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Trauma, Orthodontic Treatment and Mouthguards: Revise and Update

Since it is compulsory among school children to wear mouthguard during school PA, I personally, fit custom-made mouthguard for 50% of the young patients that I treat. But I usually face the following question “Does the ready-made mouthguard performs well in comparison to the custom-made version?”. Before we answer this question, let us do some revision.

What we know?

Incidence and prevalence of dental trauma

• It represents 17% of body injuries (0-6y) and 5% of body injuries (above 6y) (Zaleckiene, 2014)

• Majority of accidental damaged incisors remained untreated (70% - 80%) (Chadwick,2006)

• The most common affected tooth: upper central incisors (80%) and upper lateral incisors (16.4%)

• The most common injury type are enamel dentin fracture without pulpal involvement (40%) and enamel fracture (30%)

• 10% of orthodontic new patients have evidence of trauma (Bauss, 2004)

Overjet and trauma

• The chance of trauma could reach 45% if the overjet is more than 9 mm compared to 23% in those with OJ less than 9mm (Todd & Dodd, 1985)

• Children with OJ above 3mm have twice the risk of trauma than those with OJ less than 3mm ( Nguyen,1999)

Risk factors for incisor trauma

General factors:

• Gender (16-30% males, 4-19% females)

• Age (Damage to permanent incisors increases with age)

• Environmental,

• Behavioural,

• Cultural diversities and social deprivation,

• Obesity, and

• Vital impairment.

Dental factors:

• Overjet (Nguyen 1999)

• Lip competency

Role of orthodontics

• Preventive approach

• Primary management of trauma

• Secondary Treatment: It involves orthodontic movement of displaced tooth (sub-chronic phase)

• Tertiary management which involves comprehensive orthodontic treatment (chronic phase)

Prevention of Traumatic Dental Injuries

• Anti-bullying and health policies within schools

• Protect the teeth using mouthguards

• Early correction of the underlying malocclusion

Types of Mouthguards (Maeda,2009)

1. Stock-made mouthguard such as

• Pre-fabricated mouthguard

• Standard boil and bite mouthguard (mouth-formed)

2. Custom-made mouthguard (preferably more than 4-5mm thickness and ideally a double layer, soft and hard),


EJO in its November 2021 issue published a new three-arm crossover RCT that was undertaken in the UK and involved 30 patients, the RCT compared three types of mouthguard types: custom-made laboratory constructed, mouth-formed OPRO® Gold Braces, and pre-fabricated Shock Doctor® Single Brace.

The paper was led by Dr Aneesh Kalra.

In summary: Patients wearing fixed appliances prefer custom-made and mouth-formed mouthguards but mostly custom-made mouthguards.

What do you think?

**PS: No finaical interst**

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