Mouth Guards Notes 2024 PDF

MOUTH GUARDS DR CRAIG PECK 2024  LEARNING OUTCOMES Explain the importance of MG’s Classify MG’s Be able to construct a mouth guard for a paediatric patient Advise parents on the most appropriate mouth guard for their child (w.r.t. age, stage of d...

MOUTH GUARDS DR CRAIG PECK 2024  LEARNING OUTCOMES Explain the importance of MG’s Classify MG’s Be able to construct a mouth guard for a paediatric patient Advise parents on the most appropriate mouth guard for their child (w.r.t. age, stage of development, sport type, finances) What is it? = appliance manufactured from elastic/ shock- absorbable material Fits over teeth & part of gum Makes contact with opposing teeth (when mouth is closed)  Aim Prevent trauma of mouth (esp. ant. teeth), jaw & face 50% of all sports injuries affect oral cavity Dental trauma in contact sports account for 10-40% of injuries in children Injuries to Mx incisors = ± 80% MG’s reduce overall risk of injury by 1.6-1.9% When should MG’s be used?  Ideal Mouth guard Good protection → cover all teeth Comfortable → not thick/ heavy Minimum discomfort Not interfere with speech (difficult initially) Not interfere with breathing/ restrict O2 uptake Not cause drying of the mouth Moderate shock absorption and hardness Low water absorbency, durable, low wear resistance How do mouth guards work? 1. Absorption of shocks 2. Protects hard tissues # of ant. teeth/ avulsion injuries # of post. teeth/ restorations Tooth injuries almost totally eliminated 3. Protects soft tissue ↓ injuries to lips, tongue, cheeks  4. Protects jaws a) Opens space between condylar head and glenoid fossa → protects head of condyle + capsule → ↓ chances of condylar # ↓ risk of concussion/ severe intracranial injuries (subdural haematomas), as forces less transmitted through base of skull to brain b) Shocks absorbed → not directly transmitted to vertebrae/ brain → ↓ neck injuries c) Stabilizes the neck muscles when in occlusion→ ↓ movement of head on neck Types of mouth guards 1. Preformed (stock type/ factory made) (I) 2. Boil-n-bite (mouth-formed) (II) 3. Model-formed (custom made/ lab made): Low vacuum suction (III) Pressure laminated (IV) Type I = Stock type =Preformed in S, M, L Sport shops, pharmacies Can’t be adapted to improve fit – use unmodified Low level of protection, unretentive, cheapest Flat occlusal surface – comfort, stability Speech and breathing issues Held in position by clenching teeth= unsafe NOT acceptable– should not be used.  Type II = Boil-n-bite Preformed shell: = Adapted to fit mouth ↑ deformation → ↓ retention and Largest range (sports stores) occlusal thickness Preformed shell Can bite right through-- ↑ injuries  Thermoplastic material Uncomfortable, Unretentive  Lined with gel Protection inadequate  Softened in warm water, molded to fit mouth Last minute back-up Fungal growth Type III (custom made): low vacuum Model-formed/ lab made Disadvantage: Expensive? Dental appointment needed Low vacuum suction; Ethylene vinyl acetate (EVA)= Proform Most widely accepted with good retension Comfortable – better fit/ not bulky ↓ speech/ breathing problems and ↓ salivation Type III (manufacturing) 1. Impression Mx (Class III= Md also??) 2. Cast model (palate cut away) 3. Thermoplastic material= proform → vacuum seal 4. Trim & polish ** ORTHO PT’S (tooth movement?) and Mixed dentition considerations when making! Manufacturing (cont…) Fitting of mouth guard Snug Must not be able to dislodge with lip Must not open bite too much-- heat slightly Dimensions (III and IV): not < 3mm thick 3-4 mm thick (O and B) Peak energy absorption at 4mm NEVER > 6mm Type IV = Pressure laminated Custom made Eg. Max mouth guards Multiple layers EVA (Drufosoft) laminated over models Improvement on Type III MG’s Drufomat pressure machine High heat and up to 6 bars of pressure→ chemical fusion of different layers→ more accurate adaptation Lamination eliminates problem of unevenly stretched areas/ decreased thickness Type IV (cont…) 4mm thickness– 2 layers of EVA vacuum sealed over each other ↑ thickness ∝ ↑ impact sport Maximum fit, comfort and protection Minimum impact on breathing and speech ↓ nausea Maintenance NB!! Strict daily OH regimen Clean mouth guard – soap & water Store MG in box/ bag with perforations → prevent fungal growth REPLACE EVERY SEASON (± 1x per yr) **NB!! Use of mouth guards should be encouraged