Sports Medicine

, Volume 37, Issue 2, pp 117–144 | Cite as

Mouthguards in Sport Activities History, Physical Properties and Injury Prevention Effectiveness

  • Joseph J. KnapikEmail author
  • Stephen W. Marshall
  • Robyn B. Lee
  • Salima S. Darakjy
  • Sarah B. Jones
  • Timothy A. Mitchener
  • Georgia G. dela Cruz
  • Bruce H. Jones
Review Article Mouthguards in Sport Activities History, Physical Properties and Injury Prevention Effectiveness


Three systematic reviews were conducted on: (i) the history of mouthguard use in sports; (ii) mouthguard material and construction; and (iii) the effectiveness of mouthguards in preventing orofacial injuries and concussions. Retrieval databases and bibliographies were explored to find studies using specific key words for each topic. The first recorded use of mouthguards was by boxers, and in the 1920s professional boxing became the first sport to require mouthguards. Advocacy by the American Dental Association led to the mandating of mouthguards for US high school football in the 1962 season. Currently, the US National Collegiate Athletic Association requires mouthguards for four sports (ice hockey, lacrosse, field hockey and football). However, the American Dental Association recommends the use of mouthguards in 29 sports/exercise activities.

Mouthguard properties measured in various studies included shock-absorbing capability, hardness, stiffness (indicative of protective capability), tensile strength, tear strength (indicative of durability) and water absorption. Materials used for mouthguards included: (i) polyvinylacetate-polyethylene or ethylene vinyl acetate (EVA) copolymer; (ii) polyvinylchloride; (iii) latex rubber; (iv) acrylic resin; and (v) polyurethane. Latex rubber was a popular material used in early mouthguards but it has lower shock absorbency, lower hardness and less tear and tensile strength than EVA or polyurethane. Among the more modern materials, none seems to stand out as superior to another since the characteristics of all the modern materials can be manipulated to provide a range of favourable characteristics. Impact studies have shown that compared with no mouthguard, mouthguards composed of many types of materials reduce the number of fractured teeth and head acceleration. In mouthguard design, consideration must be given to the nature of the collision (hard or soft objects) and characteristics of the mouth (e.g. brittle incisors, more rugged occusal surfaces of molars, soft gingiva). Laminates with different shock absorbing and stress distributing (stiffness) capability may be one way to accommodate these factors.

Studies comparing mouthguard users with nonusers have examined different sports, employed a variety of study designs and used widely-varying injury case definitions. Prior to the 1980s, most studies exhibited relatively low methodological quality. Despite these issues, meta-analyses indicated that the risk of an orofacial sports injury was 1.61.9 times higher when a mouthguard was not worn. However, the evidence that mouthguards protect against concussion was inconsistent, and no conclusion regarding the effectiveness of mouthguards in preventing concussion can be drawn at present. Mouthguards should continue to be used in sport activities where there is significant risk of orofacial injury.


National Collegiate Athletic Association Latex Rubber Shock Absorption Ethylene Vinyl Acetate Ethylene Vinyl Acetate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We would like to thank Ms Ann Marie Gibson for her editorial comments and Ms Stephanie Morrison for her technical review. Mr Kristin Goel and Ms Claudia Coleman assisted us in obtaining many of the references cited in this paper, especially those more difficult to obtain.

The views, opinions and/or findings contained in this report are those of the authors and should not be construed as official Department of the Army position, policy or decision, unless so designated by other official documentation.

Citations of commercial organisations and trade names in this report do not constitute an official Department of the Army endorsement or approval of the products or services of this organisation.

No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the contents of this review.


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Copyright information

© Adis Data Information BV 2007

Authors and Affiliations

  • Joseph J. Knapik
    • 1
    Email author
  • Stephen W. Marshall
    • 2
  • Robyn B. Lee
    • 1
  • Salima S. Darakjy
    • 1
  • Sarah B. Jones
    • 1
  • Timothy A. Mitchener
    • 1
  • Georgia G. dela Cruz
    • 1
  • Bruce H. Jones
    • 1
  1. 1.US Army Center for Health Promotion and Preventive MedicineAberdeen Proving GroundMarylandUSA
  2. 2.Departments of Epidemiology and Orthopedics and Injury Prevention Research CenterUniversity of North Carolina at Chapel HillChapel HillUSA

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