by Tom Billups, C.S.C.S.

You know immediately that something bad has happened. If you have ever suffered a fractured or broken tooth or been witness to such an injury, you never forget the sound at the moment of impact. Unfortunately, I have experienced both. If you play rugby, I believe you have to wear a mouthguard.

Mouthguards were originally developed by London dentist Woolf Krause in 1890 as a way to protect boxers from lip lacerations. These early mouthguards were held in place by clenching your teeth. The first mouthguard in the United States is attributed to Chicago dentist Thomas Carlos in 1916, and fortunately there has been considerable research conducted on mouthguard use in sport and injury prevention over the last several decades. Although not unanimous in their findings, a majority of the research has found that a mouthguard, when fitted and used properly, can prevent or reduce the number and severity of concussions and oral/facial injuries. The American Dental Association estimates mouthguards prevent approximately 200,000 injuries each year in high school and college football alone. It has been estimated that if total tooth avulsions occur, and are not immediately treated, athletes could spend ten to fifteen thousand dollars per tooth in dental costs over their lifetime.

The term mouthguard encompasses an array of different types of appliances. There are ready-made stock mouthguards that are inexpensive, but offer minimal protection and even less comfort, (imagine something similar to Woolf Krause’s original design). This type of mouthguard is simply removed from the packaging and placed in an athlete’s mouth. I would not recommend using s stock mouthguard for any level of rugby.

The second type of mouthguard used is “boil and bite” type. These are the most commonly used mouthguards in youth and high school sports and are made of a thermoplastic material that allows them to be “fitted” after the material has been warmed in boiling water.

In 1993, Joon Park, PhD et al, reported that the boil and bite mouthguard provided a “false sense” of protection due to the reduction in the thickness of the mouthguard after boiling while preparing to fit the guard.

The boil and bite mouthguard’s ability to provide protection is further reduced when athletes cut down the size of the guard to make it more comfortable to wear. It has been determined that trimming the length of a boil and bite guard, so the back teeth are uncovered, lessens the gag reflex in some athletes, but severely limits the guard’s ability to provide protection against injury.

A third type of mouthguard is a custom made guard. A custom made mouthguard allows your dentist to address multiple important considerations. The athlete’s age, sport, competition level, and existing dental or other medical concerns are just some of the elements a dentist factors into consideration when making a custom guard. Custom mouthguards have demonstrated good retention of their shape, and have virtually no adverse effect on breathing. They are very comfortable to wear and therefore make requiring their use an easy conversation to have with players. The importance of a custom mouthguard to an athlete’s performance has been underscored by a major sporting goods brand, Under Armour, who designed a line of “Peformance Mouthwear” which includes custom mouthguards. Their process involves your dentist taking an impression and shipping it to Under Armour’s laboratory where they manufacture the guard and, once completed, returning the appliance to your local dentist for a final fitting.

Here at Cal, we supply our rugby players with custom made mouthguards and mandate that they wear them while training and competing. Although numerous dentists now participate in this aspect of our sport medicine services, Derric DesMarteau DDS was instrumental in the creation of our custom made mouthguard program. We lost Dr. DesMarteau last month to cancer and I dedicate this column posting to him.

He was a world-class dentist and a warrior to the end.  

Tom Billups began his rugby career in 1984 and has spent time as a player in New Zealand (Bay of Plenty), the U.S. (The Old Blues), England (London Harlequins), and Wales (Pontypridd) for domestic teams as well as representing the U.S.A. at international tournaments with the Eagles. After hanging up his boots, Billups got into coaching leading the Eagles and now with University of California – Berkeley. Read the entire bio of Tom Billups as well as Billups first column My Rugby Path and then check out what Billups is saying about the game of rugby in The Billups Column on Rugby Rugby.