Page 142 - JSOM Summer 2020

MG generally separates the upper and lower dentition and at In a 1979 report of survey results of dental injuries across the
least a portion of the teeth from the adjacent soft tissue. MGs 16 US Army posts, MGs were found not to have been used in
are generally classified into three types: stock, boil-and-bite, greater than 96% of sports-related “accidental dentofacial”
and custom. Stock MGs are those sold over the counter and injury cases. The authors advocated for an institutional MG
1
not shaped to an individual’s dentition. They are essentially requirement for the US Army. In 1994, the US Army Center for
U-shaped devices with a central channel for the teeth and Health Promotion and Preventive Medicine (now the US Army
ridges on both sides held in place by clenching the teeth; they Public Health Command), in partnership with the US Army
are generally not recommended by dentists. The boil-and-bite Dental Command, initiated the “Put More Bite Into Health
MG consists of thermoplastic material. The device is immersed Promotion” campaign. One part of this campaign emphasized
in hot water to soften it, placed in the mouth, and then shaped MG education and fabrication. Despite this, in fiscal year
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to the dentition with finger, tongue, and bite manipulation. 1998, it was reported that only 2,587 MGs were fabricated
Custom MGs are produced in dental laboratories from im- in the entire US Army Dental Care System. Since the US
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pressions of the mouth and the fit is generally checked by a Army Soldier population was 479,299 in 1998 (unpublished
dentist. 21–23 Table 1 provides more information on the various data from the Defense Medical Epidemiology Database), this
types of MGs. suggested that only 0.54% of Soldiers had Army-fabricated
MGs.
MGs are hypothesized to reduce the likelihood of orofacial
injuries through several mechanisms. First, during direct, A study conducted in 2000–2003 during basic training at
30
forceful, horizontal impact to the mouth, MGs may prevent Fort Leonard Wood, Missouri, found that when boil-and-bite
fracture or dislocation of the teeth by separating the mandib- MGs were required for more training activities, incidence of
ular (inferior) and maxillary (superior) teeth and absorbing or orofacial injuries was reduced. Shortly thereafter, the Army
redistributing the impact forces over a broader area. Second, Training and Doctrine Command (TRADOC) issued Change
during traumatic jaw closures (vertical impacts), MGs may 2 to TRADOC Regulation 350-6 requiring the issue and fit-
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protect against mandibular bone fractures by stabilizing the ting of MGs at basic training inprocessing. This also required
mandible and absorbing the impact force. Third, MGs may the use of MGs for specific training activities, including pugil
reduce laceration and bruising of soft tissue by separating the stick activities, unarmed combat, rifle/bayonet training, and
teeth from the soft tissue, thus inserting a protective layer be- confidence/obstacle courses. The current TRADOC Regula-
tween hard and soft tissue. 24–26 tion 350-6 incorporates this requirement.
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This is the first of a two part series on MGs. Part 1 covers the Currently, Army Regulation 600-63 requires unit command-
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history of MG use in the US military and among athletes; part ers to coordinate with medical and safety personnel to receive
2 will discuss the effectiveness of MGs for the prevention of subject matter expert advice on appropriate MG use for Sol-
orofacial injuries. diers. The regulation directs commanders to enforce MG use
during military training and sports activities that could involve
injury to the face or mouth. Most military dental clinics will
Mouthguards in the US Military
construct custom MGs for Servicemembers on request, and
In 1975, CPT Leonard Barber of the US Army Dental Corps boil-and-bite MGs are often available.
was the first to advocate MG use for military personnel, espe-
cially those involved in contact sports. CPT Barber provided Mouthguard Use in Sports
27
details on how to construct a latex rubber MG that was based
on a model developed by Dr Marvin Chapin at the University The history of MG use in sports has been fairly well docu-
of North Carolina School of Dentistry. This was a custom mented in the medical literature. The first uses were in boxing
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MG in that it involved applying coats of latex rubber over and football, and more recently, MG use has been mandated
dental impressions of the Soldier. for high school and college ice hockey, field hockey, and

TABLE 1 Description of Types of Mouthguards, Their Protection Level, Comfort, Fit, and Cost 68
Type Description Level of Protection Comfort and Fit Cost
• Used as bought, with no • Offers least protection of • May inhibit breathing or • Inexpensive
preparation three types of mouthguards speaking when worn • Widely available in
Stock • Must be held in place by • Mouth must be closed to • Limited adaptability sporting goods stores
clinching teeth during use provide protection (falls • Sizes are limited (typically
out if mouth is open) small to large)
• Wearer softens • Not as good as custom, but • May inhibit speaking when • Inexpensive
mouthguard in hot water more protection than stock worn • Widely available in
and inserts into mouth mouthguards • May not stay in place in sporting goods stores
Boil-and-Bite after cooling • May lose thickness and mouth
• Tray is molded and shaped cushioning throughout use
to wearer’s bite using
fingers, lips, and tongue
• Impressions of individual’s • Offers best level of • Provides highest level of • Expensive
mouth are taken by dentist protection comfort and fit of the three • Obtained through dentist’s
Custom • Mouthguard is fashioned • Made from high-quality types office
from dental impression to materials to ensure high
custom fit the individual level of protection

140 | JSOM Volume 20, Edition 2 / Summer 2020