Recreational Injury Interventions



Mouth protectors have been used to reduce oral/dental injuries for a variety of sports-related activities. These devices are most often used in boxing, football, hockey and rugby. For sports where helmets are used the addition of face guards is effective in reducing oral injuries. In 1962 the National Alliance Football Rules Committee mandated wearing of mouth protectors and face guards for high school, junior college, and some college athletes. The National Alliance is composed of the National Federation of State High School Athletic Associations, the Junior College Athletic Association and the National Association of Intercollegiate Athletics (NAIA). In 1973 the NCAA adopted the same mandatory ruling. The incidence of oral trauma has decreased from 50% of all football injuries to about 0.4% today.15  Mouth protectors protect against concussion, neck injuries, and some serious central nervous system injuries by decreasing the force transmitted through the temporomandibular joint to the base of the skull.16  Evidence for these possible protective effects of mouth guards has not been reviewed for this report. Mouth protectors are required for youth football and hockey, but there is no such requirement for baseball, basketball or touch football even though these sports have a substantial number of oral injuries.17  Many athletes wear stock/generic mouth protectors while others wear custom-made/fitted devices.

Review of mouthguard studies:


Kaufman et al., 1984

Study design and target population

Randomized double-blind controlled trial

Population: 40 football players from C. W. Post College in New York State.


Mandibular Orthopedic Repositioning Appliance (MORA) vs conventional mouthguards (CM) Devices worn during the entire football season.

N=21 players in MORA group and 19 players in CM group


(1) football performance

(2) number of injuries

(3) severity of injuries

(4) type of injuries

(5) physical fitness

(6) satisfaction with mouthpiece

Injury defined as any impairment which caused the player to miss a practice or game. Severity of injuries was based on number of games/practices missed.


MORA wearers had significantly decreased injury severity, and significantly increased satisfaction with the mouthpiece compared to CM wearers. Incidence of TMJ symptoms similar in each group. ANOVA and ANCOVA analysis techniques used.

Study quality and conclusions

Authors conclude that MORA beneficial to football players. Double blind aspect of the study carefully carried out. It was not possible to readjust MORA devices during season.


Heinz, 1968

Study design and target population

Before/after study design.

Population : 9 state high school athletic associations.


Rules requiring mouth protectors and face guards for football effective in 1962.

Three periods covered:

1955-58 (no face or mouth protection).

1959-61 face guards mandatory, some mouth protectors worn.

1963-65 both face guards and mouth protectors required.


Dental injuries per 100 players.


Dental injuries 2.26 per 100 players prior to 1959. Use of face guards reduced injuries to 1.0-1.4 per 100 players. Dental injuries between 0.3 to 0.6 per 100 players following passage of rules mandating both mouth protectors and face guards.

Study quality and conclusions

Rules mandating face guards and mouth protectors associated with decrease in dental injuries.

These states kept injury data for their own athletic insurance programs. Statistics not uniform by state.

Summary of mouth guard interventions

Mouth guards and face masks are effective in reducing dental injuries in football. These devices should also be considered for use in touch football, basketball and baseball.15,17. No additional studies were found to include in the update of mouth guard interventions.

Recommendations on mouth guards

At present there is not enough research evidence to recommend custom mouth protectors over conventional mouth guards.

Recommendations for future research

There is a need for well-designed epidemiological studies first to document the incidence of oral trauma in a wide variety of sports and then to evaluate the protective effect of mouth guards.