Prioritizing model trimming to prevent thinning during mouthguard thermoforming: Influence of increased height associated with an acute model angle.

BACKGROUND/AIM: The shape of the working model is one of the major factors affecting the thickness of thermoformed mouthguards. The aim of this study was to clarify the priority of model trimming to prevent thinning during mouthguard thermoforming. MATERIALS AND METHODS: Mouthguards were thermoformed using 4.0 mm thick ethylene-vinyl-acetate sheets and a vacuum forming machine. Working models were trimmed so that the angles of the labial surface to the model base were 100°, 90°, and 80°. The posterior height was unified to 30 mm, and the anterior heights were 30 mm (A100-L), 35 mm (A90-M), and 40 mm (A80-H), respectively. When the sheet temperature reached 100°C, vacuum forming was performed. Six specimens were formed for each condition. Mouthguard thickness (incisal edge, labial surface, cusp, and buccal surface) was measured using a specialized caliper accurate to 0.1 mm. Differences in thickness reduction rate due to model shapes were analyzed by one-way ANOVA and Bonferroni's multiple comparison tests. RESULTS: At the incisal edge, there were no significant differences in the reduction rate of the thickness of the mouthguard according to model shapes. On the labial surface, cusp, and buccal surface, the smaller the model angle, the smaller the reduction rate of thickness, and significant differences were observed between A100-L and A80-H, and A90-M and A80-H. On the labial and buccal surfaces, A80-H was more than 7.1% thicker compared with A100-L and more than 5.6% thicker compared with A90-M, and the thickness reduction rate was reduced when the model was trimmed to an acute angle. At the cusp, A80-H was more than 4.3% thicker than A100-L and A90-M. CONCLUSIONS: It is useful to trim the model at an acute angle in order to prevent thinning during mouthguard thermoforming, even if the anterior height of the model is increased.

Which sports have a higher risk of maxillofacial injuries?

OBJECTIVES: Sports etiology is one of the most common causes of maxillofacial injuries. This work aimed to provide an up-to-date review of sports-related maxillofacial injuries. METHODS: An updated review was conducted on Pubmed and Google Scholar. No publication year and language restrictions were applied. Two different search strategies were performed, the first addressed which sports, generally associated with maxillofacial injuries, and the second search was conducted to determine the frequency of maxillofacial injuries associated with each sport individually. RESULTS: The first search returned 26 articles distributed across different sports, from different countries, and with varied age distribution. The second search displayed 85 articles on individual sports group. Papers were rated and categorized according by the sport associated to the reported injury. A useful sports risk scale for maxillofacial injuries has been developed. Peculiar themes from all participating sports were evaluated. The use of protective equipment and other preventive measures were highlighted. CONCLUSIONS: Some sports with ball and cycling can be considered riskier sports for maxillofacial injuries. Athlete education and the mandatory use of mouthguards, helmets, and eye protection, among other things, are crucial to prevent these injuries. Tailor-made mouthguards and protective masks, which are becoming cheaper, are in vogue. The Sports-related Maxillofacial Injuries Risk scale can be useful for athletes, athletic coaches, and maxillofacial surgeons.

Decreased exercise capacity in young athletes using self-adapted mouthguards.

PURPOSE: There is evidence of both the preventive effects and poor acceptance of mouthguards. There are various effects on performance depending on the type of mouthguard model. Hemodynamic responses to wearing a mouthguard have not been described. The aim of this study was to investigate the effects of self-adapted mouthguards with breathing channels (SAMGvent). METHODS: In this randomized crossover study, 17 healthy, active subjects (age 25.12 ± 2.19 years) underwent body plethysmography and performed two incremental exertion tests wearing a (SAMGvent) and not wearing (CON) a mouthguard. Blood lactate, spirometrics, and thoracic impedance were measured during these maximum exercise tests. RESULTS: The mean values using a SAMGvent revealed significantly greater airway resistance compared to CON (0.53 ± 0.16 kPa·L-1 vs. 0.35 ± 0.10 kPa·L-1, respectively; p = < 0.01). At maximum load, ventilation with SAMGvent was less than CON (118.4 ± 28.17 L min-1 vs. 128.2 ± 32.16 L min-1, respectively; p = < 0.01). At submaximal loads, blood lactate responses with SAMGvent were higher than CON (8.68 ± 2.20 mmol·L-1 vs. 7.89 ± 1.65 mmol·L-1, respectively; p < 0.01). Maximum performance with a SAMGvent was 265.9 ± 59.9 W, and without a mouthguard was 272.9 ± 60.8 W (p < 0.01). Maximum stroke volume was higher using a SAMGvent than without using a mouthguard (138.4 ± 29.9 mL vs. 130.2 ± 21.2 mL, respectively; p < 0.01). CONCLUSION: Use of a self-adapted mouthguard led to increased metabolic effort and a significant reduction in ventilation parameters. Unchanged oxygen uptake may be the result of cardiopulmonary compensation and increased breathing efforts, which slightly affects performance. These results and the obvious preventive effects of mouthguards support their use in sports.

Physiological Effects of Wearing Athletic Mouth Pieces While Performing Various Exercises.

The purpose of this study is to evaluate physiological responses associated with exercise using two different mouthpieces compared with not using a mouthpiece. Improved performance while using the PX3 Bite Regulator (PX3) may significantly reduce the risk of concussions by allowing an athlete to better prepare, react, absorb, and/or avoid impact completely compared with the restricted breathing or mandibular instability that occurs when using mouthguards. Twenty-three subjects completed a battery of five physiological tests; the 1.5-mile run, sit and reach, anaerobic endurance, leg press, and bench press. Each test battery was completed under three conditions: wearing a PX3, wearing a mouthguard, or no mouthpiece respectfully. The PX3 resulted in significantly faster 1.5-mile run times (667.4 ± 9.4 vs. 684.9 ± 9.2 vs. 679 ± 7.9 s, p ≤ 0.05) and significantly longer anaerobic endurance runs (311 ± 23 vs. 283 ± 18 vs. 286 ± 18yds, p ≤ 0.05) compared with the mouthguard and no mouthpiece. The leg press lifts (51.8 ± 4.1 vs. 46.0 ± 4.3, p ≤ 0.05) while wearing the PX3 were significantly greater than when wearing a mouthguard. There were improvements, but no significant differences for sit and reach (16.8 ± 0.8 vs. 15.9 ± 0.8 vs. 16.4 ± 0.8 in., p = 0.73) and bench press (17.7 ± 1.8 vs. 17.2 ± 1.6 vs. 17.2 ± 1.7 lifts, p = 0.94). The increased performance with the PX3 could be a result of better jaw alignment and/or decreased resistance to airflow.

Avaliação dos métodos de higienização sobre S. mutans dos protetores bucais / Evaluation of cleaning methods on custom-made mouthguards of S. mutans

Objetivo: avaliar a eficácia de três diferentes métodos de higienização sobre cepas de S.mutans dos protetores bucais feitos sob medida: dentifrício fluoretado, detergente neutro eclorexidina. Materiais e Métodos: foram confeccionados 30 protetores bucais feitos sob medida com placas de silicone de 3 mm que foram contaminados em meio de sobrevivência BHI (BrainHeart Infusion) suplementado com 1% de glicose e sacarose e 0,5% de extrato de levedura e incubados em jarra de anaerobiose a 37°C em estufa bacteriológica por 15 dias. O meio foi renovado a cada 24 horas. Após a contaminação, foi feita a coleta dos protetores bucais, esfregaço e plaqueamento na superfície do meio de cultura mitis salivarius com bacitracina. Os protetores foram higienizados com escova dental, com três diferentes meios de higienização:dentifrício fluoretado, detergente neutro e clorexidina e, após a higienização foram submetidos a uma nova coleta, esfregaço e plaqueamento. Após incubação, foi feita a contagem do total de bactérias viáveis. Os resultados obtidos foram submetidos à análise estatística e ao teste não paramétrico de Wilcoxon. Resultados: houve redução microbiana significativa da contagem deS. mutans utilizando clorexidina e detergente (p<0.05). Não houve diferença significante na contagem antes e depois utilizando o dentifrício (p>0.05). Conclusão: a clorexidina e o detergente podem ser utilizados para desinfecção dos protetores bucais.

Objective: The effect of three different cleaning methods on custom-made mouth guards’strains of S. mutans: fluoridated tooth paste, neutral detergent and chlorhexidine. Materials and Methods: it were made 30 mouthguards custom-made with 3mm silicone slabs that have been subjected to a microbiological processing in supplemented BHI (Brain Heart Infusion). They were in cubated in anaerobic jar at 37 ° bacteriological green house for 15 days, changing the medium every 24 hours. After the contamination, samples were drawn and it was made the collection, smear and plating on surface of the culture medium mitis salivarius with bacitracin and then they were cleaned with tooth brush with three different modes of cleaning: chlorhexidine, neutral detergent and fluoridated tooth paste. After incubation, the count was made of total viable bacteria. The results were statistically analyzed by the Wilcoxon non-parametric test. Results: there wasa significant reduction in microbial counts before and after using chlorhexidine and detergent (p<0.05). There wasn’t significant difference in the count before and after using the tooth paste(p>0.05). Conclusion: chlorhexidine and detergent can be used for disinfection of mouth guards

Effects of various mouthpieces on respiratory physiology during steady-state exercise in college-aged subjects.

Protective mouthpieces have been used in a variety of sports to decrease the risk of orofacial injury. There are limited data to suggest that mouthpiece use during exercise may also provide an ergogenic effect. The aim of the present study was to investigate the effects of 3 different mouthpiece designs-boil-and-bite (BB) mouthpiece, ethylene vinyl acetate (EVA) custom mandibular mouthpiece, and polypropylene (Poly) custom mandibular mouthpiece-on respiratory physiology parameters and compare them with results of a no-mouthpiece (NM) condition. Sixteen college-aged, recreationally fit subjects ran for 10 minutes in 4 separate trials; mouthpiece conditions were randomly assigned to each trial for all subjects. Respiratory and cardiorespiratory measures, including oxygen uptake, carbon dioxide exhalation, ventilation, heart rate, tidal volume, and respiratory rate (RR), were assessed throughout testing. A repeated-measures analysis of variance indicated that RR was significantly lower (P = 0.04) in the BB mouthpiece condition (27.92 breaths per minute [BPM]) than in the NM condition (30.63 BPM). In paired t tests between conditions, the RR demonstrated in the BB condition (27.92 BPM) was significantly lower (P = 0.04) than that of each other condition (NM, 30.63 BPM; EVA, 29.92 BPM; and Poly, 29.92 BPM). The outcomes of the present study demonstrate that the use of the BB mouthpiece decreased RR during exercise. The differences cited between conditions may be attributed to the design of the mouthpiece and its mandibular placement as well as the activity of the genioglossus muscle. However, future studies should assess these parameters to determine the plausibility of these theories.

Mandatory mouthguard rules for high school athletes in the United States.

High school athletes seem particularly predisposed to dental injury, but athletic mouthguards have an excellent track record of success in reducing the severity and incidence of dental injuries in sports. Therefore, it has been suggested that mouthguards be made mandatory for high school athletes who participate in sports with risk of injury. The National Federation of State High School Associations currently recommends that mouthguards be mandated for high school football, lacrosse, ice hockey, and field hockey players as well as for wrestlers who are wearing orthodontic appliances. Different states have tried to mandate additional sports with varying degrees of success. This article summarizes the process that leads to rule changes for high school athletes at the national level and discusses the history of 4 states--Minnesota, Maine, New Hampshire, and Massachusetts--that have tried to mandate mouthguards for different sports. Common complaints that lead to the cessation of mouthguard rules, such as speech considerations, breathing ability, and cleanliness, are discussed.

Effects of mouthguards on vertical dimension, muscle activation, and athlete preference: a prospective cross-sectional study.

Mandibular repositioning and subsequent neuromuscular signaling are proposed mechanisms of action for commercial mouthguards marketed for performance enhancement. A prospective cross-sectional study of 24 healthy adult weightlifters with normal occlusal relationships was designed to determine whether 2 self-fit performance mouthguards; a custom-fabricated, bilaterally balanced, dual-laminated mouthguard; and no mouthguard (control) differed in their effects on vertical dimension, muscle activation, and user preference during a 75% maximum power clean lift. Each subject was tested for each of the mouthguard categories: Power Balance POWERUP, Under Armour ArmourBite, custom, and no mouthguard. Interocclusal distance was measured at baseline and with each mouthguard. Mean and peak activity of the anterior temporalis, masseter, sternocleidomastoid, and cervical paraspinal muscles was measured during sitting and during a 75% maximum power clean lift. A mouthguard preference questionnaire was completed. Analyses were conducted to determine whether interocclusal distance differed among mouthguard type and to examine the effect of mouthguard type on mean and peak muscle activation during the clean lift. Interocclusal distance was affected by mouthguard type (P = 0.01). Mean and peak activity of the anterior temporalis and masseter muscles and mean activity of the sternocleidomastoid muscle differed among mouthguards (P < 0.05). Mouthguard type did not influence muscle activation of the cervical paraspinal muscle group. Overall, the Power Balance mouthguard produced more muscle activity. Participants preferred custom mouthguards nearly 2:1 over self-fit performance mouthguards (P = 0.05). Participants perceived that they were stronger and were less encumbered when using a custom mouthguard during submaximum power clean lifts.

Effect of external airflow resistive load on postural and exercise-associated cardiovascular and pulmonary responses in pregnancy: a case control study.

BACKGROUND: Facial coverings (e.g., balaclavas, niqabs, medical/surgical masks, respirators, etc.), that impose low levels of airflow resistive loads, are worn by millions of pregnant women worldwide, but little data exist addressing their impact on pregnancy-associated cardiovascular and pulmonary responses. METHODS: 16 pregnant and 16 non-pregnant women were monitored physiologically (heart rate, blood pressure, mean arterial pressure, total peripheral resistance, stroke volume, cardiac output, oxygen saturation, transcutaneous carbon dioxide, fetal heart rate) and subjectively (exertion) for 1 h of mixed sedentary postural activity (sitting, standing) and moderate exercise (bicycle ergometer) with and without wearing N95 filtering facepiece respirators with filter resistive loads of 94.1 Pa (9.6 mm H2O) - 119.6 Pa (12.2 mm H2O) pressure. RESULTS: The external airflow resistive loads were associated with increases in diastolic pressure (p = 0.004), mean arterial pressure (p = 0.01), and subjective exertion score (p < 0.001) of all study subjects. No significant differences were noted with the external resistive loads between the pregnant and non-pregnant groups for any cardiovascular, pulmonary and subjective variable over 1 h. CONCLUSIONS: Low external airflow resistive loads, during combined sedentary postural activity and moderate exercise over 1 h, were associated with increases in the diastolic and mean arterial pressures of all study subjects, but pregnancy itself was not associated with any significant differences in physiologic or subjective responses to the external airway resistive loads utilized in the study.

Mouthguard and sports drinks on tooth surface pH.

The influence of sports drinks and mouthguards on the pH level of tooth surface was examined. A custom-made mouthguard was fabricated for each subject. The pH level was measured by electric pH meter with sensitivity of 0.01 up to 30 min. Sports drinks (pH=3.75) containing 9.4% sugar were used in this study. Measurements were performed on a cohort of 23 female subjects without a mouthguard (control), wearing a mouthguard only (MG), wearing a mouthguard after 30 ml sports drink intake (SD+MG), wearing a mouthguard during a 5-min jogging exercise (MG+EX) and wearing a mouthguard during jogging after sports drink intake (SD+MG+EX). For 7 male subjects, the same measurements were performed while a sports drink was taken over the mouthguard (MG+SD, MD+EX+SD). MG showed statistically higher pH level than control (p<0.05). SD+MG exhibited a significant decrease in pH level, and SD+MG+EX exhibited even below the critical level of pH 5.5 in some subjects. When sports drinks were taken over the mouthguard, no significant differences in pH level were observed among the different conditions.Within the limitations of this study, it was suggested that wearing a mouthguard during exercise is in itself not a possible risk factor for dental caries, while wearing a mouthguard after consuming sports drinks is.

Influence of mouthguards on the physical performance of soccer players.

AIM: To evaluate the influence of different types of mouthguard (MG) on physical performance of female soccer players. MATERIAL AND METHODS: The sample was composed of 25 female soccer players from 'Guarani Futebol Clube', age range 18-22 years. For data collection, two tests were performed: agility test (shuttle run) and aerobic capacity and VO2 (Cooper test), in addition to application of a perception questionnaire after wearing mouthguards during the tests. RESULTS: Data analysis showed that mouthguard type III presented better results in the VO2 and aerobic capacity tests (P < 0.05). In relation to difficulties experienced when wearing MGs, there were no reports of pain, discomfort, or nausea. However, 100% of athletes affirmed that it was not possible to speak with MG type I, 80% (n = 20) with type II, and no athlete found difficulty in speaking when wearing MG type III. Distractions were reported by 35% (n = 6) only when athletes wore MG types I and II. CONCLUSIONS: Among the three types evaluated, the customized MG (type III) presented better results in the athletes' physical performance evaluation, even taking into account physical tests performed without the use of mouthguards.

Influence of different types of mouthguards on strength and performance of collegiate athletes: a controlled-randomized trial.

BACKGROUND: Prevention of traumatic dental injuries relies on the identification of etiologic factors and the use of protective devices during contact sports. Mouthguards are considered to be an effective and cost-efficient device aimed at buffering the impacts or blows that might otherwise cause moderate to severe dental and maxillofacial injuries. Interestingly, besides their role in preventing injury, some authors claim that mouthguards can enhance athletic performance. Thus, the purpose of this controlled randomized trial was to evaluate and compare the effect of two different types of mouthguards on the athletic performance and strength of collegiate athletes. MATERIALS AND METHODS: Eighteen college athletes ranging from 19 to 23 years participated in this study. Devices tested in this study included an over-the-counter boil-and-bite mouthguard (O-Flow™ Max Under Armour®) (UA) and a custom-made mouthguard (CM). Physical tests were carefully selected by the head athletic trainer and aimed at evaluating the strength and performance. The following sequence was carried out on each test day: (i) 3-stroke maximum power ergometer test, (ii) 1-min ergometer test, and (iii) a 1600-m run. A random assignment was developed to test all three experimental groups on each test day. Following the tests, each athlete completed a brief anonymous survey aimed at evaluating the athletes' overall satisfaction with each type of mouthguard. RESULTS: Custom-made mouthguards had no detrimental effect on athletic strength and performance and were reported by the athletes as being comfortable and not causing difficulty in breathing. In contrast, boil-and-bite mouthguards did not perform as well and were reported as being uncomfortable and causing breathing difficulties. CONCLUSIONS: Based on the results of this study, the use of custom-made mouthguards should be encouraged in contact sports as a protective measure, without concern for any negative effect on the athletic performance of the athletes.

Unilateral or "side-locked" migrainous headache with autonomic symptoms linked to night guard use.

Night guards are commonly prescribed as a palliative measure for bruxism, temporomandibular joint symptoms, and associated disorders. We describe a patient with a 10- to 12-year history of night guard use with concurrent unilateral side-locked migrainous headaches with autonomic symptoms characteristic of trigeminal autonomic cephalgia. These headaches were refractory to numerous pharmacological interventions. Upon self-initiated cessation of night guard use, there was complete remission of headaches. We believe the headaches were initiated by night guard-initiated irritation of the trigeminal nerve and a trigeminal autonomic reflex resulting in unilateral migrainous headache with autonomic signs.

Do custom-made mouth guards have negative effects on aerobic performance capacity of athletes?

Mouth guards are considered an essential part of equipment for athletes participating in contact sports. The purpose of this study was to evaluate the effect of custom-made mouth guards on the ventilatory gas exchange effects of taekwondo athletes. The subjects were 22 elite athletes aged between 14 and 17 years. To determine the effect of mouth guard use during exercise, oxygen consumption (VO(2)) was measured with a portable gas analysis system while an exercise tolerance test with a shuttle run test protocol was performed. Values with and without mouth guard were compared. Wilcoxon ranks test was used for the statistical analysis. The results show that wearing mouth guards has no significant effect on maximal oxygen uptake (VO(2max)), minute ventilation (VE), tidal volume (VT) and respiratory exchange ratio (RER) while performing maximal exercise (P > 0.05). In conclusion, taekwondo athletes can use custom-made mouth guards without negative effects on their aerobic performance capacity.

Temporomandibular disorders in association with scuba diving.

OBJECTIVE: To determine the prevalence of temporomandibular disorders (TMD) in scuba divers and to identify the risk factors for the development of pain in the stomatognathic system before and after diving by the use of a questionnaire. DESIGN: : Retrospective cohort study based on questionnaires. PARTICIPANTS: A total of 296 active divers, aged 18 to 65 years, participating in scuba diving meetings in Heidelberg, Germany. INTERVENTIONS: Each diver answered a questionnaire containing 29 questions, predominantly on symptoms of TMD. MAIN OUTCOME MEASURES: The data collected from the divers were calculated by the use of logistic regression tests. Risk factors for the development of TMD were evaluated. RESULTS: Clenching seemed to be the greatest risk factor for pain while holding the mouthpiece and for pain in the masticatory muscle system after diving. Limited mouth opening and clenching were responsible for the development of pain in the temporomandibular joint after the dive. The prevalence of TMD-related symptoms was higher in women before, during, and after the dive. CONCLUSIONS: Individuals exhibiting TMD-related symptoms seem to be at the greatest risk of developing pain in the masticatory muscle system and/or the temporomandibular joint during or after the dive.

Fabrication of a custom diving mouthpiece using a thermoforming material.

Scuba divers may suffer from temporomandibular joint dysfunction and related problems associated with the use of commercially available diving mouthpieces. Several authors have recommended that custom diving mouthpieces be fabricated for relieving the symptoms of diver's mouth syndrome. The lost wax technique is commonly used for this purpose but may be time-consuming and is technically complicated. This article describes a simplified technique using thermoforming material for fabricating a custom diving mouthpiece.