Do Mouthguards Prevent or Reduce Oral Injuries
and Concussion during Sports Events?
Toshikazu Yasui1, Tomoya Gonda2, Yoshinobu Maeda2, Keiichi Ishigami3,
Toshiaki Ueno4, Masaru Matsumoto1, Tetsuya Takamata5, Kaoru Koide6,
Misao Kawara7, Keita Kobayashi8

Key words: mouthguard, oral injury, concussion

Abstract

evaluation of 17 articles, we concluded that properlyThis review examines the English and Japanese

fitted custom-made mouthguards can prevent orliterature investigating the efficacy of mouthguard

reduce traumatic oral injuries. Larger cohort studies

use for preventing or reducing traumatic oral injuries

are required to clarify the efficacy of mouthguards inor concussion from 1986 to 2016, using PubMed

reducing the severity of concussion.

1Department of Community Health Science, Meikai University
School of Dentistry, Saitama, Japan2
Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, Osaka, Japan
3Tokyo Dental College, Tokyo, Japan
4Sports Medicine/Dentistry, Graduate School of Medical and DentalSciences, Tokyo Medical and Dental University, Tokyo, Japan
5Sports Dentistry, Department of Oral and Maxillofacial Biology,
Graduate School of Oral Medicine, Matsumoto Dental University, Nagano, Japan
6
Department of Removable Prosthodontics, School of Life Dentistryat Niigata, Nippon Dental University, Niigata, Japan
7
Department of Oral Function and Rehabilitation, Nihon University
School of Dentistry at Matsudo, Chiba, Japan
8
Japan Dental Association, Tokyo, Japan

007

P007-011_IJSD_RA1.indd 7

Review Article 1

and manual searching. After careful reading and2017/10/19 17:01

VOLUME 10 NUMBER 1
International Journal of SPORTS DENTISTRY

Introductionand severity of oro-facial injuries. Onyeaso

Many studies have been conducted to dem-and Adegbesan4 reported that one third ofonstrate the efficacy of using mouthguards toattendees at national sports events in Nigeria

prevent or reduce traumatic oral injuries orwere non-users of mouthguards, and sufferedconcussion during sports events.

significantly more traumatic injuries than1

We conducted a systematic review in 2014 ,mouthguard users. Labella et al.5 reported thatand concluded that there was limited evidence

mouthguard users among college basketball

to support the efficacy of mouthguard use inplayers had a significantly lower rate ofreducing traumatic oral injuries, and that fur-dental injuries (0.12 vs 0.67; P < 0.05) andther studies were needed. We also conducted

dentist referrals (0.00 vs 0.72; P < 0.05) thanan international workshop in 2016 to prepare

non-users.

for a future consensus conference, where weMarshall et al. 6 reported that the use ofacquired more reports and publications frommouthguards resulted in a reduction in thevarious parts of the world, particularly fromincidence of dento-facial injuries, but notJapan, related to this issue.

concussion, among 304 rugby players.

The purpose of this report is to update thesystematic reviews of the efficacy of mouth-Maeda et al.7 reported the following findings in their review article:

guard use for preventing or reducing traumatic(1) To prove the efficacy of mouthguards inoral injuries or concussion, by searching thepreventing and reducing traumatic dento-oral

literature written not only in English, but also

injuries, we need well-designed studies within Japanese.

ethical approval.
(2) To fabricate properly fitted custom-madeMaterials and Methodsmouthguards, we need to pay more attention

We used PubMed and manual searching

to the effects of moisture on the working

with the key words [mouthguard, prevention,models, and the thermoforming temperature

reduction, trauma, concussion, sports] fromand cooling time.

1986 until 2016. More than 750 papers were

(3) Well fitted and designed custom-madeextracted. After careful reading and evalua-

mouthguards do not affect air intake, perfor-

tion, only 17 relevant articles remained.

mance or speaking.
(4) A reduction in the severity of concussion

Results

Prevention or reduction of traumatic oral
injuries
Berg et al. reported that high school wres2tling, basketball, baseball, softball, soccer, andby the use of mouthguards is still controversial
and needs scientific evidence.
(5) Education of coaches and parents about
the advantages of using mouthguards isessential.

volleyball players with mouthguards reported
fewer incidents of traumatic injury than those

McCrory et al. 8 suggested that the use ofwithout mouthguards. Biasca et al.3 reviewed

mouthguards can contribute to a reduction inhead and neck injuries among ice hockey

dento-facial traumatic injuries, particularly inplayers and suggested that mouthguard

contact sports, and that mouthguards should

use is necessary to reduce the incidence

be properly fitted and custom-made.

008

P007-011_IJSD_RA1.indd 8

2017/10/19 17:01

Do Mouthguards Prevent or Reduce Oral Injuries and Concussion during Sports Events?

In 2013, Yasui et al.9 reported on an epidemio-found that although some boxers still suffer

logical study among 1134 assorted sports

from concussion, the number of fatal incidents

players conducted by members of the Japa

has decreased. Among other preventive fac-nese Academy of Sports Dentistry (JASD).

tors used in boxing, mouthguard use is still

This study was approved by the ethical com-

a contributing factor in lowering the risk ofmittee of Osaka University on the basis thatconcussion.

every player was advised to use a custom-

Hickey et al. 13 investigated how mouth-

made mouthguard before the season started.

guards can reduce the risk of concussion byPlayers were then asked to report incidents

conducting experiments on cadavers; how-of dento-oral injuries and the percentage ofever, there has been little scientific evidence

time they used a mouthguard. Multifactorial

to support the effect of mouthguard use on

statistical analysis was carried out for age,concussion.

sex, body weight, sports discipline, years of

Based on a multi-center study among 394

experience, duration of exercise, duration ofsoccer players and 252 rugby players, Barbic etgameplay, and mouthguard usage time. They

al.14 reported that there was no significant dif-found that mouthguard usage time was aference in the frequency of concussion among

statistically significant factor in reducing theplayers using different types of mouthguards.

10

incidence of traumatic injuries. Tanaka et al.

Benson et al.15 reviewed the literature andalso described the effect of mouthguard usage

concluded that no strong evidence exists foramong 500 rugby players using the above-

the use of mouthguards or face shields tomentioned JASD format. They also foundreduce the risk of concussion.

that players using mouthguards were subject
to fewer dento-oral traumatic injuries, andA brain injuries consensus meeting con-that custom-made mouthguards can reducecluded that there is no evidence to support

breathing problems.

the use of mouthguards for reducing the risk

Ilia et al. conducted a survey among rugby
11

or severity of concussion.16

union players and reported that 64.9% of
players experienced orofacial trauma, and that

Sigurdsson17 suggested that evidence-based

wearing a mouthguard reduced the risk bydentistry and medicine requires large prospec-

18.5% (P = 0.009).

tive studies with randomized interventions

Vucic et al.

to investigate the actual protective effects ofconducted a survey among

1299 field hockey players and reported thatmouthguards.

players complained less about custom-madeThe American Medical Society for Sports

mouthguards than mouth-formed mouthguards

Medicineʼs position statement on concus-( p ≤ 0.05); however, males were still less likely

sion in sport stated that there is no current

to have a custom-made mouthguard thanevidence that mouthguards can reduce thefemales.

severity of, or prevent, concussion.18

Prevention or reduction of concussion

A survey among 412 high school football

Mouthguards originated from boxing, whereplayers conducted by Winters and DeMont19

concussion is the main cause of fatal injury. We

indicated that there was a significant dif009

P007-011_IJSD_RA1.indd 9

Review Article 1122017/10/19 17:01

ference (P = 0.0423) in the mild traumaticbrain injury / concussion injury rate between

erly fitted custom-made mouthguards can pre-custom-made mouthguards (incidence of 3.6%)

vent or reduce traumatic oral injuries. We still

and the group using over-the-counter mouth-need cohort studies conducted on a greaterguards (incidence of 8.3%). However, McGuine

scale to clarify the efficacy of mouthguards inet al.

reducing the severity of concussion.

reported that the rate of sport-related

concussion was higher in players who wore acustom-made mouthguard (P < 0.001) than inplayers who wore a generic mouthguard.
Further epidemiological data is required
to determine the efficacy of mouthguards
in reducing the severity of concussion. ThisVOLUME 10 NUMBER 1

We already have some evidence that prop-the group using laminated 3 mm thickness

20

should include the use of larger cohort groups
and recording with objective measures suchas the Sport Concussion Assessment Tool 5th

Acknowledgments

The authors would like to thank the Japa-

nese Academy of Sports Dentistry and its
members.

Conﬂicts of interest
The authors report that they have no conﬂicts of interest related to this study.

Edition (SCAT 5)16.

References
1.	Yasui, T., Maeda, Y., Ueno T., et al.: A Study of theLiterature on Mouthguards (1986 to 2012). Sports
Dentistry, 17, 53-71, 2014. (in Japanese)
2.	Berg, R., Berkey, D.B., Tang J.M., et al.: Knowledge
and attitudes of Arizona high-school coaches regarding oral-facial injuries and mouthguard use amongathletes, J Am Dent Assoc, 129: 1425-1432, 1998.
3.	Biasca, N., Wirth, S. and Tenger, Y.: The avoidabilityof head and neck injuries in ice hockey: an historicalreview, Br J Sports Med, 36: 410-427, 2002.
4.	Onyeaso, C.O. and Adegbesan, O.A.: Oro-facial
injury and mouthguard usage by athletes in Nigeria,
Int. Dent. J., 53: 231-236, 2003.

International Journal of SPORTS DENTISTRY

Discussion

5.	Labella, C.R., Smith, B.W. and Sigurdsson, A.: Effectof mouthguards on dental injuries and concussions incollege basketball, Med Sci Sports Exerc, 34(1): 41-4,
2002.
6.	Marshall, S.W., Loomis, D.P., Waller, A.E., et al.:Evaluation of protective equipment for prevention ofinjuries in rugby union, Int J Epidemiol, 34: 113-118,2005.
7.	Maeda, Y., Kumamoto, D., Yagi, K., et al.: Effectiveness and fabrication of mouthguards, Dent Traumatol.
25: 556-564, 2009.
8.	McCrory, P., Meeuwisse, W.H., Aubry, M., et al.
Consensus statement on concussion in sport: the4th International Conference on Concussion in Sport
held in Zurich, November 2012, Br J Sports Med,47(5):250-8, 2013.

9.	Yasui, T., Maeda, Y., Tanaka, Y., et al.: A Large-scale
Survey of the Preventive Effect of Mouthguards
against Traumatic Oral Injury during Sports; AnInterim Report, Sports Dentistry, 17: 9-13, 2013. (inJapanese)
10.	Tanaka, Y., Maeda, Y., Yang, T.C., et al.: Prevention ofOrofacial Injury via the Use of Mouthguards amongYoung Male Rugby Players, Int J Sports Med, 36(03):254-261, 2015.
11.	Ilia, E., Metcalfe, K., and Heffernan, M. Prevalence ofdental trauma and use of mouthguards in rugby union
players, Aust Dent J, 59(4): 473-81, 2014.
12.	Vucic, S., Drost, R. W., van Wijk, A. J., et al.: Patternsof orodental injury and mouthguard use in Dutch field
hockey, Br J Sports Med, 50(11): 661-8, 2016.
13.	Hickey, J. C., Morris, A. L., Carlson, L. D., et al.: The
relation of mouth protectors to cranial pressure anddeformation, J Am Dent Assoc, 74: 735-740, 1967.
14.	Barbic, D., Pater, J., and Brison, R. J.: Comparison ofmouth guard designs and concussion prevention incontact sports. A multicenter randomized controlled
trial, Clin. J. Sport Med., 15: 294-298, 2005.
15.	Benson, B. W., Hamilton, G. M., Meeuwisse, W. H.,
et al.: Is protective equipment useful in preventing
concussion? A systematic review of the literature, Br. J.
Sports Med., 43;56-67, 2009.

010

P007-011_IJSD_RA1.indd 10

2017/10/19 17:01

Do Mouthguards Prevent or Reduce Oral Injuries and Concussion during Sports Events?

17.	Sigurdsson, A.: Evidence-based review of preventionof dental injuries, J Endod, 39(3 Suppl): S88-93, 2013.
18.	Harmon, K. G., Drezner, J. A., Gammons, M., et al.:American Medical Society for Sports Medicine position statement: concussion in sport, Br J Sports Med,
47(1): 15-26, 2013.
19.	Winters, J. and DeMont, R.: Role of mouthguards
in reducing mild traumatic brain injury/concussion
incidence in high school football athletes, Gen Dent,
62(3): 34-8, 2014.

20.	McGuine, T. A., Hetzel, S., McCrea, M., et al.: Protective equipment and player characteristics associatedwith the incidence of sport-related concussion in highschool football players: a multifactorial prospective
study, Am J Sports Med, 42(10): 2470-8, 2014.
Correspondence
Tomoya Gonda

Department of Prosthodontics, Gerodontology and Oral

Rehabilitation, Osaka University Graduate School of Dentistry
1-8 Yamadaoka Suita Osaka 565-0871, Japan
Phone: +81-6-68789-2954
Fax: +81-6-6879-2957
Email: tgonda@dent.osaka-u.ac.jp011

P007-011_IJSD_RA1.indd 11

Review Article 116.	McCrory, P., Meeuwisse, W., Dvorak, J., et al.:Consensus statement on concussion in sport-the5th international conference on concussion in sport
held in Berlin, October 2016. British journal of sports
medicine. doi: 10.1136/bjsports-2017-097699, 2017.

2017/10/19 17:01