[Custom-made mouthguards and prevention of orofacial injuries in sports].

The importance of sports dentistry has become even greater due to the role that sports have in modern society. As the risk of sports-related injuries appears already in the period of children's play and is constantly present in various risk-related sporting activities, the role of dental profession has become extremely important. Custom-made mouthguards are the most highly recommended mouthguards used for successful prevention of orofacial and dental injuries. It is important to inform athletes of the best characteristics of a custom-made mouthguard such as retention, comfort, fit, ease of speech, resistance to tearing, ease of breathing as well as good protection of the teeth, gingiva and lips. The shape and surface of the mouthguard which encloses the teeth, the gingival and the hard palate can vary depending on the anatomical features of the athlete's jaw, his/her dental arch, the type of sports activity, as well as the materials used in the manufacture of the mouthguard. Mouthguards should not extend distally further than the first molars because some athletes complain of the vomiting reflex. In addition, mouthguards may interfere with breathing. They should reach the mucogingival border labially and extend a few millimeters palatally in order to provide the best protection for the labial gingival and good retention. The labial flange should extend up to 2 mm of the vestibular reflection. The palatal flange should extend about 10 mm above the gingival margin thus enclosing the greatest part of the anterior palate surface with a slight narrowing distally not further than the first molars. Materials used in the manufacture of mouthguards should satisfy a number of physical, mechanical and biological requirements. Essential properties of materials used in the manufacture of mouthguards include water absorption, density, thickness as well as temperature transmission, energy absorption and drawing strength (tensile strength) of custom-made mouthguards. Such materials should have an optimal consistency in order to cushion the traumatic impact. Currently, ethylene-vinyl acetate (EVA) is the most commonly used mouthguard material. An optimal thickness of the mouthguard is achieved by the application of vacuum forming pressure-lamination technique in two layers of a thermoplastic sheet of EVA copolymer and if needed, by placing two layers of protective air-cells against the critical area. Some investigations in the Croatian samples showed that the most common injuries in water polo occur in the orofacial region (96.4% of cases), of which 80% are injuries of lips, tongue and cheek. In the period from 1997 to 2005 the number of orofacial injuries increased by 62%. Dental trauma occurs in 7.6% of cases. In basketball players soft tissue injury in the orofacial complex was established in 69.4% and dental trauma in 11.3% of the respondents. In the selected sample of handball players, soft tissue injuries were established in 78.8%, dental trauma and loss of teeth in 13.6% and temporomandibular joint injuries in 6.8% of the cases. In tae-kwon-do players 88% of orofacial injuries were lacerations, but only 12% reported dental and temporomandibular joint trauma. Only a half of the examined professional basketball players wore mouthguards, and none of the examined tae-kwon-do players. Clinical value of intraoral custom-made mouthguards was proven. Dentists play the key role in the prevention and treatment of sports-related dental and orofacial injuries, collection and dissemination of relevant information, as well as promotion of research on the preventive procedures related to injuries of such a specific aetiology.