, cost, and lack of requirement for their use.⁷

There have been several “Patient Pages” in JADA to be used by dentists to help engage patients in conversation about mouthguards, facilitating discussion to encourage their use.  Each underscores the importance of mouthguard use and informs consumers about the 3 types that are available - ready-made, boil and bite, and custom made.^8-12 

Recent trends to increase ‘realism’ in video games has resulted their incorporating more actual player behaviors including what they do with their mouthguards while at the free throw line.¹³  While perhaps not the most desirable behavior, it raises the profile and awareness of mouthguards. Further, by having a sport idol model their use, it serves to increase their ‘coolness’ factor.

While still being able to highlight the benefit of custom fit mouthguards, dentists can also recommend the use of over-the-counter mouthguards with the ADA Seal of Acceptance.  Look for the ADA Seal—your assurance that the product has been objectively evaluated for safety and efficacy by an independent body of scientific experts, the ADA Council on Scientific Affairs.  A product earns the ADA Seal for athletic mouthguards by providing scientific evidence, which is evaluated according to objective requirements, demonstrating the safety and efficacy of ready-to-use and mouth-formed (boil-and-bite) mouthguards.

To qualify for the Seal of Acceptance, the company must provide evidence that:

• The product components are safe for use in the mouth and do not harm or irritate oral soft tissues.
• Mouth-formed appliances can be prepared by the average person with low risk of injury to oral hard or soft tissues, or damage of orthodontic appliances.
• The mouthguard is free of sharp or jagged edges.
• The mouthguard passes tests outlined by the American National Standards Institute/American Dental Association for hardness, ability to resist tearing and withstand impact; as well as a measurement of the amount of water absorbed.¹⁴

Comparison finds custom mouthguards made by dentists to perform best;¹⁵ having an over-the-counter option that meets ANSI/ADA standards helps with the cost barrier to engagement while still affording the consumer with a safe method of protecting their teeth.

Dentists are encouraged to ask patients if they participate in team sports or other activities with risks of injury to the teeth, jaw and oral soft tissues (mouth, lip, tongue, or inner lining of the cheeks). The Councils recommend that people of all ages use a properly fitted mouthguard in any sporting or recreational activity that may pose a risk of injury. The Councils also recommend educating patients about mouthguards and orofacial injury risks, including appropriate guidance on mouthguard types, their protective properties, costs and benefits. The key educational message is that the best mouthguard is one that is utilized during sport activities.

1. American Dental Association, Policy Statement on Orofacial Protectors (Trans.1994:654; 1995:613; 2016:322). American Dental Association, Current Policies 1954 - 2017; 2016. p. 181.)
2. ADA Council on Access, Prevention and Interprofessional Relations; Council on Scientific Affairs. Using mouthguards to reduce the incidence and severity of sports-related oral injuries. J Am Dent Assoc 2006;137(12):1712-20; quiz 31.
3. Fasciglione D, Persic R, Pohl Y, Filippi A. Dental injuries in inline skating - level of information and prevention. Dent Traumatol 2007;23(3):143-8.
4. Knapik JJ, Marshall SW, Lee RB, et al. Mouthguards in sport activities : history, physical properties and injury prevention effectiveness. Sports Med 2007;37(2):117-44.
5. Kumamoto DP, Maeda Y. A literature review of sports-related orofacial trauma. Gen Dent 2004;52(3):270-80; quiz 81.
6. Gould TE, Piland SG, Shin J, Hoyle CE, Nazarenko S. Characterization of mouthguard materials: physical and mechanical properties of commercialized products. Dent Mater 2009;25(6):771-80.
7. O'Malley M, Evans DS, Hewson A, Owens J. Mouthguard use and dental injury in sport: a questionnaire study of national school children in the west of Ireland. J Ir Dent Assoc 2012;58(4):205-11.
8. For the dental patient. Do you need a mouthguard? J Am Dent Assoc 2001;132(7):1066.
9. Mouthguards lower dental injuries. J Am Dent Assoc 2002;133(3):278.
10. For the dental patient. The importance of using mouthguards. Tips for keeping your smile safe. J Am Dent Assoc 2004;135(7):1061.
11. For the dental patient. Keep sports safe--wear a mouthguard. J Am Dent Assoc 2012;143(3):312.
12. For the dental patient. Protecting teeth with mouthguards. J Am Dent Assoc 2006;137(12):1772.
13. Stephen Curry’s mouth guard routine gets video game treatment.  2015.
14. ANSI/ADA Standard No.99-2001(R2013) Athletic mouth protectors and materials. Chicago: American Dental Association.
15. DeYoung AK, Robinson E, Godwin WC. Comparing comfort and wearability: custom-made vs. self-adapted mouthguards. J Am Dent Assoc 1994;125(8):1112-8.

What products have earned the ADA Seal of Acceptance?
Get a complete list of ADA Accepted Sports Mouthguards

Professional Resources

2009 Statement on Athletic Mouthguards from the ADA Council on Access, Prevention and Interprofessional Relations and the ADA Council on Scientific Affairs

ADA Policy on Orofacial Protectors (Trans.1994:654; 1995:613; 2016:322; page 181 [login required])

ANSI/ADA Standard No. 99-2001(R2013) Athletic Mouth Protectors and Materials

Search JADA for articles related to mouthguards

Search the ADA Catalog for products related to mouthguards

Patient Resources

JADA “For the Patient” pages:

• Sealing the Deal: Buying Products That Have the ADA Seal of Acceptance (January 2013)
• Keep Sports Safe—Wear a Mouthguard (March 2012)

ADA MouthHealthy.org:

• Mouthguards
• Quiz: Test Your Knowledge About Mouthguards
• 3 Things All Athletes Should Do for Their Teeth

Academy for Sports Dentistry: Mouthguards

American Academy of Pediatric Dentistry: Policy on Prevention of Sports-related Orofacial Injuries