EVA mouthguards: how thick should they be?

A major consideration in the performance of mouthguards is their ability to absorb energy and reduce transmitted forces when impacted. This is especially important to participants in contact sports such as hockey or football. The thickness of mouthguard materials is directly related to energy absorption and inversely related to transmitted forces when impacted. However, wearer comfort is also an important factor in their use. Thicker mouthguards are not user-friendly. While thickness of material over incisal edges and cusps of teeth is critical, just how thick should a mouthguard be and especially in these two areas? Transmitted forces through different thicknesses of the most commonly used mouthguard material, ethylene vinyl acetate (EVA) (Shore A Hardness of 80) were compared when impacted with identical forces which were capable of damaging the oro-facial complex. The constant impact force used in the tests was produced by a pendulum and had an energy of 4.4 joules and a velocity of 3 meters per second. Improvements in energy absorption and reductions in transmitted forces were observed with increasing thickness. However, these improvements lessened when the mouthguard material thickness was greater than 4 mm. The results show that the optimal thickness for EVA mouthguard material with a Shore A Hardness of 80 is around 4 mm. Increased thickness, while improving performance marginally, results in less wearer comfort and acceptance.

Orofacial/cerebral injuries and the use of mouthguards by professional athletes in Switzerland

The objective of the present study was to measure the occurrence of orofacial and cerebral injuries in different sports and to survey the awareness of athletes and officials concerning the use of mouthguards during sport activities. Two hundred and sixty-seven professional athletes and 63 officials participating in soccer, handball, basketball and ice hockey were interviewed. The frequency of orofacial and cerebral trauma during sport practice was recorded and the reason for using and not using mouthguards was assessed. A great difference in orofacial and cerebral injuries was found when comparing the different kinds of sports and comparing athletes with or without mouthguards. 45% of the players had suffered injuries when not wearing mouthguards. Most injuries were found in ice hockey, (59%), whereas only 24% of the soccer players suffered injuries when not wearing mouthguards. Sixty-eight percentage of the players wearing mouthguards had never suffered any orofacial and cerebral injuries. Two hundred and twenty-four athletes (84%) did not use a mouthguard despite general acceptance by 150 athletes (56%). Although the awareness of mouthguards among officials was very high (59%), only 25% of them would support the funding of mouthguards and 5% would enforce regulations. Athletes as well as coaches should be informed about the high risk of oral injuries when performing contact sports. Doctors and dentists need to recommend a more intensive education of students in sports medicine and sports dentistry, and to increase their willingness to become a team dentist.

Exercise capacity in athletes with mouthguards

The objective of this study was to determine the effect of wearing a mouthguard on maximal exercise capacity and cardiopulmonary parameters at peak workload, and to assess the athletes' attitudes toward wearing a mouthguard. Thirteen volunteer male athletes (18 to 27 years old) were interviewed before and after delivery of a custom-made laminated mouthguard. A visual analogue scale (VAS, 0 - 100 mm) was used for judgment of interference with breathing, speaking, concentration and athletic performance. In addition, the athletes were subjected to a cardiorespiratory examination on a cycle ergometer with and without mouthguards. Subjectively, the athletes rated the mean interference with performance to be 37 mm VAS at the beginning of the study. Mean scores of impairment decreased to 23 mm VAS (p = 0.081) after wearing the mouthguard for four weeks, and further improved to 12 mm VAS (p < 0.001) after the test on the cycle ergometer. Objectively, the maximum workload during spiroergometry was even slightly elevated during exercise with the mouthguard (330.2 W) compared to exercise without the mouthguard (314.5 W). Peak minute ventilation and oxygen uptake were not different during exercise with and without the mouthguard. The present study demonstrated that a custom-made mouthguard does not significantly affect or reduce maximum exercise performance of athletes.

Beneficial effects of air inclusions on the performance of ethylene vinyl acetate (EVA) mouthguard material

Objective: To investigate the impact characteristics of an ethylene vinyl acetate (EVA) mouthguard material with regulated air inclusions, which included various air cell volumes and wall thickness between air cells. In particular, the aim was to identify the magnitude and direction of forces within the impacts. Method: EVA mouthguard material, A mm thick and with and without air inclusions, was impacted with a constant force impact pendulum with an energy of 4.4 J and a velocity of 3 m/s. Transmitted forces through the EVA material were measured using an accelerometer, which also allowed the determination of force direction and magnitude within the impacts. Results: Statistically significant reductions in the transmitted forces were observed with all the air inclusion materials when compared with EVA without air inclusions. Maximum transmitted force through one air inclusion material was reduced by 32%. Force rebound was eliminated in one material, and reduced second force impulses were observed in all the air inclusion materials. Conclusion: The regulated air inclusions improved the impact characteristics of the EVA mouthguard material, the material most commonly used in mouthguards world wide.

Comportamentos alimentares e saúde oral em voleibolistas

Introdução e objectivos: A saúde oral em atletas é parte essencial para a saúde geral, sendo um factor determinante para a qualidade de vida e desempenho desportivo. Logo, um bom estado de saúde só existirá se a cavidade oral se encontrar ausente de patologias. Os desequilíbrios nutricionais possuem efeitos sobre a cavidade oral, condicionando assim a qualidade de vida e desempenho do atleta. Desta forma, o excesso de ingestão de alguns alimentos podem ser factores de risco para a saúde, tendo conta em que, a etiologia da cárie dentária está relacionada com a ação de microorganismos orais que produzem ácidos orgânicos, a partir do metabolismo dos hidratos de carbono. O objectivo deste estudo foi avaliar a saúde oral bem como os hábitos alimentares e o uso de protetores bucais durante a prática desportiva. Participantes e Métodos: Foram observados 55 atletas de voleibol entre os 15 e 18 anos de ambos os géneros, do clube de voleibol Academia José Moreira e Leixões. Tratou-se de um estudo transversal, no qual foi realizado exame clínico intraoral (índice de cárie CPOd, indice de erosão dentária BEWE) e preenchimento de questinário, em que os indivíduos foram caracterizados em 5 componentes: dados sociodemográficos (idade, peso e estatura), dados sobre perceção de saúde, dados sobre comportamentos de saúde oral, dados sobre prática desportiva e dados sobre comportamentos alimentares (questionário semi-quantitativo de frequência alimentar). A análise estatística descritiva e inferencial dos dados recolhidos foi realizada com o auxílio do programa informático SPSS, versão 23.0. Resultados: Os hábitos de saúde oral não são os mais adequados e a percentagem de atletas que visita o médico dentista é elevada para “só quando tem dores” ou “ocasionalmente”. A média do CPOD geral foi de 4,22 ± 4,55. Não houve diferenças estatisticamente significativas (p>0,05) entre o CPOD geral e o IMC. Nenhum dos atletas usa protetor bucal durante a prática desportiva. Os alimentos mais consumidos foram a carne, fruta, leite, peixe e, biscoitos, bolos e bolachas; e os menos consumidos foram as bebidas alcoólicas, mel ou compotas e café. Conclusão: Os hábitos de higiene oral são um melhor indicador do que o IMC para a presença de cárie. Não há relação direta entre índice CPOD e IMC. Seria importante prestar mais informação sobre vantagens do uso de protetores bucais junto dos atletas e de treinadores bem como, esclarecer que a consistência e as propriedades sensoriais ligadas à textura e à consistência dos alimentos na superfície dentária interferem com a cárie.