Practice Tips #47: Protect Your Patient’s Dentition With Vacuum Formed Mouthguards

Provide superior protection to your patients by providing custom-formed mouthguards produced in office. Delta Dental conducted a survey that shows how many children engage in “high-risk” sports activities without a mouthguard. Studies showed that mouthguards greatly reduce the risk of injury.

Youth Mouthguards for Use During Sports

One way to stay protected is with the use of a pressure-formed mouthguard. It provides a superior fit and function to a “boil-and-bite” guard purchased over-the-counter. A custom formed appliance will not only stay in place better, but allows for better breathing enhancing comfort and performance.

With the start-up of kid's sports in the summer, such as the millions of American children start football practice. By the end of July, most kids need to have mouthguards. Now is the time to get involved in this process. A small, but prominently placed sign that states something like “ASK US ABOUT MOUTHGUARDS” might be extremely helpful in opening a discussion on this subject.

By offering this service to your patients, you are not only growing your practice, but also providing a truly important service to your patients. What parent wouldn’t want the extra protection for their child if they were simply made more aware of the possible risks of injury? Many patients may not be aware of how mouthguards not only protect teeth, but can cushion impact and reduce the risk of concussion. Of course, participants in many other sports can benefit from the use of mouthguards too. Once you have the techniques down, you can market year-round for basketball, hockey, volleyball, and a host of other activities.

Dr. Shaun Doherty of Massillon Smiles in Ohio has been making athletic mouthguards for patients for some time now. They’re very popular with the local football team, in fact, the Tigers.

Creating the Mouthguard

Here we see Dr. Doherty’s step-by-step process for making custom mouthguards in the team colors:

PHOTO: The fresh impression

1. Naturally, he starts with an impression of the maxillary arch.
2. From the impression you make and trim a model. Reducing the palate and/or making holes in the palate improves the adaptation of the material to the model and produces an appliance with superior fit. Although this step is not necessarily required, it improves the results.
3. As an added step, spray the model with silicone spray to make it easier to remove the formed appliance from the model.
4. Using a vacuum former, heat the mouthguard material until you have about 1” of “droop.” Drop the material over the model and turn on the vacuum for about 30 seconds. Turn the vacuum off and let the formed appliance cool completely while on the model to avoid distortion.
5. Once the mouthguard has cooled, remove it from the model and trim with a scissors.

PHOTO: Trimming the appliance

TECH TIP: Fine trimming and smoothing of the edges of the appliance can be performed with a Scotch Brite™ wheel on a lathe.

PHOTO: Carefully finishing the edges on the lathe to remove any flashing.

At this point, the mouthguard is finished and usable, but with just a few more steps you can create something that will really stand out and help your practice stand out as well.

Put the appliance back on the model (this helps you handle it).

Now you can apply custom graphic elements. In this case, tiger stripes are drawn on the appliance with a fine marker. Decals of the team name and logo are also applied. Craft and hobby stores (and sometimes dollar stores) can be a good source of decals to match your needs. Although, a skilled hand (like that of Dr. Doherty) is good too.

PHOTO: Applying custom graphics to the prepared appliance.

Once additional graphics have been applied, an extra layer of thin EVA (0.030”) is applied to “seal” in the graphics. When using thinner materials like this, drop the material over the model and begin to form as soon as it starts to droop.

PHOTO: Drop the material down as soon as it starts to droop.

As with the original mouthguard, turn the vacuum on once the material is in place and let it run for about 30 seconds to get a good fit. This extra layer will not only seal in your custom graphics, but will also provide an extra layer of protection (literally and figuratively) for your patient.

To laminate this extra layer, a pressure dome will need to be incorporated in addition to the standard vacuum former. The pressure dome is placed on top of the vacuum former immediately after the application of vacuum to introduce positive pressure from above, bonding the layers together. Hold the pressure dome in place for approximately 45 seconds.

PHOTO: Positive pressure is required to laminate the thin layer to the mouthguard.

Once again, allow plenty of time for the finished appliance to cool completely. Cut away bulk excess of clear material with a scissors (as done with the original basic mouthguard) trim and polish the edges with a Scotch Brite™ pad (also as before) and then finish trimming with a hot knife or Scotch Brite™ wheel (as shown above).

If using a hot knife, take care to feather the edges as well to help blend the two materials together. If not using a knife to trim, you will still want to feather the edges using a heated spatula.

The technique illustrated above allows further customization of the mouthguard by applying additional graphic elements. Not only team names or logos can be incorporated this way, you can also individualize by adding player names, numbers or other custom graphics for a mouthguard that will appeal to the patient (helping to improve compliance and generate referrals).

Mouthguard materials are also available in a pre-fabricated factory laminate. These laminates can be purchased in multi-color patterns that could mimic your school colors (e.g. 1/2 black and 1/2 red). American Dental Accessories, Inc. carries a full line of Proform™ laminates in many colors and color combinations which could simplify providing a custom look to your patient.

PHOTO: Just a few of the Proform colors and color combinations that are available.

One important thing to note: If making for a local school or youth league, one must be mindful of league rules and regulations which dictate the color of the mouthguard. Many leagues prohibit solid red mouthguards, as these may hide the presence of blood. Also, white or clear mouthguards are sometimes disallowed as the referees need to be able to tell at a glance if a player is wearing one (and these may not be readily visible). Be certain to check your local league for the specifics before launching a mouthguard program.

A custom-formed appliance will help protect the smiles you’ve helped create and help you differentiate your practice.

PHOTO: Go Tigers! (or whatever team you may root for)

We would like to thank Dr. Shaun Doherty of Massillon smiles for his invaluable assistance in producing this month's Practice Tips. His step-by-step photos, assistance in proofing, and refining the technique are greatly appreciated.