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Effectiveness of hard inserts in sports mouthguards: a systematic review

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Abstract

Objectives To improve the protective capacity of conventional ethylene-vinyl acetate mouthguards, some authors have suggested reinforcement with a hard material to distribute impact energy more widely. The research question for this systematic review was: 'does the inclusion of a hard insert in mouthguards improve the protection of anterior teeth from a direct blow?'

Data sources Three bibliographic databases (PubMed/Medline, Ovid/Embase and the Cochrane CENTRAL databases) were searched up to 20 February 2021. Additional searches included hand searching of key articles and journals.

Data selection A systematic search of the literature included studies where the intervention was the incorporation of hard material into sports mouthguards and where the comparator was conventional mouthguard material. Eligibility required the use of anatomical specimens or anatomical analogues which included or represented anterior maxillary teeth. Twelve eligible publications were identified.

Data extraction Data extraction was first carried out independently by two reviewers. Discrepancies were resolved by discussion.

Data synthesis Results of individual studies were conflicting and methodological diversity created difficulty in making a synthesis of results. All studies employed low-energy impacts that did not represent the potentially high-energy impacts encountered in sport.

Conclusion The efficacy of hard inserts in sports mouthguards has not been demonstrated.

Key points

  • Efficacy of hard inserts in sports mouthguards is not demonstrated by research.

  • Results of studies are conflicting and in some studies, protection is reduced by the incorporation of hard inserts.

  • It is possible that some hard inserts may cause additional tissue damage.

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Acknowledgements

Thanks to Mr Ryan Finnerty, Head Coach and General Manager of Manchester Storm Ice Hockey Team.

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Authors and Affiliations

  1. Dental Practitioner, Shelley and Pope Dental Practice, 117 Stockport Road, Denton, Manchester, M34 6DH, UK; Honorary Research Fellow, University of Manchester, Manchester, UK; Team Dentist, Manchester Storm Ice Hockey Club, Manchester, UK

    Andrew Shelley

  2. Musculoskeletal Science and Sports Medicine, Department of Life Science, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK

    Keith Winwood

  3. Department of Engineering, Manchester Metropolitan University, Faculty of Science and Engineering, Manchester, UK

    Thomas Allen

  4. Emeritus Professor of Oral and Maxillofacial Imaging, Division of Dentistry, School of Medical Sciences, University of Manchester, Manchester, UK

    Keith Horner

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  1. Andrew Shelley
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  2. Keith Winwood
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  3. Thomas Allen
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  4. Keith Horner
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Contributions

Andrew Shelley, Keith Winwood, Thomas Allen and Keith Horner were involved in all stages of producing this systematic review, including planning, study selection, analysis and writing of the manuscript.

Corresponding author

Correspondence to Andrew Shelley.

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The authors declare that there are no conflicts of interest.

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Shelley, A., Winwood, K., Allen, T. et al. Effectiveness of hard inserts in sports mouthguards: a systematic review. Br Dent J (2022). https://doi.org/10.1038/s41415-022-4089-x

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  • DOI: https://doi.org/10.1038/s41415-022-4089-x

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