Concerns regarding sports mouthguard compliance in contact sports

Author Dr E. Jan Chithalen (B.Sc., DDS, FASD, Toronto, Canada) is a Fellow and Board Member of Academy of Sports Dentistry, USA and a Sports Team Dentist for Hamilton Bulldogs, Hamilton Tiger-Cats and Toronto. Dr Jan is a Keynote Speaker at the DentalReach Conference & Awards (DRDCA) 22: Sports Dentistry Edition. Brochure & Registration Link: Click here

Basketball is considered a “non-contact” sport, yet it is interesting that it has the highest rate of dental injuries. Why is that? Many other contact and collision sports also have dental injuries, but why don’t they have the same types of injuries and the same number per capita of players? Studies show that this is because of : first, use of helmets and second is the use of sports mouthguards.

Concern 1 – Enforcing the use of mouthguards

In North America, Sports Mouthguards have been mandated in 5 major sports by the National Federation of High Schools –

1. Football
2. Hockey
3. Lacrosse
4. Field Hockey
5. Wrestling (only required if the athlete is undergoing orthodontics.)

A major problem is when sports leagues do not enforce these mandates – about two thirds of athletes do not comply with the mandates requiring mouthguards – even though studies show athletes are up to 60 times more likely to sustain a dental (intra &/or extra-oral) injury if NOT wearing a Sports Mouthguard.

Dentists specially trained as sport “Team Dentists” are quick to point out that a Sports Mouthguard does not guarantee no dental injury, but like wearing a seatbelt in a car accident – the intensity & severity of any injury is less severe and debilitating when a seat belt is worn at the time of trauma. A broken bone, a severed tendon or ligament can be repaired and heal. However, a tooth does not heal. The amputated or damaged portion can only be repaired, restored or the whole tooth may need to be completely replaced. Dental injuries are lifetime & handicap injuries! The lifetime cost of each tooth (in today’s dollars) is estimated to be upwards of $20,000 not even counting pain, suffering or the time taken for appointments.

The upside is that dental professionals (and properly trained Team Dentists) overall are exceptionally good at rehabilitating the injury, restoring function and even aesthetics. But nothing any dentist does can truly replace the original. Perhaps a dental professional’s abilities and results may have lessened the impact and importance of Sports Mouthguard use because leagues & athletes see the positive sides of our efforts that allow an athlete to return to play more quickly??

It is always frustrating to Sports Team Dentists that many athletes will spend hundreds to thousands of dollars on shoes, skates, or specialized equipment for their sport, but spend truly little if anything at all on something to protect their teeth and oral tissues. It is not uncommon to see ice hockey players keep their mouthguards tucked in their gloves or football players jamming the mouth guard in their helmet face-cage. Do they not realize that like a safety belt in the car, it is only decoration if not worn at the time of impact? Any appliance works properly if it is used and worn properly (according to proper instructions) and is functionally in place at the time of impact or trauma.

The truth is becoming known; like most things in the world, it comes down to money. With recommendations from veteran Team Dentists, insurance companies are now asking:

1. Does the league mandate a mouthguard on their list of essential equipment?
2. Was the athlete wearing a Sports Mouthguard when the dental injury happened?

A “No” answer to either question automatically negates any insurance covered benefit. Remember, this can lead to even more catastrophic & costly dental replacements in the athlete’s future.

Concern 2: Commercially available mouthguards

It remains the duty & responsibility of the dental professional (Team Dentist) to educate all sports league, players and even other members of the multi-disciplinary medical support team that “cover” injuries for both home & visiting team athletes, on the need for and benefits of wearing (and mandating & enforcing) a custom dentist-made mouth guard.

Currently, most insurance companies will dictate not whether an athlete wears a Mouthguard, but stresses that no coverage will be provided without a mandated mouth guard being worn at the time of trauma – during practices AND games.

Some may counter that “over-the-counter” (OTC) guards have “dental coverage” if injuries were sustained while wearing their brand of Mouthguards – offering insurance coverage up to $32,000! But the fine print clarifies that coverage is only up to $1,000 per tooth. It is extremely unlikely anyone would ever break all 32 teeth in a sporting accident. This is what is called “marketing”, not protection.

Concern 3: Lack of Research

In my opinion, a major challenge in North America is access to research funding and the time it takes to create research studies to support Mouthguard use. The “Sports Dentist” aspect of dental practices is an extremely small component. Few general or even specialty dentists have access to research facilities.

A greater challenge is to design a proper prospective, randomly-controlled scientific study whose purpose is to inflict blows that may or may not result in any dental or head injury (concussion) dependent on having a mouthguard in their mouth!

The best current Team Dentists, leagues, and organizations such as the Academy for Sports Dentistry (ASD) have is retrospective, historical data and while we can (and do) collect as much data as possible from teams willing to participate in such studies, pundits may argue the situations are much different from one team to another and from one game to another. All qualified “Team Dentists” will emphatically argue based on what they see at all sports games & practices. Injuries do – and always will occur!

Concern 4: Mouthguards affecting ‘performance’

Another growing concern is using the term “performance” when addressing any oral appliance or mouthguard. Performance is a subjective term, based on what each individual league or team (not science!) considers “cheating” or gaining an advantage. It is just “semantics”, and what any veteran Team Dentist would not want associated with any appliance inserted in an athlete/patient’s mouth.

Some oral appliances have been shown to improve balance and thus improve speed, agility and explosiveness – all things an athlete wants. All athletes are looking for an edge. If new and ongoing research can show that “bite-correcting oral appliances” or “Therapeutic Oral Appliances” supports true scientific claims, this is what will get athletes excited about their use – and we, as Team Dentists will be excited for them, both to reach their full potential as athletes, but also to help reduce the need for us to provide emergency treatments for severe lifelong injuries that may NOT put them back together again.

Any scientific studies along these lines to increase the (mandated) use of Mouthguards can only help Team Dentists and indeed all members of the health care profession to promote and stress the use of custom, dentist-made Sports Mouthguards.

Concern 5: Awareness

For centuries, history (and common sense) has said “an ounce of prevention is worth a pound of cure” This is absolute gospel when it comes to dental injuries. Every Team Dentist has had to restructure their day because an athlete has smashed their lips and/or teeth in a practice or game. Every case is a lifelong injury that affects everyone – the athlete, their families and the Team Dentist. It is the way every Team Dentist helps our teams – and helps our athletes get back to the sport they love.

It is only possible through education of everyone –

• parents,
• elementary & high school boards & teachers,
• all coaches & leagues,

and especially

• all athletes, amateur and professional.

Discussions and education can help all these people see the benefit of preventing dental injuries by mandating and enforcing the wearing of custom Dentist-made Sports Mouthguards. This can help avoid those lifelong – and costly – injuries.

The reality is that Team Dentists can speak to parents, athletes, business groups, referees, to support our cause because we know the pain and suffering, the time spent by us and lost by patients / athletes that sustain preventable dental injuries. We also know the huge sums of money that go into repairing and replacing something that is priceless.

It is every Team Dentist’s hope that through dentistry, better athletic health can assist every athlete hoist that championship trophy without pain – but always with a huge and wonderful SMILE!