The role of mouthguards

in preventing and reducing

sports-related trauma
James IJ Green
Prim Dent J. 2017;6(2):27-34

Ta b l e 1
ABSTRACT
Sports where
A mouthguard, also known as a gumshield, mouth protector or sports guard mouthguard use
is an appliance that covers the teeth and surrounding mucosa with the aim is recommended7
of preventing or reducing trauma to the teeth, gingival tissue, lips and jaws.
The device is usually worn on the maxillary arch and works by separating the • Acrobatics
maxillary and mandibular dentition, protecting the teeth from the surrounding
soft tissue, absorbing or redistributing shock and/or stabilising the mandible • American football
during traumatic jaw closure. They may also play a role in preventing and • Baseball/softball
reducing concussion by absorbing impact forces that would otherwise be • Basketball
transmitted through the base of the skull to the brain, although the evidence • Bicycling
for this is less conclusive.
• Boxing
A mouthguard will usually fall into one of three categories: stock mouthguards • Equestrian events
(which are made ready to use and are believed to give the least protection), • Extreme sports
the mouth-formed or ‘boil and bite’ type (which are heated in hot water, placed • Field events
in the mouth and moulded to the teeth) and custom-made mouthguards (which
• Field hockey
are usually made on a stone model of the maxillary teeth and surrounding tissue
and are thought to give the most protection). • Football/soccer
• Gymnastics
These devices can be made from various materials but ethylene-vinyl acetate • Handball
is by far the most popular material, probably because of the ease with which
• Ice hockey
it can be used for the production of custom-made mouthguards.
• Inline skating
This paper gives a review of the role of mouthguards in preventing and reducing • Lacrosse
sports-related trauma and examines the materials that are used to fabricate them. • Martial arts
• Racquetball
• Rugby

KEY WORDS
Athletic Injuries, Brain Concussion,
Facial Injuries, Mouth Guards, Mouth
Protectors, Protective Devices, Tooth
Avulsion, Tooth Fractures, Tooth
Injuries, Tooth Loss
AUTHOR
James IJ Green
Maxillofacial and Dental Laboratory
Manager, Great Ormond Street Hospital
for Children, London.
A
mouthguard, also known as a • Shot putting
gumshield, mouth protector or • Skateboarding
sports guard, has been defined
• Skiing
as “a resilient device or appliance placed
inside the mouth (or inside and outside), • Skydiving
to reduce mouth injuries, particularly • Squash
to teeth and surrounding structures.”1 • Surfing
Mouthguards are typically made for the
• Volleyball
maxillary arch, but mandibular2 and
• Water polo
bimaxillary3,4 mouthguards have also
been described. • Weightlifting
• Wrestling
In a study of 409 athletes, the sports
with the highest injury prevalence were
reported as wrestling (83.3%), boxing Academy of Sports Dentistry (IASD)
(73.7%), basketball (70.6%) and karate recommends that mouthguards should be
(60%).5 The British Dental Association used in 29 sports and exercise activities
(BDA) recommends the use of a well- (see Table 1):7 They may also be used
made mouthguard for anyone engaged by those participating in rollerblading,
in contact sports6 and the International rollerskating, tennis and water sports.8

Vol. 6 No. 2 Summer 2017 27

 The role of mouthguards in preventing
and reducing sports-related trauma

Concussion
TA b l e 2
Concussion, also known as mild traumatic
HOW A MOUTHGUARD CAN PREVENT OR REDUCE brain injury or minor head trauma,
Sports-related TRAUMA is the most common type of traumatic
brain injury and can be defined as a
“complex pathophysiological process
Trauma Type Mechanism affecting the brain, induced by traumatic
Tooth dislocation Separates the upper and lower teeth and absorbs biomechanical forces”.31 Concussion is
Tooth fracture or redistributes shock during impact one of the most common and potentially
dangerous types of trauma sustained
Bruising of soft tissue Separates the teeth from the soft tissue and cushioning
in collision sports.32-34 The evidence on
Laceration of soft tissue and distributing the force of an impact
whether mouthguard use can lower the
Mandibular fracture Absorbs or redistributes shock and/or stabilises the risk of concussion is not conclusive.29, 35-37
mandible during traumatic jaw closure
One study reported that mouthguard
Concussion due to a Positions the jaw to absorb impact forces that would use can result in an approximate 50%
direct blow to the jaw otherwise be transmitted through the base of the skull reduction in bone deformation and
to the brain intracranial pressure12 while another
found that it can significantly reduce
acceleration of the head and mandibular
Mouthguard efficiency Australian Rules football players which distortion.38 Clenching or increased
Mouthguard use can prevent or reduce reported that custom-made mouthguards mastication muscle activity due to wearing
the prospect of sports-related trauma in had a significant protective effect.25 a mouthguard may enhance cervical
numerous ways (see Table 2). muscle activity, thus decreasing head
A cross-sectional survey of 1,020 high acceleration and reducing the risk or
Orofacial trauma school basketball players reported severity of concussion.39,40
According to one investigation, a third an approximate seven-fold increase
of all dental trauma can be attributed to in orofacial injuries among those not Three cross-sectional studies suggest that
sporting accidents,9 and a study of 178 wearing mouthguards19 and a similar mouthguards have a role in concussion
school-age rugby players reported head, study of 2,470 high school students prevention.21,41,42 Dorney suggested that
orofacial and dental injuries as common, recommended that mouth guards a custom-fitted, triple-laminated, pressure
with the latter being the most prevalent should be mandatory in baseball and moulded mouthguard had a protective
(26%).10 A cross-sectional survey basketball.21 A prospective cohort study effect against repeat concussion for a
reported dental trauma in 49.6% of of 50 US college basketball teams rugby player over one season.43 One
409 participants of the XV Pan American reported that using a custom-made case series revealed no post-concussion
Games. This study reported enamel mouthguard resulted in significantly differences in neurocognitive deficits
fracture as the most common injury lower rates of dental injuries and dentist between those who used mouthguards
(39.8%), with root fracture the least referrals, but did not significantly affect and those who did not,44 while another
common (0.4%); the teeth most affected oral soft tissue trauma rates.23 Another that studied a team of university
were the maxillary central incisors prospective cohort study, this time looking football players who wore custom-made
(n = 113), followed by the mandibular at 304 New Zealand rugby players, mouthguards reported that no concussions
central incisors (n = 19).5 reported that mouthguard use appeared were sustained during one season.45
to lower the risk of orofacial injury.26 Benson et al suggested that mouthguard
The use of mouthguards in preventing use had a protective effect on concussion
and reducing orofacial trauma is well While these investigations conflict with severity (measured by time loss from
supported in the literature.3,11-29 They can a prospective cohort study of 321 unrestricted participation).46 A study
decrease the severity and prevalence of university rugby players that found no of 1,033 professional ice hockey
jaw fractures12,17 and reduce injuries to association between mouthguard use or players reported that the risk of
the teeth and lips.11,13,14,18 Studies that non-use and sustained trauma, especially concussion was not significantly
have supported the use of mouthguards with regards to oral injuries,30 meta- different between players that wore
include a study of 754 high school analyses of studies involving mouthguards mouthguards and those that did not,
American football players which reported that the incidence of orofacial but symptom severity was significantly
advocated the use of mouthguards injuries is 1.6-1.9 times higher for athletes greater for those not wearing
in preventing orofacial trauma18 and who do not use mouthguards compared mouthguards compared with those
a randomised controlled trial of 301 with those who do.29 who did.47

28 p r i m a r y d e n ta l j o u r n a l
Numerous other studies report no
significant relationship between
mouthguard use and concussion
rates.23,26,30,48
Disadvantages of
mouthguard use
Speech impairment is probably
the main complaint of mouthguard
users, although this is less likely to
be an issue with the custom-made
type.49, 50 Other disadvantages include
possible respiratory difficulties and
general discomfort.51 Temporomandibular
joint anterior disk displacement
can be worsened by clenching a
mouthguard or wearing one that
is too thick.52
A mouthguard can provide additional
retentive plaque surfaces and impede
the protective effect of saliva53 and
wearing one after consuming a sports
drink could increase the risk of caries.54
Wearing a mouthguard can also
increase the number and intensity
of oral mucosal injuries, which may
lead to localised soft tissue reactions
such as erythema, hyperkeratosis and
ulceration.55 A mouthguard should be
cleaned before and after use, changed
regularly and replaced if it becomes
sharp or jagged or if the user develops
an irritation in the mouth.
Mouthguard materials to withstand a pulling force) give an
The protective ability of a mouthguard indication of mouthguard durability, since
is determined both by its design and the it may be bitten and chewed by the user.
materials used. Mouthguard material Water absorbency is another important
should have moderate shock absorption factor, since a mouthguard with high
ability (reduction in force or impact water absorbency is more likely to absorb
energy transmitted to the underlying saliva and bacteria.57 The main materials
surface) to reduce forces on the tissues that have been used for the fabrication of
and moderate hardness (resistance to mouthguards are ethylene-vinyl acetate
permanent shape change with a force acrylic resin, latex rubber, polyurethane,
applied) to redistribute forces over a polyvinylchloride and silicon rubber.
larger area.22,56-58 Tear strength (ability to
resist tearing) and tensile strength (ability
Ethylene-vinyl acetate
Ethylene-vinyl acetate (EVA),
the copolymer of ethylene and
figure 1 vinyl acetate (see Figure 1), is
the most popular mouthguard
The structural formula of
material today. This is
ethylene-vinyl acetate (EVA) probably due to the ease with
which it can be utilised for the
fabrication of custom-made
3 H C
mouthguards. This material is
also used for the fabrication
of appliances such as bruxism
O C
splints59 and has been subject
to much more research. The
H H H O
physical properties of the EVA
copolymer can be altered by
changing the ratio of ethylene
C C C C
to vinyl acetate. Elasticity
is vital and determines the
H H n H H
effectiveness of the mouthguard
m
material through the absorption
of impact energy as it transfers

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rugby player with malalignment.
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Vol. 6 No. 2 Summer 2017 29

 The role of mouthguards in preventing
and reducing sports-related trauma

to the underlying tissues. If the elastic Latex rubber

limit of the copolymer is exceeded, the
material will be permanently deformed or
ruptured. A higher ratio of vinyl acetate
gives greater flexibility, softness, and
toughness,60 increased shock absorption
ability and decreased water absorbency
but reduces tear strength and hardness.61
A vinyl acetate content of 18% appears to
be the most suitable.61
This material has lower hardness, tear
strength, tensile strength and shock
absorption than EVA.57,58
Polyurethane
The hardness and shock absorption of
polyurethane is similar to that of EVA
with higher tear strength and tensile
strength.57,58

Acrylic resin Polyvinylchloride

When compared with EVA, acrylic
resin has higher shock absorption and
water absorbency, comparable tensile
strength but lower hardness and tear
strength.57,58,62
TA b l e 3
The hardness, tensile strength and water
absorbency of polyvinylchloride (PVC) is
comparable to EVA and has higher shock
absorption,57,58,62 but is not recommended
for mouthguard use due to presumed links
between the phthalates used in PVC and
certain medical conditions.63

STANDARDS FOR MOUTHGUARDS USED Silicon rubber

IN CONTACT SPORTS66 Silicon rubber has higher shock
absorption (depending on the amount
of silicon oils and/or filler present in
1 Mouthguard should enclose the maxillary teeth to the distal surface of the the material) and lower hardness, tear
second molars strength and tensile strength when
2 Thickness should be 3mm on the labial aspects, 2mm on the occlusal aspect compared with EVA.64, 65
and 1mm on the palatal aspect
3 Labial flange should extend to within 2mm of the vestibular reflection Types
Mouthguards generally fall into three
4 Palatal flange should extend about 10mm beyond the gingival margin categories: stock mouthguards, mouth-
5 Edge of the labial flange should be round in cross section and the palatal formed mouthguards and custom-
edge should be tapered made mouthguards. Five standards for
mouthguards used in contact sports66

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mouthguards to reduce the
incidence and severity of sports-
related oral injuries. J Am Dent
Assoc 2006;137(12):1712-1720.
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29 Knapik JJ, Marshall SW, Lee RB,
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C. Injuries sustained in rugby
by wearers and nonwearers of
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31 Aubry M, Cantu R, Dvorak J,
Graf-Baumann T, Johnston K, Kelly
J, Lovell M, McCrory P, Meeuwisse
W, Schamasch P. Summary
and agreement statement of the
First International Conference
on Concussion in Sport, Vienna
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the improvement of safety and
health of athletes who may suffer
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and facial injuries in ice hockey:
the effect of protective equipment.
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34 Ragnarsson KT, Clarke WR, Daling
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Wexler BE, Yawn BP, Banja J,

30 p r i m a r y d e n ta l j o u r n a l
 TA b l e 4
413 university football players reported
that this type of mouthguard was not
A SCALE OF PROTECTION FOR MOUTHGUARDS67 large enough to completely cover all the
posterior teeth in 85% of the cohort.69
Grade Feature
Custom-made mouthguards
0 No mouthguard Custom-made mouthguards are usually
1 Stock mouthguard made from EVA and are generally
thought to offer the best protection,70
2 Boil and bite mouthguard with a greater cushioning effect and
3 Old custom made mouthguard, more than 5 years old fewer fractured teeth compared with a
mouth formed type made from a similar
4 Old custom made mouthguard, 2 to 5 years old material71-73 but the degree of protection
they offer can vary considerably.74, 75
5 Custom made mouthguard of insufficient thickness
6 Brand new custom made mouthguard Wearing a custom-made mouthguard
should not affect ventilation or
7 Custom made mouthguard using improved materials
oxygen uptake76 and may even
8 Custom made mouthguard using improved design and materials improve performance.77 Custom-made
mouthguards are less likely to impair
9 Passed effective instrumented test to evaluate mouthguards speech,49,50 more likely to prevent mild
10 Ultimate aim: grades 8 and 9 combined traumatic brain injury/concussion injuries
when compared with over-the-counter
types78 and are recommended by most
(see Table 3) and a scale of protection athlete a false sense of security.68 consultant orthodontists.79
for mouthguards67 (see Table 4) have
been proposed. Mouth-formed mouthguards The fabrication process begins by
Also known as a ‘boil and bite’ casting an impression in a dental stone
Stock mouthguards mouthguard, a mouth-formed mouthguard (see Figure 4). After the resulting model
Stock mouthguards are made ready- consists of a thermoplastic rim (see is soaked in water for ten minutes and
to-use, come in different sizes and are Figure 2), which is heated in hot water, a layer of sodium alginate separator
usually made from EVA or polyurethane. placed in the mouth and moulded to the has been applied to prevent the heated
Stock mouthguards are thought to offer teeth and surrounding tissue by biting mouthguard material adhering to the
the least protection and may give an and sucking (see Figure 3). A study of model, the mouthguard can be formed.

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Vol. 6 No. 2 Summer 2017 31

 The role of mouthguards in preventing
and reducing sports-related trauma

EVA mouthguard material is available
in various colours and thicknesses
and can be thermoformed in multiple
layers to achieve the desired thickness.
Shock absorption ability is improved
as the thickness of the material is
increased22,60,71,72,80-83 but this may
be negligible beyond a thickness of
4mm.83 According to one study, sufficient
thickness can be obtained using an
EVA sheet with a thickness of >3.8mm
at the buccal surface of the first molar
and >3mm at the occlusal surface of the
first molar, and >5.6 mm at the central
incisor.84 A mouthguard formed from
EVA sheets with a total thickness of 6mm
should satisfy these recommendations.
One way to fabricate a mouthguard of
this thickness is to prepare a 2mm layer
that covers the teeth, followed by a 4mm
layer that encompasses the 2mm layer
and also covers the desired proportion
of the soft tissue.
Variation in the fabrication process can
significantly affect the thickness of the
finished mouthguard,85 which will usually
be considerably thinner than the original
material74,86 with a loss of thickness of
approximately 50% in critical areas and
maximum thinning likely to occur at the
incisal edges of the central incisors.87
The finished mouthguard is likely to be
considerably thinner on inclined surfaces
than on flat surfaces.88 The model
should be placed in the centre of the
thermoforming machine platen or model
cup as the material tends to change
shape concentrically and almost uniformly
expand from the centre during the heating

Figure 2: A mouth-formed or “boil and bite” mouthguard Figure 3: A mouth-formed or “boil and bite” mouthguard after
heating in hot water and moulded to the teeth and surrounding
tissue by biting and sucking

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60 Park JB, Shaull KL, Overton B,
Donly KJ. Improving mouthguards.
J Prosthet Den 1994;72: (4):
373-380.
61 Bishop BM, Davies EH, von
Fraunhofer JA. Materials for
mouth protectors. J Prosthet Den
1985;53(2):256-261.
62 Loehman RE, Chan MS, Going RE.
Optimization of materials for a user-
formed mouthguard. Ann Biomed
Eng 1975;3(2):199-208.
63 Fontelles JB, Clarke C. Directive
2005/84/EC of the European
Parliament and of the Council of
14 December 2005 amending for
the 22nd time Council Directive
76/769/EEC on the approximation
of the laws, regulations and
administrative provisions of
the Member States relating to
restrictions on the marketing and
use of certain dangerous substances
and preparations (phthalates in toys
and childcare articles). Off J Eur
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64 Auroy P, Duchatelard P, Zmantar
NE, Hennequin M. Hardness and
shock absorption of silicon rubber
for mouth guards. J Prosthet Dent
1996;75(4):463-471.
65 Jagger R, Milward P, Waters M.
Properties of an experimental
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66 Scott J, Burke FJ, Watts DC. A review
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mouthguards in contact team sports.
Br Dent J 1994;176(8):310-314.

32 p r i m a r y d e n ta l j o u r n a l

Figure 4: A dental stone
model of the upper teeth
and surrounding tissue
process89 and thickness will decrease
as the distance from the centre of the
mouthguard blank increases.88 Embedding
the model in steel granules in the model
cup at an inclination of approximately 45°
(see Figure 5), should increase the mean
anterior material thickness by 75%.90
Thickness after thermoforming and
hardness is also dependent on the
manufacturer and the colour of the EVA
sheet.91 More force is required to remove
a dark-coloured mouthguard than a clear
one. A mouthguard produced from a
dark coloured material, such as black,
blue or green, may adapt better to the
Figure 5: The model is embedded
into steel granules in the model
cup with the occlusal plane at an
inclination of approximately 45°
model, and thus produce a more firmly
fitting mouthguard.92
Fabrication begins by placing a 2mm
sheet of EVA in the thermoforming
machine and heating it until its centre
is displaced by 1593 or 20mm94 from
the baseline, and a vacuum or air
pressure is applied that closely adapts
the soft material to the model.
Once cooled, the 2mm layer is gently
removed from the model, trimmed along
the gingival margins and replaced
on the model (see Figure 6), which is
returned to the thermoforming machine
as before (see Figure 7) and a 4mm
sheet is thermoformed over it. After this
top layer has cooled the material is
eased off the model, the majority of the
excess material is removed with scissors
and the peripheries of the mouthguard
are rounded and trimmed away from
the labial and buccal frena (see Figure
8). Finally, grinding the occlusal surface
of the appliance to increase mandibular
tooth contacts may lead to greater
protection, comfort and compliance.95
Intermediate layers and inclusion
of other materials within custom-made
mouthguards
Researchers have looked at the effect
of including other materials within
custom-made mouthguards, but these
are rarely used in practice. A double
layer of material (2mm and 3mm thick)
separated by sponge42 and a type
of visco-elastic polyurethane called
sorbathane laminated between sheets
of EVA have been found to improve
shock absorbency.82
Studies have reported that shock
absorption is not affected by including
a harder EVA sheet between two softer
EVA sheets,96 including a hard PVC layer
between two sheets of EVA,73 or including
an intermediate layer of titanium in the
anterior segment.97 However results

67 Patrick DG, van Noort R, Found
MS. Scale of protection and
the various types of sports
mouthguard. Br J Sports Med.
2005;39(5):278-281.
68 Widmer RP. The normal
development of teeth. Aust Fam
Physician 1992;21(9):1251-1261.
69 Kuebker WA, Morrow RM, Cohen
PA. Do mouth-formed mouth
guards meet the NCAA rules? Phys
Sportsmed 1986;14(6):69-74.
70 DeYoung AK, Robinson E, Godwin
WC. Comparing comfort and
wearability: custom-made vs self-
adapted mouthguards. J Am Dent
Assoc 1994;125(8):1112-1117.
71 Greasley A, Imlach G, Karet B.
Application of a standard test
to the in vitro performance of
mouthguards. Br J Sports Med
1998;32(1):17-19.
72 Hoffmann J, Alfter G, Rudolph NK,
Göz G. Experimental comparative
study of various mouthguards.
Endod Den Traumatol
1999;15(4):157-163.
73 Bemelmanns P, Pfeiffer P.Shock
absorption capacities of
mouthguards in different types
and thicknesses. Int J Sports Med
2001;22(2):149-153.
74 Guevara PH, Hondrum SO, Reichl
RB. A comparison of commercially
available mouthguards and a
custom mouthguard. Gen Dent
2001;49(4):402-406.
75 Warnet L, Greasley A. Transient
forces generated by projectiles
on variable quality mouthguards
monitored by instrumented
impact testing. Br J Sports Med
2001;35(4):257-262.
76 Gebauer DP, Williamson RA,
Wallman KE, Dawson BT. The
effect of mouthguard design on
respiratory function in athletes.
Clin J Sport Med 2011;21(2):
95-100.
77 Piero M, Simone U, Jonathan M,
Maria S, Giulio G, Francesco
T, Gabriella C, Laura A, Eva B,
Gianni M, Francesco C, Giovanni
G. Influence of a custom-made
maxillary mouthguard on gas
exchange parameters during
incremental exercise in amateur
road cyclists. J Strength Cond Res
2015;29(3):672-677.
78 Winters J, DeMont R. Role of
mouthguards in reducing mild
traumatic brain injury/concussion
incidence in high school football
athletes. Gen Dent 2014;62(3):
34-38.
79 Bussell MA, Barreto LS. The
recommendation and provision
of mouthguards: a survey of
consultant orthodontists in the UK.
J Orthod 2014;41(2):141-146.
80 Oikarinen KS, Salonen MAM,
Korhonen J. Comparison of the
guarding capacities of mouth
protectors. Endod Den Traumatol
1993;9(3):115-119.
81 Westerman B, Stringfellow PM,
Eccleston JA. Forces transmitted
through EVA mouthguard materials
of different types and thickness.
Aust Dent J 1995;40(6):389-391.
82 Bulsara YR, Matthew IR. Forces
transmitted through a laminated
mouthguard material with a
sorbothane insert. Endod Den
Traumatol 1998;14(1):45-47.
83 Westerman B, Stringfellow PM,
Eccleston JA. EVA mouthguards:
how thick should they be? Dent
Traumatol 2002;18(1):24-27.
84 Mizuhashi F, Koide K, Takahashi
M. Assessing change in
mouthguard thickness according
to the thickness of the original
mouthguard sheet. Dent Traumatol
2014 Dec;30(6):468-471.
85 Farrington T, Coward T, Onambele-

Vol. 6 No. 2 Summer 2017 33

 The role of mouthguards in preventing
and reducing sports-related trauma

of studies examining the inclusion of

foil or a stainless steel arch have been
equivocal.42,73,98

The number of teeth fractured on impact

is similar when comparing a 5mm sheet
of EVA to a 3mm thick sheet of styrene
butadiene, a harder and stiffer material,
over a 2mm sheet of EVA.71

The inclusion of systematic air cells in

EVA increases shock absorbency81,99
but using a foam material to introduce
randomly spaced air cells does not.100
Figure 6: The 2mm layer of EVA is Figure 7: The model with the 2mm layer
Conclusion removed from the model, trimmed of EVA embedded into steel granules in
Mouthguard use is advised for those along the gingival margins and the model cup prior to thermoforming
participating in sports and exercise returned to the model the 4mm layer
activities where there is a risk of
orofacial trauma. Mouthguards have
been subject to much research; the
vast majority of which has come to the
conclusion that they have a vital role in
protecting the teeth, gingival tissue, lips
and jaws. They could also play a part
in preventing and reducing concussion,
although there is currently insufficient
evidence to confirm that this is the case.
The custom-made type is widely seen
as superior and the evidence regarding
fabrication techniques outlined in this
paper should be taken into account in
order to ensure that the device offers
the best protection possible. Figure 8: The finished custom-made mouthguard

Pearson G, Taylor RL, Earl P,
Winwood K. The effect of model
inclination during fabrication on
mouthguard calliper-measured and
CT scan-assessed thickness. Dent
Traumatol. 2016;32(3):192-200.
86 Waked EJ, Caputo AA. Thickness
and stiffness characteristics of
custom-made mouthguard
material. Quintessence Int
2005;36(6):462-466.
87 Tunc ES, Ozdemir TE, Arici S.
Postfabrication thickness of single-
and double-layered pressure-
formed mouthguards. Dent
Traumatol 2013;29(5):378-382.
88 Kojima I, Takeda T, Nakajima
K, Narimatsu K, Konno M,
Ozawa T, Ishigami K. Thinning
factors influence on custom-made
mouthguards thermoforming. Dent
Traumatol 2015;31(2):103-112.
89 Takahashi M, Koide K, Satoh
Y, Iwasaki S. Shape change
in mouthguard sheets during
thermoforming. Dent Traumatol
2016;32(5):379-384.
90 Farrington T, Coward T,
Onambele-Pearson G, Taylor
RL, Earl P, Winwood K. An
investigation into the relationship
between thickness variations
and manufacturing techniques
of mouthguards. Dent Traumatol
2016;32(1):14-21.
91 Takahashi M, Koide K, Mizuhashi
F. Influence of color difference of
mouthguard sheet on thickness
after forming. J Prosthodont Res
2012;56(3):194-203.
92 Del Rossi G, Lisman P, Signorile J.
Fabricating a better mouthguard.
Part II: the effect of color on
adaptation and fit. Dent Traumatol.
2008;24(2):197-200.
93 Takahashi M, Koide K, Suzuki
H, Iwasaki S.Optimal heating
condition of ethylene-vinyl acetate
co-polymer mouthguard sheet in
vacuum-pressure formation. Dent
Traumatol 2016;32(4):311-315.
94 Mizuhashi F, Koide K, Takahashi
M. Difference in pressure-formed
mouthguard thickness according
to heating condition. Dent
Traumatol 2016;32(1):22-26.
95 Geary JL, Clifford TJ, Kinirons MJ.
Occlusal accommodation and
mouthguards for prevention of
orofacial trauma. Oral Health Prev
Dent 2009;7(1):55-59.
96 Westerman B, Stringfellow PM,
Eccleston JA. The effect on energy
absorption of hard inserts in
laminated EVA mouthguards. Aust
Dent J 2000;45(1):21-23.
97 Kataoka SH, Setzer FC, Gondim E
Jr, Caldeira CL. Impact absorption
and force dissipation of protective
mouth guards with or without
titanium reinforcement. J Am Dent
Assoc. 2014;145(9):956-959.
98 Watermeyer GJ, Thomas CJ,
Jooste CH. The protective potential
of mouthguards. J Dent Assoc
S Afr. 1985;40(4):173-177.
99 Westerman B, Stringfellow PM,
Eccleston JA. Beneficial effects of
air inclusions on the performance
of ethylene vinyl acetate (EVA)
mouthguard material. Br J Sports
Med 2002;36(1):51-53.
100 Westerman B, Stringfellow PM,
Eccleston JA, Harbrow DJ. Effect
of ethylene vinyl acetate (EVA)
closed cell foam on transmitted
forces in mouthguard material.
Br J Sports Med. 2002;36(3):
205-208.

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