Sports Medicine Research: In the Lab & In the Field: Mouthguard Use in Youth Ice Hockey & Why They Don't Wear Them (Sports Med Res)


Thursday, August 4, 2011

Mouthguard Use in Youth Ice Hockey & Why They Don't Wear Them

Patterns of Mouthguard Utilization among Atom and Pee Wee Minor Ice Hockey Players: A Pilot Study

Raaii F, Vaidya N, Vaidya K, DiBacco N, Les C, Sethi A and Vaidya R. Clin J Sport Med. 2011 July; 21(4): 320-324.

The correct usage of mouthguards during sports activities has been proven to reduce the risk of dental injuries and maxillofacial trauma. While the facts behind the benefits of proper mouthguard use are well established the issue of compliance remains largely unknown. Therefore, Raaii and colleagues, utilized a descriptive cross-sectional study to determine if youth hockey players were wearing their mouthguards correctly and, if not, why? The authors included 180 consenting travel hockey players between 9 and 12 year of age. All included participants that played in an Ontario-based “travel-level checking league,” where mouthguards were required. Surveys were completed under the direct supervision of both the coach and a researcher, following either a practice or game. The main outcomes measured by this self-reported survey was the type of mouthgaurd used, whether or not the participant correctly wore their mouthguard, and any reason for noncompliance. The results concluded that of the 180 players surveyed, 83 (46%) used a “boil-and-bite” mouthguard, 62 (34%) used a custom-made mouthguard, and 35 (19%) used a stock-type mouthguard. While a majority of respondents (68%) reported they used their mouthguards “almost always,” only 92 (51%) reported they wore their mouthguards properly during practice. Furthermore, only 57 (32%) players reported that they properly wore their mouthguards during games. Custom-made mouthgaurds had the highest compliance followed by boil-and-bite. Stock-type mouthguards had the least compliance. Older players, compared to younger players, tended to not wear their mouthguards properly as often. When asked why they were noncompliant, the largest group of participants (43%) listed a difficulty talking as the primary reason for noncompliance. Other reasons included feeling of difficulty breathing and improper fit of the mouthguard (players were allowed to choose multiple reasons).

Overall, this study revealed some very interesting results and highlights the need for more education of players with respect to correct mouthguard usage. Particularly interesting, was the association between athlete’s age and reason for noncompliance. The authors suggest that as individual skills progress, teams begin to focus on working collectively; therefore, communicating effectively is increasingly important. The type of mouthguard may also influence compliance not just because of comfort but because custom-made mouthguards may make players like feel they can communicate more effectively. In the current study, compliance and proper use were self-reported and they found a high rate of noncompliance but it would be interesting to see how their results compare to data generated by someone verifying compliance and proper use of mouthguards. What are some habits that you see in your everyday practice? Have any of your athletes expressed any of the issues for noncompliance reported by these participants? If so, how do you handle these complaints? Also, do you observe any differences in age of your athlete with respect to mouthguard utilization?

Written by: Kyle Harris
Reviewed by: Jeffrey Driban


Jay Clark ATC said...

In youth hockey programs in my hometown, a lot of the young athletes have used mouthguards incorrectly, biting theirs in their mouth like Patrick Kane does after the whistle blows. This practice creates a lot of wear and tear on these mouthguards. Some of the kids stopped using them instead of getting a new one.

I've handled a lot of these complaints by having a stock of mouthguards with both me and in the ATR. But I don't see any raise in compliance just by letting kids replace their mouthguards.

I'm becoming more of a proponent in participation education of young athletes and their parents regarding the rationale behind mouthguard use. And I think that this study really shows how many athletes can take away useful information from this.

Finally, I think that we can get coaches to help out with communication issues by teaching athletes alternatives to talking. The coach that I worked with had kids hit the blade of the stick on the ground when they wanted the puck instead of calling for it. I also think that with enough time with the team, more nonverbal methods can be utilized, and hopefully that can raise compliance rates.

Kirsten Miner said...

Mouthguards can feel cumbersome and uncomfortable. A lot of the complaints I've gotten are that its too big and its rubbing the insides of the athlete's cheeks or gums. In these cases either the mouthguard wasn't molded in the first place or it was molded improperly. While mouthguards do change your ability to talk clearly most commands from teammates on the field are one word and not many syllables so in some cases its a matter of practicing with the mouthguard to get used to it and figure out how to talk on the field. Jay, I agree with you that as teams grow together and as athletes get older their field sense improves and they know where their teammates are without needing to always hear them. Most contact sports require the use of mouthguards and most coaches I've worked with will not let an athlete participate in games without a proper mouthguard; this helps with compliance.
All mouthguards I've seen have been one size fits all. In terms of improving compliance I think it would help to have S, M, L sizes to at least try and accommodate different size mouths. Youth athletes and females tend to have smaller mouths than males or adult athletes. Having size options plus molding the mouthguard I think will greatly improve the comfort and compliance.

Kyle Harris said...


I enjoyed your comments about the different sizes of mouthguards. Thank you. I agree that having different sizes would increase the likelihood of the mouthguard properly fitting. I think the most crucial factor, which you pointed out, is the cooperation of the coaching staff. In the case of sports which require mouthguards, I try to make proper mouthguard fitting technique, and common signs a mouthguard has been improperly modified part of my seasonal coaches meeting. I think that if you have good coach support, and equip them with the tool necessary to identify improperly fitted mouthguards and/or educate their athletes on proper mouthguard fitting, ensuring that all athletes have proper mouthguards is a much more manageable task for the clinician. Thanks for the comment!

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