Running Head: MOUTHGUARDS

Professional Position Paper: Custom Mouthguards VS Boil and Bite

Alina Atilano Ayala
Natalie Fitzgerald
Nicola Baldwin
July 29, 2016
Durham College
Carolynn Maynard. RDH

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The dental hygienist plays an important role educating clients who are involved in sports
activities. Mouthguards are a type of oral splint fabricated to protect the oral cavity from injuries
which can often be irreversible and may lead to functional, aesthetic and psychological problems
(Duarte-Pereira et al., 2007). Mouthguards protect the dentition from injury, specifically the
incisors from frontal blows and maxillary teeth from the mandibular teeth should a blow to the
jaw occur. The mouthguard also protects the soft tissues, lips, cheeks and tongue during sports
activities (Gawlak, Mierzwinska-Nastalska,Manka-Malara & Kaminski, 2013). There are
different types of mouthguards available, our focus being custom made and boil and bite
mouthguards. We believe that custom made mouthguards offer superior protection and comfort
compared to the boil and bite type and it is important to be knowledgeable when our educating
clients.
Boil and bite mouthguards can be purchased over the counter and require the user to self
adapt at home. This type of mouthguard is not made from an impression of the users teeth,
resulting in a less comfortable and accurate fit. Athletes often chew on the mouthguard, due to
the poor fit which deteriorates the occlusal thickness, resulting in reduced protection and comfort
(Winters & Demont, 2014). The mouthguard is made from thermoplastic material which is self
adapted using the tongue, fingers and biting pressure after immersing in hot water. This type of
mouthguard seems to be the most popular and is used by more than 90% of sports participants
(Tuna & Ozel, 2014). We feel that the athlete is less likely to wear the mouthguard when fit and
comfort are an issue, increasing the risk of orofacial and dental injuries.
Custom made mouthguards are made by a dental professional by taking upper and lower
alginate impressions and a wax bite registration. Stone models are made and the mouthguard is
fabricated in a dental lab (Gawlak, et al, 2016). A vacuum former uses pressure to mold the

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multiple layers of EVA material resulting in a custom fit. This style of mouthguard is moderately
expensive compared to the boil and bite style and also requires an in office visit, which may be
deciding factors for the client when selecting a mouthguard. It is our responsibility to present the
client with the education to assist them in making the best choice when protecting their mouths
during sports activities.
Although there is massive evidence about how beneficial custom mouthguards are, there
are also some setbacks that make them less effective. In one study, it was found that custom
made mouthguards induced the gag reflex more often than any other mouthguard tested (Gawlak,
et al, 2016). An impression is also required for the fabrication of a custom mouthguard, which
may also induce the gag reflex.
Another study found that custom made mouthguards had no advantage over boil and bite
mouthguards in protection from cerebral concussion (Tuna & Ozel, et al, 2014). In addition to
this, custom made mouthguards become loose over time. They thin and perforate as they are
worn down during use. Because of this, there is no way to ensure their proper thickness after
prolonged use and they will need to be replaced as wear occurs (Pressure laminated
mouthguards, 2011). This also results in a great expense for the client.
Boil and bite mouthguards are also more easily accessible, being available at a wide
variety of super stores. They also offer a cheaper alternative to custom made mouthguards. They
are cheaper to replace at approximately $20-30 (DenTek Maximum Protection Dental Guard Kit,
n.d.), making them more financially possible. For a client with financial issues, purchasing a boil
and bite mouthguard may be all they can afford and they will provide more protection than no
mouthguard at all.

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A mouthguard is indicated for athletes involved in contact sports (Gawlak, et al, 2014).
There are three types of mouthguards that can be worn: boil and bite, stock type and custom
made (Gawlak, et al, 2014). Our opinion is that custom made mouthguards are the most superior
mouthguards out of the three options offered. They offer the athlete a better fit and adaptation to
their dentition, which in turn, creates a more superior protection and allows for a higher level of
function due to its smaller dimensions (Gawlak, et al, 2014). In a study done where 168
mouthguards were assessed by 21 athletes, it was found that custom mouthguards made with the
injection molding technique received the best results (Gawlak, et al, 2014). Custom mouthguards
made with the thermoforming pressing and flasking technique also obtained great results
(Gawlak, et al, 2014). It was also found that standard mouthguards led to more mucosal irritation
and was more uncomfortable to the athlete (Gawlak, et al, 2016). Porida, a type of standard
mouthguard, was tested on 21 athletes and it was found that it caused difficulties with breathing,
speaking, damage to the mucosa, and TMJ problems (Gawlak, et al, 2016). Custom made
mouthguards were also tested and it was found that they created less speech difficulties and led
to less clenching (Gawlak, et al, 2016). An other article was reviewed where it was concluded
that custom made mouthguards were superior to standard mouthguards. In this study, Porida (a
type of standard mouthguard) received the lowest score out of all of the mouthguards that were
tested (Gawlak, et al, 2013). It had a very loose fit and poor retention (Gawlak, et al, 2013). It
also hindered hygiene and was very prone to deformation (Gawlak, et al, 2013). Shock doctor, an
other standard mouthguard, was reported to be too bulky, make hygiene maintenance very
difficult and prone to damage (Gawlak, et al, 2013). The Impak brand was said to have either too
much or too little flexibility (Gawlak, et al, 2013). It was also reported that it was difficult to
adjust it to the oral cavity and it had an uncomfortable fit (Gawlak, et al, 2013). Corflex and

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Erkoflex 2 are a brand of custom made mouthguards that were shown to have the highest score
in terms of fit and comfort (Gawlak, et al, 2013). In a different study where the prevalence of
injury was tested between over the counter mouthguards and laminate mouthguards, it was found
that wearing properly fitted laminate mouthguards in the posterior occlusal area reduced the
incidence in mild traumatic brain injury and concussion (Winters DDS & DeMont PhD, CAT(C),
ATC, 2014). In an article where the comfort, wearability, physiological effects and influence of
an athletes performance of mouthguards were tested, it was found that custom fitted
mouthguards were superior to boil and bite mouthguards in all of the categories (Duarte-Pereira
et al., 2008). Custom fitted mouthguards were found to interfere less with breathing, speaking,
and comfort (Duarte-Pereira et al., 2008). It also led to less oral dryness, nausea and produced a
better adaptability to dentition which allowed for the ease of drinking (Duarte-Pereira et al.,
2008). In comparison, boil and bite mouthguards were reported to produce a bad taste in the oral
cavity, made it difficult to maintain the mouth closed while wearing it and also made it
impossible for the athlete to drink.
In conclusion, custom made mouthguards provide the greatest amount of protection and
wearability for the client. With a custom made mouthguard, the wearer is guaranteed to have a
proper fit for their unique mouth size. This prevents the mouthguard from affecting the breathing
and comfort of the oral mucosa. Having a proper fit also prevents the athlete from easily popping
the mouthguard off to chew it while playing the sport. Chewing the mouthguard prevents it from
offering the protection intended as it is not being worn for entire duration. It also decreases its
wearable life as chewing will result in greater wear faster.
The most important thing is education. The dental hygienist must be aware of whether
their clients participate in recreational or competitive sport. It is the dental hygienists

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responsibility to bring up the conversation surrounding the benefits of a mouthguard, and more
specifically, a custom made one. Coaches also need to take on the responsibility to educate their
team and the parents on the importance of getting a custom fit mouthguard that properly fits the
child to provide comfort and protection from craniofacial injuries. It should be advised they take
their children to get custom made mouthguards. Mobile mouthguard clinics are also available to
come and fit the entire team with custom mouthguards. Custom mouthguards offer the best
protection and wearability for its users when compared to boil and bite mouthguards.

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References
DenTek Maximum Protection Dental Guard Kit, 3 pc. (n.d.). Retrieved July 19, 2016, from
http://www.walmart.com/ip/DenTek-Maximum-Protection-Dental-Guard-Kit-3pc/22142283
Duarte-Pereira, D., del Rey-Santamaria, M., Javierre-Garcs, C., Barbany-Cair, J., ParedesGarcia, J., & Valmaseda-Castelln, E. et al. (2008). Wearability and physiological effects of
custom-fitted vs self-adapted mouthguards. Dental Traumatology, 24(4), 439-442.
http://dx.doi.org/10.1111/j.1600-9657.2008.00595.x
Gawlak, D., Maka-Malara, K., Kamiski, T., uniewska, M., & Mierzwiska-Nastalska, E.
(2016). Comparative evaluation of custom and standard boil and bite (self-adapted)
mouthguards and their effect on the functioning of the oral cavity. Dent Traumatology
Dental Traumatology. doi:10.1111/edt.12269
Gawlak, D., Mierzwiska-Nastalska, E., Maka-Malara, K., & Kamiski, T. (2014). Assessment
of custom and standard, self-adapted mouthguards in terms of comfort and users subjective
impressions of their protective function. Dent Traumatol, 31(2), 113-117.
http://dx.doi.org/10.1111/edt.12132
Gawlak, D., Mierzwiska-Nastalska, E., Maka-Malara, K., & Kamiski, T. (2013). Comparison
of usability properties of custom-made and standard self-adapted mouthguards. Dent
Traumatol,30(4), 306-311. http://dx.doi.org/10.1111/edt.12085
Humphrey, D. (2015). Mouthguards. Lecture, Durham College.

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Pressure laminated mouthguards: Role in prevention/reduction of injuries to athletes mouth and

brain in contact sports. (2011). Can J Dental Hygiene, 45(1), 9-10.
Tuna, E. B., & Ozel, E. (2014). Factors Affecting Sports-Related Orofacial Injuries and the
Importance of Mouthguards. Sports Med Sports Medicine, 44(6), 777-783.
doi:10.1007/s40279-014-0167-9
Winters DDS, J. & DeMont PhD, CAT(C), ATC, R. (2014). Role of mouthguards in reducing
mild traumatic brain injury/concussion incidence in high school football athletes. General
Dentistry, 1-5.