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
• Gender (16-30% males, 4-19% females)
• Age (Damage to permanent incisors increases with age)
• Cultural diversities and social deprivation,
• Obesity, and
• Vital impairment.
• 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**