Construction and Use of Mouthguards When in Orthodontic Treatment

Construction and Use of Mouthguards When in Orthodontic Treatment

It is widely accepted in the dental community that mouthguards reduce injuries in sport, and the most effective mouthguard is that traditionally made indirectly on a model. These mouthguards are made from an impression of the teeth, soft tissues, and fitted predominantly to the upper teeth.

The prescription of sports mouthguards, to a person who is undergoing orthodontic treatment, is a difficult situation to apply traditional indirect mouthguard construction methods. Traditionally made mouthguards are expensive to produce, very time consuming to fit in the orthodontic practice, and the materials used for indirect traditional mouthguards cannot be easily refitted, by the Orthodontist, or by the patient.

From fixed arch expanding devices, to braces on upper and lower teeth, the modern orthodontist can now prescribe direct mouthguards, suitable for the treatment demands, the age of the patient, and the type of sport played, i.e. helmet with face-mask v. no face mask or no helmet. The mouthguards shown in this article are designed for sports played in Australia. Signature Mouthguards also supplies mouthguards designed for the popular sport(s) played in the USA and Canada.

The orthodontic patient in all forms of activity, including sleep, can sustain cuts, gouges, scratches, tears, punctures, bruising and soreness of the cheeks, lips, gums and tongue. The orthodontic patient playing any form of sport, but particularly Football, Australian Football, Rugby League, Rugby, Boxing, Field Hockey, Mixed Martial Arts and Basketball is at high risk of such injuries, including catastrophic penetrating injuries.

The Orthodontic Mouthguard point of purchases (POP) display kit pictured is a 24 unit display box with 3 different sized upper mouthguards in Adult, Intermediate (Teens) and Youth models. Each Product / unit contains 2 separate mouthguards and a direct method fitting instruction leaflet. The Product, Twin Pack (TP) has 1 Upper arch mouthguard with high profile labial / buccal flanges and 1 Lower arch mouthguard with low profile labial / buccal flanges. Both mouthguards are made using Signature Master batch EVA mouthguard materials.

The Signature Master batch EVA material selected for directly fitted Signature Orthodontic Mouthguards requires low temperatures to deform, compared to high deforming temperatures used in traditional indirect mouthguard materials.

The 3 Signature Upper mouthguard(s) TP and Type 3 direct Custom design features are unique to Signature Mouthguards Pty Ltd, Australia.

The features include:

1. 3 different size upper mouthguards to suit the age of the sports person undergoing treatment.
2. 4 posterior trim guides to assist in adjusting posterior length from the rear of the mouthguard.
3. Controlled thickness throughout the mouthguard.
4. Buccal and labial inner shields.
5. Anatomical contours and finish.
6. Occlusal (internal fitting surface) channel which assists in the direct ‘warm and fit’ method.

The Signature Lower TP mouthguard design features include:

1. 4 posterior trim guides to assist in adjusting posterior length from the rear of the mouthguard.
2. Controlled thickness throughout the mouthguard.
3. Buccal and labial inner shields.
4. Anatomical contours and finish.
5. Occlusal (internal fitting surface) channel which assists in the direct ‘warm and fit’ method.

These features combine when the mouthguard is ‘warmed and fitted’ using the instruction leaflet and the Orthodontist’s advice, forming a ‘Band-Aid’-like general fit over the teeth, braces and soft tissues. This can be re-fitted many times in the orthodontic treatment progression. The majority of ‘braces’ patients are kids / youth so it is important for the Orthodontist to briefly explain to the parent / guardian / patient the fitting method and offer general advice, guidance and encouragement.

General advice includes:

1. Sport can be dangerous.
2. PLEASE READ THE INSTRUCTIONS BEFORE FITTING the mouthguard.
3. YOU MUST FIT THE MOUTHGUARD AND TRAIN IN IT, BEFORE USING IT IN A COMPETITIVE GAME .
4. This mouthguard is not the same as the ‘old’ boil and bite designed products.
5. Please use a clock to time each stage, you will destroy the mouthguard if you overheat it.
6. You ‘Warm and Fit’ this mouthguard over the teeth, braces and soft tissues.
7. It is HIGHLY RECOMMENDED that a parent supervises when boiling a vessel of water to warm the mouthguard.
8. Once the water boils pour it from the vessel into a MUG and WAIT 3 MINUTES.
9. Place the Upper mouthguard in the MUG for 1 Minute.
10. After exactly 1 Minute in the MUG, remove the mouthguard placing it over the teeth, braces and soft tissues. Bite on it and, if possible, close your lips and suck on the mouthguard AND, at the same time massage the cheeks of your face firmly with both hands, for 1 minute.
11. It is important that the patient keep the mouthguard in place for several minutes before removing the mouthguard from the mouth.
12. If the process was incomplete or unsatisfactory, repeat steps 8-11, but this time, keep the mouthguard in position after the massage for longer. Suggest up to 20 minutes AND encourage the patient to be active in this time.
13. The more the mouthguard is used, when the patient is active, the easier it is to wear during competition games.
14. Fit the Upper mouthguard first 80% of tooth sports injuries are to the upper 4 central incisors.
15. Recommend fitting the LOWER mouthguard in a separate fitting session once the Upper mouthguard is comfortable to the patient’s mouth.
16. The Mouthguard Box is made with anti-microbial additives.
17. Follow the mouthguard cleaning instructions printed on the leaflet .

The Orthodontist, parent / guardian, patients, (including Teen and Adults in braces), supported by your Front Desk staff must interact throughout all treatment phases, informing each other of all sports activities planned by the patient, while undergoing treatment.

Fixed arch expansion devices:

Taking an impression that includes palatal coverage, the fixed expansion device, all the upper teeth, and tissues, is very difficult to prescribe for a traditional indirect mouthguard.

A lower impression tray that is tailored with Beading Wax by the Orthodontist to take the upper impression for traditional indirect mouthguard construction methods can produce acceptable results for an indirect Customised option. However, intimate fit is lost quickly, the mouthguard cannot be used with braces or be re-fitted by the orthodontist and, multiple indirect mouthguard costs are prohibitive for most patients.

Signature Type 3 Mouthguard (T3) with its direct custom Perfect Fit Technology system (ProPlusGel*) is a suitable option. ProPlusGel (PPG) has equal Parts A + B, made of addition vulcanising silicone and the Primer is a cleaner. The hollow cylinder-like parts protruding upward in the fitting surface of the mouthguard provide physical retention between the mouthguard and the PPG material.

The Dental Practice advises the patient how to warm and fit Signature Type 3 Custom direct mouthguards as above, for good general fit over upper teeth, fixed expander and tissues. The staff should inform patients/parents:

ProPlusGel (PPG) is odourless and tasteless, is safe to use in the mouth and provides an instant intimate fit
READ THE INSTRUCTIONS TO MIX Part A & Part B and how to use Primer
DO NOT SWALLOW mixed or unmixed PPG
PPG DOES NOT STICK OR GLUE ITSELF TO THE MOUTHGUARD – Safety feature
Add mixed PPG to the pre-fitted cleaned mouthguard just before playing competitive games
Once PPG is set, DO NOT REMOVE/TAKE OUT MOUTHGUARD FROM THE MOUTH UNTIL AFTER THE GAME.
Before starting play, remove set, loose or dangly PPG from the mouthguard / mouth carefully, rinse the mouth well and spit the water and any pieces out
Keep the mouthguard in the mouth during breaks in the game
Drinking water or sucking/chewing on an orange can be done with the mouthguard in place
After the game, remove the mouthguard carefully, peeling the PPG from the mouthguard, around arch expanding device and discard all set/used PPG
Extra Perfect Fit Technology kits can be supplied by the Dental Reception.
Patients in orthodontic treatment have suitable cost-effective (direct) mouthguard options that are easy to fit by the patient and managed from the Orthodontist’s Front Desk – plan accordingly in your practice. Protect your patient’s future smile in the present!
The prescription of mouthguards for athletes, who are not undergoing orthodontic treatment, most particularly those who play professionally or in higher levels of competition, faces different options when considering protection and performance, with product designed to best suit the type of sport being played.

By Dr. Derek Mahony