Satisfaction with shortening the palatal extension of a mouthguard for water polo players: A randomized crossover study

Abstract

Background/aim Approximately 50% of water polo players have suffered orofacial injuries. However, fewer than 8% of players wear a mouthguard. A more comfortable mouthguard design is therefore needed to increase compliance. The aim of this study was to assess the effect of reducing the palatal extension of a custom‐made mouthguard on the degree of satisfaction with a mouthguard among water polo players. Materials and Methods Eighteen elite water polo players participated in this randomized crossover trial. Two custom‐made mouthguards were fabricated for each participant using 4‐mm‐thick ethyl vinyl acetate foils, defined by the extension of the palatal margin from the cervical line: conventional (6 mm) and shortened (2 mm). The mouthguards were worn during all training sessions and matches, in a randomized sequence (one mouthguard type for the first and fourth weeks and the other for the second and third weeks). Mouthguards were evaluated on 10‐point scales for discomfort, interference with oral functions, protection, and general satisfaction after each training session or match. Results Players evaluated the shortened mouthguard as having less interference with speech (Effect 1.30; P < 0.001), breathing (Effect 0.98; P = 0.004), swallowing (Effect 1.30; P < 0.001), and athletic performance (Effect 0.61; P = 0.03) compared with the conventional mouthguard. The perceived degree of protection was similar among participants when wearing each type of mouthguard. Overall, players were more satisfied with the shortened mouthguard (Effect 0.64; P = 0.03). Conclusions Reducing the palatal extension of a custom‐made mouthguard from 6 to 2 mm improves the overall satisfaction of elite water polo players without affecting the perceived degree of protection.

Effect of thickness and occlusal accommodation on the degree of satisfaction with mouthguard use among water polo players: A randomized crossover trial

“…13 Comfort can be increased if the palatal margin is extended only 2 mm from the cervical line and tapered, and if the buccal peripheries are rounded. 17,18 Interestingly, this study did not show that player comfort could be increased through occlusal adjustment of the mouthguard. 17 Although most regions of the conventional mouthguard did not reach the minimum recommended thickness of 2-4 mm, it must be conceded that having less protection from a thin but comfortable mouthguard is better than having no protection when players decline to wear one because it is considered too thick.…”

“…Therefore, the conventional custom-made mouthguard appears to offer a good balance between sufficient retention and tolerance. 18 Occlusal-accommodated mouthguards showed sufficient thickness, bilateral and balanced occlusion, and higher perceived protection during wear, suggesting that these should offer superior protection to conventional mouthguards. However, only two players (goalkeeper and 2-m offense/defense) preferred this type of mouthguard for training and competing, although younger players did seem to tolerate these mouthguards better than older players.…”

“…More specifically, players were also asked to rate any perceived protection, improvement in athletic performance, and satisfaction on a similar 10-point scale. 18,32 In the third session, each participant was interviewed to check compliance, to record side effects, and to assess both mouthguard preference and the reasons for that preference. Finally, to assess their value, the participants were asked to state the maximum amount of money (in Euros) they would be willing to pay for each mouthguard.…”

“…When designing any mouthguard for sports use, guidance recommends that its labial flange should extend to within 2 mm of the vestibular reflection, 2 mm of the palatal gingival margin, and that it should cover at least to the first maxillary permanent molar. 13,14,17,18 The recommended guide thicknesses are 3 mm labially, 3 mm occlusally, and 2 mm palatally, but the optimal values at different sites are not well established for each sport. It is known that thicker mouthguards offer greater protection, but this comes at the cost of greater interference with oral functions such as breathing, swallowing, and speech.…”

“…The sample size was determined by considering a type I error of 0.05, a power of 0.8 to find a difference ≥0.8 points in satisfaction between each mouthguard, an estimated within-standard deviation of 1.3 in degree of satisfaction,18 and an estimated dropout rate of 20%. Data from different training sessions and matches were not significantly different and, therefore, they were averaged for each participant and for each type of mouthguard.…”