By Timothy Reardon, D.D.S., M.S.
A well-constructed mouthguard is probably the most important piece of equipment a boxer can have throughout his career, especially at the professional level. Its purpose is not just the protection of his teeth from fracture or displacement. It should also help to prevent or at least minimize injuries to the surrounding soft tissue, and it should protect the bony structures of the head and neck. Finally, it is the only defense that a professional boxer has against injuries to the brain during the course of a bout.
The condyle and fossa, which compose the bony elements of the temporomandibular joint (the TMJ or jaw joint), and even the vertebrae of the neck, should be supported by the correct amount of coverage and thickness found in a well-constructed mouthguard. It should act as a shock absorber and equally distribute and transfer impact forces throughout the mouthguard. Thus the chances for concussion or other severe injuries are greatly reduced.
The criteria to meet these concerns cannot be achieved with inexpensive stock or boil-and-bite type mouth guards sold at stores or through magazines. A good experienced dentist is needed to deliver this vital piece of protection.
The vast majority of mouthguards for boxers can be made on the upper arch. The only exception is when the boxer has a prognathic (lower jaw is ahead of the upper jaw) bite. Occasionally a fighter will request a combination upper/lower mouthguard. This is usually just a personal preference due to having worn one before. I personally see no advantage to this double type mouthguard.
I think it is a good idea for a boxer to do roadwork wearing the mouthguard. Also it should be worn during as many gym activities as possible. This helps the boxer get use to breathing with it, and it will rapidly become second nature to have it in place.
Because of the superior retention of the heat/pressure multi-laminated mouthguard, in general there is no need for it to be removed between rounds of a fight. The fighter can drink and speak well with the mouth guard in place. And this is one less thing for the cornermen to worry about. I have seen many fighters sent out at the beginning of a new round without their mouthguards.
Also, because of the superior retention, it is extremely difficult for a fighter to have this type mouthpiece knocked out or for him to spit it out. Of all of these type mouthguards that I have made for professional fighters, to my knowledge none have been knocked out during the course of a bout.
Mouthguards do have a useful life. They should be replaced at least yearly or possibly sooner depending on the amount of use. Superstition or force of habits come into play, and a fighter often hangs onto an old mouthguard long after it should be remade.
Custom-made heat/pressure multi-laminated mouthguards
This is the type of mouthguard that I prefer. It is usually constructed to the upper model of the boxer’s teeth within close specifications of material, technique, machinery, and design. It is fabricated with a special high-heat/pressure-forming machine, with a maximum pressure of six atmospheres.
The advantages are:
Precise adaptation due to the increased pressure and negligible deformation when worn for prolonged periods of time. There is no elastic memory when high heat is combined with high pressure during fabrication.
Ability to thicken any area as required because of the laminating capability of the machinery used.
Ability to achieve constant occlusal separation and proper occlusal balance necessary for concussion prevention.
No interference with breathing and speech.
Individual design to the specifications predetermined through consultation of dentist, technicians and sports professionals.
Because of the specified and required thickness determined by the dentist, this mouthguard will deliver the intended protection expected by the boxer.
Research has shown that mouthguards are subject to high compressive stress during use.
Tensile strength, tear strength, elongation and the amount of elasticity are important factors and an indication of durability. Hardness, rebound, penetration and dynamic resilience also have been related to the degree of protection provided.
For maximum protection, the energy absorbed by the mouthguard should be dissipated by it rather than transferred to the underlying teeth and surrounding structures. Many materials commonly in use today have a tendency to wear or harden during use and quickly suffer a diminished capacity to absorb the forces of impact. Only ethyl-vinyl acetate, the advanced material used in heat/pressure multi-laminated mouth- guards, has the ability to withstand the stresses of function and provide the most effective, long-term protection for the boxer.
As with any good appliance, the fabrication of a custom-made heat/pressure multi-laminated mouthguard is very technique sensitive. It begins with an extremely accurate impression. A two-part alginate, System 2 by Accudent, a division of Ivoclar North America, along with their special trays, has been found to work very well. It takes a very detailed impression with excellent extension for the needed retention. The impression should then be poured as soon as possible with a strong material like Die-Keen stone from Modern Materials. This helps to prevent fracturing of the teeth on the cast if multiple mouthguards are to be made.
The preferred machine, and this is just a personal preference because there are a number of good ones on the market, is the Druformat from Westone laboratories of Colorado Springs, Co. They also supply a very good ethyl-vinyl acetate material that comes in various degrees of thickness and many colors.
If the dentist does not have access to a heat/pressure machine, Space Maintainers of Chatsworth Ca. is a commercial lab that can be used.
Dr. Timothy Reardon is a practicing orthodontist in Las Vegas. He has made mouthguards for many professional boxers including a number of current and past world champions. These are a few of his patients: Livingstone Bramble, Javier Castillejo, Hannah Fox, Stevie Johnston, Kevin Kelley, Wayne McCullough, Paul Spadafora, and Johnny Tapia.
Dr. Timothy Reardon is a resident of Las Vegas, Nevada where he has been a practicing Orthodontist since 1997. Although he is an Orthodontist, all of the views, opinions, and/or recommendations contained herein are solely his own and do not necessarily reflect those of other orthodontists. All readers are strongly cautioned that the information contained herein is not intended to, and never should, substitute for the necessity of seeking the advice of a qualified medical, legal, or financial professional whenever a boxer or his/her representatives have specific questions regarding the best course of action that a boxer should take. Furthermore, since it is possible that general information herein may pertain only to a law, regulation, rule or acceptable standard of practice for a particular jurisdiction, a boxer or his/her representatives must always inquire with the appropriate licensing jurisdiction to determine the applicable laws, regulations, rules, and acceptable standards of practice for each jurisdiction.
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