Should my child wear a mouthguard?

Yes — and specifically a well-fitted, custom-made one, for training as well as games. Sport mouthguards is the service page; what kind of mouthguard should I use? and a new mouthguard: chemist or dentist? cover the same decision for adults.

The Australian Dental Association (ADA) recommends parents include mouthguards on the list of must-have items in a child's sports bag.

The gap most families have

Dr Karin Alexander, President of the Australian Dental Association, has pointed out that while many children understand the need for mouth protection in winter sports such as football and hockey, far fewer people consider it for summer sports.

Basketball and cricket carry just as much risk of injury to the mouth or face. A cricket ball, an elbow under the ring, a collision going for a mark — the mechanism is the same.

Dentists recommend wearing a mouthguard during training as well as game time. Training is where much of the contact happens, and where guards are most often left in the bag.

The other commonly missed category is non-team activity — skateboarding, scootering, BMX, mountain biking, trampolining and horse riding all produce facial injuries, and none of them have a coach insisting on a guard.

What is at risk without one

Children who do not wear a custom-fitted mouthguard while playing sport are at risk of:

• damaged and dislodged teeth — see what should I do if I have a chipped tooth? and chipped and cracked teeth
• broken jaws — the territory of oral and maxillofacial surgeons
• cut lips

The ADA describes the resulting injuries as painful, expensive and disfiguring.

The cost point is worth dwelling on, because it is routinely underestimated. A knocked-out permanent front tooth in a child is not a one-off repair. It commits the family to decades of replacement restorations, because a dental implant cannot be placed until facial growth is complete — generally the late teens or early twenties, and later in males.

Until then the gap is managed with a temporary solution: a denture, a bonded bridge, or an orthodontic appliance holding the space. Each of those has a service life measured in years, not decades. Bridges, implants or dentures compares the eventual options, and how much do dental implants cost? puts a figure on the endpoint. The lifetime cost of one avulsed upper central incisor at age ten is, in practice, one of the largest dental costs a person can incur — and it is prevented by a guard costing a small fraction of a season's registration fees.

The upper front teeth take the overwhelming majority of sports dental injuries, which is exactly what a guard covers.

What a mouthguard actually does

Three things, and only the first is widely understood:

1. It separates the teeth from whatever hits them — a ball, an elbow, the ground.
2. It distributes and absorbs impact force across a larger area rather than concentrating it on one or two teeth.
3. It separates the upper and lower teeth, which matters because a blow under the chin drives the lower teeth into the uppers. It also cushions the jaw joints and pads the lips against the teeth, which is what prevents most of the soft-tissue lacerations.

What it does not reliably do is prevent concussion. That claim is made in marketing and the evidence for it is weak. A mouthguard protects teeth, lips and jaws. Buy one for that reason.

Custom-fitted, not boil-and-bite

The ADA recommends a custom-fitted mouthguard, properly fitted by a dentist, to ensure maximum protection against dental and facial injuries.

The ADA does not recommend over-the-counter or boil-and-bite mouthguards. They offer little or no protection to the teeth and mouth.

That is an unusually blunt position from a professional body, and it is worth taking at face value.

The three types, and why the difference is real:

• Stock guards come ready-made in a few sizes. They are held in place by clenching, which means they cannot be worn while talking or breathing hard. They are the worst option available and are widely sold.
• Boil-and-bite guards are softened in hot water and bitten into. The result is thin exactly where it matters — over the biting edges of the front teeth — because the material displaces under the bite. They also loosen with use.
• Custom guards are made on a plaster or digital model of the individual mouth — at Smile Solutions, in the on-site laboratory. They can be made to a controlled thickness where protection is needed, they stay in without clenching, and they permit speech and breathing. Pressure-laminated custom guards, built up in layers, are thicker and more protective again and are the usual choice for high-impact sport.

A guard that does not stay in place, or that the wearer takes out because it is uncomfortable, is not protection. This is the practical reason custom guards outperform: they get worn.

Fitting, and refitting

• Growing children need refitting. A guard made two seasons ago may no longer fit as teeth erupt and jaws grow — see the order and appearance of baby teeth for what is changing underneath. Have it checked each season, and expect to replace it more often than an adult would.
• A guard that has been chewed, torn, or has lost its shape is finished. Children chew them; it is normal and it ends the guard's useful life.
• Children in braces need a guard designed for that — made to accommodate the appliance and to allow for teeth moving during treatment. A boil-and-bite cannot do this, and forcing one over fixed appliances risks damaging both. Tell the practitioner the child is in orthodontic treatment when the guard is being made. See braces and children's braces and Invisalign.
• Custom guards can be made in a choice of colours, which materially improves the odds a child actually wears it. This is not a trivial point.
• Check the fit at the start of every season, not the week of the first game. Contact us to book it in.

Care and storage

• Rinse in cold water after use, and clean it with a brush and mild soap rather than toothpaste, which is abrasive — the same rule that applies to dentures.
• Store dry, in its ventilated case, away from heat. A guard left in a car in a Melbourne summer will distort permanently and stop fitting.
• Keep it away from pets. Dogs destroy them with remarkable consistency.
• Take it to dental appointments so the fit can be checked.

If a tooth is knocked out anyway

This is the most time-critical situation in dentistry, and knowing it is worth more than anything else on this page.

A permanent tooth:

1. Find the tooth. Hold it by the crown — never the root.
2. If dirty, rinse briefly in milk or saline. Do not scrub it — the cells on the root surface are what allow it to reattach.
3. Put it straight back in the socket, the right way round, and have the child bite gently on a cloth to hold it there.
4. If it cannot be replanted, keep it moist. In the order of preference given by the International Association of Dental Traumatology: milk, then HBSS or a tooth-preservation solution, then the child's own saliva — inside their own cheek if they are old enough not to swallow it — then saline. Water only as a last resort: it is a poor medium, but the IADT is explicit that it is "better than leaving the tooth to air-dry". Never let the tooth dry out.
5. Get to a dentist immediately. Minutes matter. Emergency dentistry, or phone 13 13 96.

A baby tooth is NOT replanted — putting it back can damage the permanent tooth developing above it. See a dentist anyway, the same day. Should I pull out my child's loose tooth? covers the difference between a tooth lost to a knock and one lost naturally.

Go to a hospital emergency department instead if there is a suspected jaw fracture, a significant head injury, loss of consciousness, vomiting or confusion, or spreading facial swelling with difficulty swallowing or breathing.

Full guidance at Children's Dental Emergencies.

A distinction worth making

A sports mouthguard is not the same thing as a night guard.

A night guard — properly an occlusal splint — is a hard, thin appliance made to protect teeth from grinding during sleep. It is a different design for a different job, and the two are not interchangeable in either direction. A sports guard worn overnight is unhygienic and can alter the bite; a splint offers no impact protection. See TMD & Teeth Grinding, night-time tooth grinding and clenching, and how can I stop grinding my teeth when I sleep?

Common questions

At what age should a child start? As soon as they play a sport with a risk of contact, including at junior levels. The upper front permanent teeth arrive at around age seven, and they are the ones most often injured.

Does a guard need to cover the lower teeth too? Usually not. An upper guard is standard; a lower guard is occasionally made where the bite or the sport requires it.

Does private health cover it? Many extras policies contribute to a custom mouthguard, often annually. Check your policy and ask the practice for the item number; published fees are in the price guide. Note that a mouthguard is not covered by the Child Dental Benefits Schedule — see how the schedule operates for what is.

My child says it makes them gag. Say so — it is a fixable design problem. A guard can be trimmed shorter at the back, and a custom guard is far less likely to cause this than a bulky over-the-counter one. If the appointment itself is the difficulty, combating dental anxiety in children may help.

Can they wear it with a retainer? No — the retainer comes out and the guard goes in. Keep the retainer in its case, not in a pocket.

Related pages: Sports Mouthguards, Children's Dental Emergencies, Children's Dentistry, Chipped or Cracked Teeth, Should my child see a specialist paediatric dentist?, Protecting your child from dental disease, and in the media, Brodie Grundy's mouthguard.

Practical details

Written by Karleen Giampietro, Smile Solutions. The full team is listed by name.

Smile Solutions makes custom mouthguards in its own on-site laboratory.

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000 — getting here. Phone 13 13 96, contact us, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment.

Published 3 September 2018. Quoted comments are attributed to the Australian Dental Association. General information only — it is not a diagnosis, a treatment plan or a promise of any particular outcome, and it does not replace advice from your treating practitioner. Every practitioner's registration can be verified free on the AHPRA public register at ahpra.gov.au.

Smile Solutions trades under ABN 28 193 514 103.