Effects of a Custom Bite-Aligning Mouthguard on Performance in College Football Players

The production and materials of mouthguards: Conventional vs additive manufacturing - A systematic review

This investigation presents a critical analysis of mouthguard production, focusing on the evaluation of conventional vs additive manufacturing methods, the materials involved, and aspects such as their failure and prevention. It also summarizes the current trends, perspectives, and the main limitations. It is shown that some of the shortcomings can be solved by implementing additive manufacturing technologies, which are systematically reviewed in this research. Due to the specific materials used to produce mouthguards, there are certain additive manufacturing technologies that dominate and a wide variety of raw materials. The costs vary depending on the technology.

Comfort and wearability properties of custom-made and boil-and-bite mouthguards among basketball players: A randomized parallel arm clinical trial

BACKGROUND/AIM

Thermoplastic mouthguards have been a reliable means of protection against impacts and shocks for a century. Although orofacial injuries are prevalent among basketball players, many athletes still avoid using mouthguards due to concerns regarding impaired breathing, speech interference, and nausea. This study aims to compare basketball players' subjective assessments of two different thicknesses of custom-made mouthguards (MGs) with boil-and-bite MGs (B&B MG).

MATERIAL AND METHODS

A total of 60 systematically healthy male professional basketball players, without active orthodontic treatment, were enrolled and randomly assigned to three groups: Group 1 (received B&B MGs; n = 20), Group 2 (received custom-made MGs with a 3 mm thickness [ethyl vinyl asetat]; n = 20), and Group 3 (received custom-made MGs with a 5 mm thickness; n = 20). To evaluate MG comfort and usability, 12 key factors, including comfort, fit, stability, tiredness, thirsting, oral dryness, nausea, speaking, breathing, drinking, ease of wear and removal, and inclination to chew, were assessed. The athletes were made to rate these factors using a 10 cm-long Visual Analog Scale, measured at three-time intervals, and the values for both inter-group and intra-group were compared.

RESULTS

Data from 48 basketball players were retrieved, and data analysis revealed that B&B MGs had the least favorable parameter values. Among the B&B MG group, stability was reported to be poorer during the initial measurement (p < .05). In the second measurement, B&B MGs showed significantly lower values for comfort, stability, tiredness, speaking, and inclination to chew (p < .05). During the third measurement, the B&B MG group exhibited significantly reduced values for comfort, breathing, drinking, and speaking (p < .05). In contrast, no statistically significant difference was observed between 3 and 5 mm thickness MGs in these measurements.

CONCLUSIONS

Custom-made MGs with different thicknesses consistently outperformed B&B MGs in all measurements, indicating the potential to tailor MG thickness based on sport, age, professional level of athlete, and presence of other protective equipment. While custom-made mouthguards are considered the gold standard, dentists who provide B&B MGs can lead to cost savings while maintaining protection and encouraging athletes to use higher-quality custom-made mouthguards.

Faculty of sports science students, physical education teachers, and athletes' level of knowledge and attitude about mouthguards

OBJECTIVES

Traumatic dental injury occurs during sports competitions, training, and practice and can be prevented by the use of mouthguards. For this reason, this study aimed to evaluate the knowledge and attitudes of sports science faculty students, physical education teachers, and athletes about mouthguards.

METHODS

Five hundred thirty-two participants were reached via social media. In the questionnaire consisting of 20 questions, questions about the sociodemographic characteristics of the participants were asked in part 1, and questions about their level of knowledge and attitudes about the mouthguards were asked in part 2. Descriptive statistical analysis and a chi-square test were used to evaluate the data.

RESULTS

The number of people who think that mouthguards protect the athlete from traumatic dental injury is 381 (71.6%). The number of people who think that mouthguards affect the performance of the athlete is positively 228 (42.9%). To protect against traumatic dental injury, 51.48% of the participants preferred the custom-made; 39.3% of them preferred the boil-bite; 33.22% of them preferred the standard/stock type mouth guard; and 22.96% of them preferred the helmet, and 18.26% of them preferred the face mask.

CONCLUSIONS

The knowledge and attitude of sports science faculty students, physical education teachers, and athletes are low about mouthguards. Since these people who are engaged in sports have a high exposure to traumatic dental injuries, education should be given to increase their awareness about mouthguards.

Sports performance adaptations through occlusal splint: Case reports of triathlon athletes

OBJECTIVE

Occlusal disturbances affect human posture and sports performance. This study aimed to monitor biomechanical adaptations to personalized occlusal splints.

METHODS

Splints were customized based on stabilometry, thermography, sEMG, and kinesiography, and administered to three triathlon athletes. They were evaluated during a 4-month period, using isokinetic indexes, running kinematics and anaerobic outputs.

RESULTS

Individuality emerged as a key factor driving type, quantity, quality, and time trajectories of adaptations. The use of instrumental and clinical tests allowed the detection of static balance and biting function improvements, but not necessarily parallel to sports performance improvements.

CONCLUSION

The authors argue that strength and kinematic imbalances are joint and task-specific and support the use of multi-stage monitoring of the biomechanical effect of mouthpieces. Kinematics of cycling and running may be widely assessed with ecological and inexpensive methods. Strength imbalances need to be continuously monitored due to the high informative value to injury prevention.

Influence of wearing mouthguards on performance among athletes: A systematic review

OBJECTIVES

While the use of mouthguards is well established to prevent orofacial and dental trauma occurrence, limited evidence exists regarding their influence on athletic performance. The objective of this study was to conduct a systematic review of the literature to assess the effect of wearing mouthguards on athletic performance.

DESIGN

Systematic review.

METHODS

An extensive search was performed in the databases of PubMed/MEDLINE, Embase, Scopus and Cochrane Library for studies published up to August 2022. Only peer-reviewed studies involving humans in vivo and investigating the use of mouthguards on performance among athletes were included. Quality assessment was performed using the Cochrane Collaboration's risk of bias tool.

RESULTS

The initial query yielded 4785 citations, of which 41 studies met the inclusion criteria, comprising a total of 852 athletes. Overall, wearing mouthguards was found to improve athletic performance compared to the control group (without mouthguards). Custom-made mouthguards were found to be more effective in enhancing athletic performance compared to other types of mouthguards.

CONCLUSIONS

Wearing mouthguards should be advocated by athletes not only for the prevention of orofacial and dental trauma but also for their potential improvements in athletic performance in specific actions. However, caution must be exercised in interpreting these findings due to the variability in outcome measures and the lack of important methodological details.

Sports mouthguard overview: Materials, fabrication techniques, existing standards, and future research needs

Sports mouthguards are proven devices that reduce both the probability of and damage to orofacial tissues. While commonly used, clinicians may be unaware of the different sports mouthguard materials, proposed fabrication techniques, design recommendations, and newer digital fabrication methods. An overview of existing sports mouthguard standards is presented. It identifies that identify that the present requirements, while historically chosen in good faith, appear to be arbitrarily selected and not from clinical evidence-based derived data. In addition, identified sports mouthguard heterogeneous testing and data acquisition methods distinguishes that little possibility is afforded for the correlation of results. Furthermore, updated evidence with concussion prevention and/or alleviation is presented with evidence provided by sports mouthguard imbedded technology. The need for continued research is stressed to provide evidence-based data for concussion alleviation/prevention, digital fabrication methods and materials, and clinically based information for the revision of existing standards.

Effects of wearing a customized bite-aligning mouthguard on powerful actions in highly trained swimmers

Background/objectives

The potential advantages of wearing customized bite-aligning mouthguards on several performance parameters such as muscular strength, power and reaction time have been reported. Literature shows that the concurrent activation potentiation phenomenon, elicited by a powered and balanced jaw clenching, can provide athletes with several neuromuscular advantages. The aim of the present study was to investigate the acute effects of jaw clenching while wearing a customized bite-aligning mouthguard on swimming start, countermovement jump and swim bench test, in contrast to two other conditions: non-jaw clenching and jaw clenching without mouthguard.

Methods

A randomized, repeated measure within study design was used to compare the condition effect on eight highly trained elite male and female swimmers.

Results

Statistical analysis revealed a significant increase in the countermovement jump height (p = 0.041) when comparing the use of mouthguards with the non-jaw condition. In the swim bench, a significant greater time to peak force (p = 0.049) was found when comparing the use of mouthguards with the jaw condition. Although, non-significant effects, small differences were found in the start reaction time and 15-m freestyle swimming when comparing the use of mouthguards with the non-jaw condition.

Conclusion

This study demonstrated that wearing customized, bite-aligning mouthguards had an ergogenic effect on specific measures of vertical jump and swim bench test, whereas non-meaningful but small differences were found in swimming start.

Occlusal Splints and Exercise Performance: A Systematic Review of Current Evidence

The role of the dento-mandibular apparatus and, in particular, occlusion and jaw position, received increased attention during last years. In the present study, we aimed to systematically review, on the light of the new potential insights, the published literature covering the occlusal splint (OS) applications, and its impact on exercise performance. A structured search was carried out including MEDLINE^®/PubMed and Scopus databases with additional integration from external sources, between March and June 2021. To meet the inclusion criteria, studies published in the English language, involving humans in vivo, published from 2000 to 2021 and that investigated the role of occlusal splints on athletes' performance were selected. Starting from the 587 identified records, 17 items were finally included for the review. Four main aspects were considered and analyzed: (1) occlusal splint characteristics and occlusion experimental conditions, (2) jump performance, (3) maximal and explosive strength, and (4) exercise technique and biomechanics. The results of the systematic literature analysis depicted a wide heterogenicity in the experimental conditions and suggested the application of the OS as a way to improve athletes' or individuals' oral health, and as a potential tool to optimize marginal aspects of exercise performance.

Acute Effects of Wearing Bite-Aligning Mouthguards on Muscular Strength, Power, Agility and Quickness in a Trained Population: A Systematic Review

The purpose of the present systematic review was to determine the acute effects of wearing bite-aligning mouthguards on muscle strength, power, agility and quickness in athletes. A search of the current literature was performed using the electronic databases (until 1 May 2021) Web of Science, Scopus and Medline. The inclusion criteria were: (1) descriptive design studies; (2) with randomized clinical trials; (3) examining the within-subject acute effects of wearing mouthguards on functional and neuromuscular performance parameters; (4) in physical active, recreational or high-standard athletes. Twenty-seven studies met the inclusion criteria. Sixteen reported positive effects in some of the variables assessed, two reported negative effects and the rest found no significant differences. Overall, the main findings described in the literature are inconclusive concerning the neuromuscular advantages of using mouthguards in muscle strength, power, agility and quickness. These discrepancies might be related to several factors such as differences in testing protocols, poor control of the jaw magnitude and improper mouthguard designs. Despite these differences, after conducting the present systematic review, the authors speculate that jaw clenching while wearing custom-made, bite-aligning oral devices might promote beneficial effects in lower limb power actions, especially in jump ability and knee extension movements. Thus, athletes might consider the use of mouthguards, not only for their protective role but also for the potential ergogenic effects in specific actions, mainly those for which lower limb muscular power are required.

Influence of a Vented Mouthguard on Physiological Responses in Handball

Schulze, A, Laessing, J, Kwast, S, and Busse, M. Influence of a vented mouthguard on physiological responses in handball. J Strength Cond Res 34(7): 2055-2061, 2020-Mouthguards (MGs) improve sports safety. However, airway obstruction and a resulting decrease in performance are theoretical disadvantages regarding their use. The study aim was to assess possible limitations of a "vented" MG on aerobic performance in handball. The physiological effects were investigated in 14 male professional players in a newly developed handball-specific course. The measured values were oxygen uptake, ventilation, heart rate, and lactate. Similar oxygen uptake (V[Combining Dot Above]O2) values were observed with and without MG use (51.9 ± 6.4 L·min·kg vs. 52.1 ± 10.9 L·min·kg). During maximum load, ventilation was markedly lower with the vented MG (153.1 ± 25 L·min vs. 166.3 ± 20.8 L·min). The endexpiratory concentrations of O2 (17.2 ± 0.5% vs. 17.6 ± 0.8%) and CO2 (4.0 ± 0.5% vs. 3.7 ± 0.6%) were significantly lower and higher, respectively, when using the MG. The inspiration and expiration times with and without the MG were 0.6 ± 0.1 seconds vs. 0.6 ± 0.1 seconds and 0.7 ± 0.2 seconds vs. 0.6 ± 0.2 seconds (all not significant), respectively, indicating that there was no relevant airflow restriction. The maximum load was not significantly affected by the MG. The lower ventilation for given V[Combining Dot Above]O2 values associated with MG use may be an effect of improved biomechanics and lower respiratory drive of the peripheral musculature.

Effects of occlusal splints on shoulder strength and activation

Introduction: The use of oral appliances to enhance sports performance has been advocated by some authors, however, studies addressing the effectiveness of these strategies are inconclusive. Methods: Here we investigate the effects of dental occlusions on shoulder strength. Fourteen healthy male subjects (age = 21.67 ± 0.86 years) without temporomandibular joint (TMJ) disorder participated in this study. Isokinetic strength was evaluated in shoulder abduction/adduction and arm external/internal rotation tests. Three randomised conditions were assessed: (1) occlusal splint (OS), which repositioned the TMJ in centric relation; (2) placebo splint (PS); and (3) no-splint (N). The strength tests were performed at a speed of 60°/sec in concentric mode. Muscle activity was measured by surface electromyography (EMG) in the main muscles engaged in the movements. Results: Significant differences in peak torque between OS and both of the other experimental conditions were found in some of the analyzed variables. Moreover, there was significantly higher muscular EMG activation in the OS condition when compared to the other conditions for some of the tested muscles. These data suggest that splints may have a positive ergogenic effect on shoulder muscular strength in healthy male subjects. Conclusion: OS may provide an advantage for healthy subjects engaged in sports whereby shoulder and arm strength are important for performance. Key messages Occlusal splints in centric relation position have an ergogenic effect, by increasing strength and muscle activation on shoulder in healthy subjects. These results could have implications for sports or other physical activities were arm and shoulder strength are important.

Development and Implementation of an Intraoral Device for Occlusal Stability during Sports Performance: A Case Report

INTRODUCTION

Sports dentistry assumes a clinical relevance, not only in the prevention of orofacial trauma by the use of mouthguards, but also with the development of intraoral devices that aim to provide greater occlusal stability, as well as a greater balance in the level of certain structures of the cranio-cervical-mandibular complex. In this way, the dentistry can have an intervention action on sports performance.

OBJECTIVES

The objective of this research was to verify the existence of a correlation between occlusal stability and an eventual balance of some facial structures during sports performance using a specially developed Occlusal Stability Sports Performance Device.

METHODOLOGY

An individualized mandibular intraoral device was manufactured and evaluated on an athlete canoeing. Infrared thermography was the complementary diagnostic method used for this purpose.

RESULTS

Greater symmetry of certain regions of interest of the cranio-cervico-mandibular complex was observed with the implementation of the Occlusal Stability Sports Performance Device. These areas were the anterior temporal muscle, the masseter muscle and the temporomandibular joint. No asymmetry decrease was found in the anterior triangle region of the neck.

CONCLUSION

The use of this type of intraoral devices may allow greater occlusal stability and consequent balance of anatomical structures constituting the cranio-cervical-mandibular complex. Infrared thermography is an effective diagnostic tool for studying the results of the intraoral device on the cranio-cervico-mandibular complex use during canoeing.

Over-the-counter performance enhancing mouthguards are unable to decrease blood lactate and improve power output during a Wingate anaerobic test (WAnT)

Background/Objective

Mouthguards are the primary mode of protection against maxillofacial injuries in contact sports, but recent research has also linked performance enhancement to this piece of equipment. The purpose of this study was to test the claims of the Under Armour ArmourBite (UAAB) mouthguard to decrease blood lactate concentration ([BL]) and increase power when compared to a generic over-the-counter mouthguard (OTC) and no mouthguard (NOMG) during an anaerobic performance test.

Methods

Seventeen recreationally active males (23.4 ± 2.7 years; 179.6 ± 7.4 cm; 83.0 ± 14.0 kg) were tested using the 30 s Wingate anaerobic test (WAnT) during three separate testing sessions.

Results

There were no differences in [BL] between any of the conditions immediately or 5 min posttest. There were also no differences in peak, relative or average power, or fatigue index during the WAnT. The UAAB mouthguard was therefore unsuccessful in improving anaerobic performance.

Conclusion

It is likely that more expensive, custom-fit dental mouthguards may be necessary for individuals to see any benefits to athletic performance.

Effects of Two Different Self-Adapted Occlusal Splints on Electromyographic and Force Parameters During Elbow Flexors Isometric Contraction

Limonta, E, Arienti, C, Rampichini, S, Venturelli, M, Cè, E, Veicsteinas, A, and Esposito, F. Effects of two different self-adapted occlusal splints on electromyographic and force parameters during elbow flexors isometric contraction. J Strength Cond Res 32(1): 230-236, 2018-The study was aimed at determining the acute effects of 2 types of occlusal splints on maximum isometric strength and fatigue of the elbow flexors muscles. The hypothesis was that splint-induced masticatory muscle repositioning might improve primary muscles recruitment by stretching masticatory muscles especially with the thicker splint. On 9 physically active volunteers with no temporomandibular joint and masticatory muscles disorders, we assessed maximum voluntary contraction (MVC) of the elbow flexors with diurnal (OSD, 1-mm thick) and sport (OSSP, 3-mm thick) splints, and without splint (control, Ctrl). On different days, participants performed 60 seconds of isometric contraction at 100% MVC (100%60s) and 80% MVC contraction until exhaustion (80%exh) under OSD, OSSP, and Ctrl in random order. Time of force output within target (t-target), force distance from target (ΔF), and force coefficient of variation were calculated. Percentage of force decay (ΔFi-Fe) was determined during 100%60s. From the electromyographic (EMG) signal, root mean square (EMG RMS) and mean frequency (EMG MF) were determined. Neuromuscular efficiency (NE) was calculated as the ratio between force and EMG RMS. MVC contraction and NE were significantly higher in OSSP and OSD than in Ctrl. During MVC, EMG MF was significantly lower in both splint conditions, and EMG RMS showed a nonstatistical tendency to lower values under both splint conditions. During 80%exh, t-target was longer in OSD and OSSP (+7.8% and +5.2%, respectively) than in Ctrl. ΔFi-Fe was lower in OSSP than in Ctrl and OSD. These results support the hypothesis of a NE improvement of the elbow flexors possibly induced by acute, splint-induced masticatory muscles repositioning.

Is there enough evidence that mouthguards do not affect athletic performance? A systematic literature review

BACKGROUND

Although there is evidence that mouthguards prevent orofacial trauma occurrence during sport practice, the influence of this device on athletic performance has not been systematically quantified.

OBJECTIVES

We aim to systematically review the literature to determine the effect of mouthguards on athletic performance and if the type of mouthguard influences this overcome.

MATERIALS AND METHODS

A comprehensive search was performed in the Systematic Electronic Databases: Pubmed, Scopus, Web of Science and the Cochrane Library from their inception to February 2017. The publications were grouped based on their outcome: (i) the use of mouthguards; or (ii) the type of mouthguards. We conducted descriptive analyses and quality assessments of the included studies.

RESULTS

The search identified 489 citations. After screening the studies, we identified 15 trials comprising a population of 312 athletes. According to the risk of bias evaluation, nine studies were considered 'high' risk of bias, and six 'low' risk of bias. Overall, custom-made mouthguards did not interfere or improve athletes' performance when compared with the control group (without mouthguard). Custom-made mouthguards showed the smallest range of changes in players' performance compared with other types of mouthguards.

CONCLUSIONS

This systematic review provides evidence for sports professionals to advocate the use of custom-made mouthguards to prevent injury, and these devices do not impair performance. The scientific evidence should be interpreted carefully because there is a great variability in outcome measures and lack of important methodological details.