A boil-and-bite mouthguard (top) and a custom molded mouthguard (bottom). Those are my own simulated teeth in the photo!
Mouthguards. Can’t talk with ‘em, not allowed on the track without ‘em. At least that’s how it is in my sport, roller derby. A surprising number of professional contact sports don’t require mouthguards, but these simple gadgets seem to have a lot going for them. They don’t just protect your teeth - their makers say they can prevent concussions, and even give you better cardiovascular endurance. What’s behind these claims?
Do they at least protect your teeth?
When the CDC considered making a recommendation for mouthguards to prevent dental injuries, they concluded there is not enough evidence to issue such a guideline. The American Dental Association, meanwhile, did their own survey of the evidence and came out recommending custom-fitted mouthguards for most sports, contact or otherwise. One study found that half of all football injuries were to the mouth before mouthguards were commonly worn, and only 1% afterwards. A study on NCAA college basketball did find reduced dental injury among players who wore mouthguards.
Really, how can the ADA not push for mouthguards? Their own paper includes a section called “Mouthguard Advocacy” and mentions that they’ve been promoting “properly fitted mouthguards” for over 50 years. The best, they say, are the kind custom-made by a dentist at $200 a pop. The ADA even recommends that you enlist a dentist’s help when you mold your $5 store-bought mouthguard.
Custom mouthguards definitely fit better than the boil-and-bite style, which is a big advantage if they work at all, since you won’t be popping it out of place and chewing on it during games. My own custom-fit guard sticks to my teeth so well I don’t need to take it out to talk to my teammates, or even for water breaks. (The technical name for that feature is “retention”.)
The dentists can hardly be impartial when custom guards are part of their business, but their approach seems to be a common-sense one: wear a mouthguard and maybe it will help.
What about concussions?
Athletes (not to mention our coaches and dentists) are working without enough information. There is no consensus on the optimal thickness of a mouthguard, no clear comparisons of the different types, and no really good large studies on whether mouthguards work at all, to protect our teeth or our brains. A review in the British Medical Journal asks the question Do mouthguards prevent concussion? and finds that all the promising-looking studies are done either by surveying a small number of athletes - too small, say the authors - or simulating impact with skull models. That review concludes that the concussion-preventing aspect of mouthguards is “a myth.”
One curiosity remains - can a mouthguard improve your sports performance by changing how you breathe? a 1991 study with just 17 subjects found that mouthguard users needed less air than non-mouthguard users when they were working hard. These weren’t expensive pieces of equipment, but over-the-counter types that aren’t even molded to the teeth. The authors think the effect is similar to pursed-lip breathing, so you could always try that instead.
Two new types of mouthguards claim to improve performance a different way, by holding the jaw in a relaxed position. Makkar does this with sci-fi looking machinery; UnderArmour skips the face electrodes but puts wedges on the molars of the guard so, they explain, you don’t clench your teeth. The idea is that when you do, cortisol levels increase in your bloodstream. This dentist explains cortisol as a “solution” [sic] that “makes you weaker, slower, and [gives you] tunnel vision.” The science is still out on this idea. Both of these guards need to be custom-molded by a dentist and cost $500 or more. Want a cheaper fix? Sticking your tongue out helps you relax your jaw too.