Gumshields - much more complicated than you'd imagine.
You should wear a gumshield to protect your teeth for more sports than you'd imagine. We're not talking about paranoia here, we're talking common sense. I've seen gumshields worn for sports as diverse as squash and motor cycling. Squash is surprisingly dangerous - the worst injuries I've seen have often been from being hit with a squash rackets or hitting the wall face first. Motor cycling long distances can be very traumatic for teeth and a well fitting mouthguard can actually make the ride much more enjoyable. And here's why .....
Teeth really don't like to be bashed. They either break or die, or sometimes they break and THEN die. So the idea is to reduce the trauma that teeth take by spreading out the load. If you're wearing a well fitting gumshield and get hit in the mouth, the force of the blow is shared out around all your teeth instead of just one or two teeth taking the force. They're effectively splinted together by the shape of the gumshield and act as a unit. If you look at the shape of the facial bones in a human skull, there are buttresses of bone from the canine teeth up to the area alongside the nose. These are the strongest areas of your upper jaw. It's also the favoured place to put dental implants because there's plenty of bone and it's nice and strong.
Here's our practice skull (it's a real one). It shows very nicely the buttress structure of the face.
The purpose is to take that impact and share it around the teeth, not really to absorb the blow with a cushioning material, so gumshields should actually be quite thin - a couple of millimetres is enough. If they're very thick, then there are several problems.
The first one is that they're horrible to wear, so where do they end up? In your pocket. And if it's in your pocket it ain't protecting your teeth!
Secondly, breathing is difficult because of the bulk and speech becomes impossible. If you're playing a team sport you need to communicate - so what do you do? Put it in your pocket!
In addition, a very thick gumshield stretches the upper lip so that if you get a direct hit, you're more likely to tear your lip apart. A 4mm gumshield won't offer significantly better protection than a 2mm gumshield and it's less likely to be worn. We can buy in gumshields that are dual layer 4mm thick, soft inside, hard outside - I don't see the point!
So if the principle is to splint the teeth together, what about "boil in the bag" gumshields? To be blunt, they're not very good. They don't splint the teeth together and they're uncomfortable to wear - where do they end up? In your pocket.
BUT there is one special case where this kind of gumshield is ideal - boxing!
A boxing glove is basically a four inch by four inch square pad - sixteen square inches in area. So however many pounds PER SQUARE INCH were delivered down the arm into a punch has been divided by sixteen. Combine this with the cushion effect of the glove and the force has been reduced significantly to each tooth. I can't recall ever seeing a boxer who'd had his teeth bashed out. What boxers ARE susceptible to is concussion. Particularly from the uppercut punch. It comes from below and smacks the teeth together such that the energy is transmitted straight up into the skull. Think of the times you've seen a boxer's gumshield fly out after a punch.
Gutta percha used to be used to make boxer's gumshields - it's the same stuff that's in the middle of golf balls and also the same material we root fill teeth with. The fit is really poor so the only way the boxer can keep it in is to keep the teeth clenched together. If they're permanently clenched they can't be suddenly driven into each other by an uppercut punch. And that's why a DIY gumshield is ironically OK for boxers!
So what's the conclusion?
Get a vacuum formed vinyl gumshield. Keep it cool and in a decent box - if it's left somewhere hot or tumble dried in your shorts pocket, the material will try to return to the original shape, which was a flat sheet - it'll distort and be ruined.
This is a blank for a gumshield. It's warmed up to make it soft and then vacuum formed over a model of the teeth. If you warm it up again, it'll relax and try to flatten out again.
Gumshields are more comfortable to wear if they have bite indents in them. Bite indents are basically dimples where the bottom teeth can sit comfortably. We can get the laboratory to do them (but they charge for them) or when the gumshield is fitted the biting surface can be carefully warmed and then you can bite on it to create them yourself.
Custom made gumshields NEED to be fitted. When they return from the laboratory, they're often "tight" somewhere and need to be trimmed to make them comfortable. It's amazing how a small tweak can be the difference between a gumshield in your mouth and one in your pocket. Have the mouthguard named and get a bright colour. It never ceases to amaze me how many get lost - at least give yourself a sporting chance of it being found and traced back to you! Keep it in a proper mouthguard box, rinse it after each use and if it is too "dry" to wear, a very small amount of Vaseline rubbed on it works wonders.
© Hesslewood Lodge Dental Practice, 16 November 2015