Sports Medicine

, Volume 49, Issue 8, pp 1217–1232 | Cite as

Effectiveness of Mouthguards for the Prevention of Orofacial Injuries and Concussions in Sports: Systematic Review and Meta-Analysis

  • Joseph J. KnapikEmail author
  • Blake L. Hoedebecke
  • Georgia G. Rogers
  • Marilyn A. Sharp
  • Stephen W. Marshall
Systematic Review



Sport activities can account for up to one-third of all orofacial injuries. Mouthguards (MGs) have been proposed as a way to reduce these injuries.


To present a systematic review and meta-analysis of the effectiveness of MGs for the prevention of sports-related orofacial injuries and concussions.


Using specific search terms, PubMed, Ovid Embase, and the Cumulative Index to Nursing and Allied Health Literature were searched to find studies that (1) contained original quantitative data on MGs and orofacial injuries and/or concussions, (2) included groups involved in sports or exercise activities, (3) included MG users and non-MG users, and (4) provided either risk ratios (RRs) and 95% confidence intervals (95% CIs) comparing injuries among MG users and non-MG users, or data that could be used to calculate RRs and 95% CIs.


Twenty-six studies met the review criteria. Investigations employed a variety of study designs, utilized different types of MGs, used widely varying injury case definitions, and had multiple methodological weaknesses. Despite these limitations, meta-analyses indicated that the use of MGs reduced the overall risk of orofacial injuries in 12 cohort trials (summary RR [nonusers/users] = 2.33, 95% CI 1.59–3.44), and 11 trials involving self-report questionnaires (summary RR [nonusers/users] = 2.32, 95% CI 1.04–5.13). The influence of MGs on concussion incidence in five cohort studies was modest (summary RR [nonusers/users] = 1.25, 95% CI 0.90–1.74).


These data indicate that MGs should be used in sports activities where there is significant orofacial injury risk.



We would like to thank Mr Kristin Goel, Ms Claudia Coleman, and Ms Patricia Brennen for assisting us with finding many of the references cited here.

Compliance with Ethical Standards


No sources of funding were used for this work.

Conflict of interest

Joseph Knapik, Blake Hoedebecke, Georgia Rogers, Marilyn Sharp, and Steven Marshall declare that they have no conflicts of interest relevant to the content of this work.


The opinions or assertions contained herein are the private views of the author(s) and are not to be construed as official or as reflecting the views of the Army or the Department of Defense.


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Copyright information

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Authors and Affiliations

  1. 1.US Army Research Institute of Environmental MedicineNatickUSA
  2. 2.99th Medical GroupNellis Air Force BaseLas Vegas ValleyUSA
  3. 3.Regional Health Command-AtlanticAberdeen Proving GroundUSA
  4. 4.University of North CarolinaChapel HillUSA

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