What Is an Orthodontic Mouthguard?
An orthodontic mouthguard is a protective device worn over teeth and braces during physical activity. It cushions the teeth, brackets, wires, lips, cheeks, and gums from impact.
Standard mouthguards are designed for teeth without braces. They fit tightly against the tooth surface. When brackets and wires are present, a standard mouthguard either will not fit or can press hardware into soft tissue during a hit. Orthodontic mouthguards solve this problem by leaving extra space around the brackets.
Mouthguards for braces are made from flexible, medical-grade materials such as ethylene-vinyl acetate (EVA). EVA is a soft, rubbery plastic that absorbs shock. The guard covers the upper teeth in most cases, since the upper jaw and front teeth face the highest risk of injury during sports. Some orthodontists recommend a lower guard as well, depending on the sport and the type of braces. [2]
The American Association of Orthodontists encourages athletes with braces to wear a properly fitted mouthguard for any sport that involves contact, falls, or flying objects. [1]
How Orthodontic Mouthguards Work
A mouthguard absorbs and distributes the force of a blow across a wider area, reducing the chance of broken teeth or damaged brackets.
When an impact strikes your face, the energy concentrates at the point of contact. Without a guard, that force transfers directly to the teeth and braces. Brackets can snap off, wires can bend or puncture soft tissue, and teeth can chip or fracture. A mouthguard acts as a shock absorber. It spreads the force across the entire surface of the guard rather than letting it focus on one tooth or bracket.
Orthodontic versions differ from regular mouthguards in a few important ways. They are typically thicker on the front surface to create a buffer zone around the brackets. They also have a slightly looser internal fit. This looser fit is intentional. Because orthodontic treatment gradually moves teeth, the mouthguard cannot grip the teeth as tightly as a regular sports guard would. A tight fit could interfere with tooth movement or make the guard uncomfortable as teeth shift between adjustment appointments.
Most orthodontic mouthguards use a layered design. The inner layer is softer and conforms to the shape of the teeth and brackets. The outer layer is firmer and provides structural strength against impact. This combination gives both comfort and protection.
Materials and Design Features
The most common material is EVA plastic. It is non-toxic, BPA-free, and easy to mold with heat. Some custom versions use a dual-laminate or triple-laminate construction, where multiple layers of different densities are bonded together under pressure.
Key design features of a mouthguard for braces include a wider arch form to accommodate brackets, rounded edges to avoid irritating the gums, and enough thickness on the labial surface (the side facing the lips) to prevent bracket imprints during impact. Many also feature a flat occlusal surface (the biting surface) so the upper and lower teeth meet evenly when the jaw closes.
When You Need a Mouthguard with Braces
Any sport with a risk of contact, collision, or falling warrants a mouthguard, especially when braces are involved. [2]
Contact and Collision Sports
Sports like football, hockey, lacrosse, boxing, and martial arts carry a high risk of direct blows to the face. A mouthguard is considered essential equipment in these activities. Many sports leagues require mouthguards regardless of whether a player wears braces.
For braces wearers, the stakes are higher. A hit to the mouth can break multiple brackets at once, requiring an emergency orthodontic visit. Loose brackets can also cut the inside of the cheeks and lips. A properly fitted orthodontic mouthguard significantly reduces these risks.
Non-Contact Sports with Falling Risk
Sports like basketball, soccer, gymnastics, skateboarding, and mountain biking involve frequent falls or incidental contact. The American Dental Association recommends mouthguards for these activities as well. [2]
Many patients and parents overlook mouthguard use in sports that seem low-risk. However, an accidental elbow during a basketball game or a fall from a bicycle can cause serious dental and orthodontic damage. The brackets on braces can act like small blades against the inside of the lips during impact.
Recreational Activities
Roller skating, scootering, skiing, and even playground activities can result in falls that affect the mouth. If the activity could cause a fall onto a hard surface, wearing a mouthguard is a reasonable precaution.
Patients with braces who participate in multiple activities benefit from keeping a mouthguard in their sports bag at all times. Some orthodontists provide a protective case along with the guard.
Evidence and Professional Recommendations
Dental and orthodontic professional organizations consistently recommend mouthguard use during sports to reduce oral injuries. [1] [2]
The American Association of Orthodontists (AAO) advises all patients with braces to use a mouthguard when playing sports. The AAO recommends that patients ask their orthodontist for guidance on the best type for their specific treatment. [1]
The American Dental Association (ADA) has long supported mouthguard use for athletes. The ADA notes that mouthguards help prevent broken teeth, injuries to the lips and face, and possible jaw fractures. [2] These recommendations apply to all athletes but carry additional importance for those with fixed orthodontic appliances.
Research on dental injuries in sports generally shows that mouthguard use reduces the incidence and severity of oral trauma. However, specific large-scale studies comparing injury rates in braces wearers with and without mouthguards are limited. The available evidence supports their use based on general mouthguard research and the added vulnerability created by orthodontic hardware.
Regulatory Status
The FDA classifies mouthguards as Class I medical devices under regulation number 872.3500. [3] Class I is the lowest-risk category. Most mouthguards in this class are exempt from premarket notification (510(k)) requirements. This means over-the-counter mouthguards sold for sports use do not go through the FDA's premarket review process for clearance or approval before reaching store shelves. Custom mouthguards made by a dental professional are fabricated as part of clinical care, similar to other dental appliances.
It is worth noting the distinction between the two main FDA review pathways. FDA clearance through the 510(k) process means a device has been reviewed and found substantially equivalent to an existing device. FDA approval through the premarket approval (PMA) process involves more rigorous testing, typically for higher-risk devices. Because most mouthguards are exempt from both of these premarket pathways, quality can vary between brands. Choosing a product that meets standards set by organizations like the ADA can help ensure adequate protection.
Benefits and Limitations
Orthodontic mouthguards offer real protection, but each type has trade-offs in fit, comfort, cost, and convenience.
Advantages
The primary benefit is injury prevention. A mouthguard shields the soft tissues of the lips and cheeks from being cut by brackets and wires during an impact. It also reduces the chance of brackets breaking off, which saves time and money on emergency repairs.
Mouthguards can also protect against more serious injuries. Tooth fractures, root damage, and tooth avulsion (a tooth being completely knocked out) are possible during sports. These injuries may require treatment from a specialist such as an endodontist or oral surgeon. Preventing them in the first place is far simpler and less costly.
For athletes with braces, a mouthguard can also improve confidence during play. Worrying about damaging braces can distract from performance. A well-fitted guard lets the athlete focus on the sport.
- Protects brackets and wires from breakage during impact
- Shields lips, cheeks, and gums from being cut by orthodontic hardware
- Reduces the risk of tooth fractures and avulsions
- May reduce the need for emergency orthodontic appointments
- Available in multiple types to fit different budgets and preferences
Limitations
No mouthguard eliminates all risk of injury. A very hard blow can still damage teeth and braces even with a guard in place. Mouthguards reduce risk; they do not remove it entirely.
Fit is an ongoing challenge for braces wearers. Because orthodontic treatment moves teeth continuously, a mouthguard that fits well today may not fit as well in a few weeks. Boil-and-bite guards can be re-molded, but they lose effectiveness after several remoldings. Custom guards may need to be remade multiple times during treatment, adding to the overall cost.
Some patients find mouthguards uncomfortable or report that they make breathing and speaking more difficult. Thicker guards offer more protection but can feel bulky. Finding the right balance between protection and comfort sometimes requires trying more than one product.
- Fit changes as teeth move during treatment, requiring periodic replacement or remolding
- Custom-made guards can be expensive and may need to be remade several times
- Boil-and-bite options may not fit as precisely as custom versions
- Stock mouthguards do not fit over braces and are not recommended [2]
- Some athletes find mouthguards uncomfortable or difficult to breathe through
Cost and Availability
Mouthguard prices range widely depending on the type. Costs vary by location, provider, and case complexity.
Stock mouthguards cost roughly $1 to $5 at most sporting goods stores. However, as noted, they are not suitable for braces because they cannot accommodate brackets. They are mentioned here only for comparison.
Boil-and-bite mouthguards designed for braces typically cost $10 to $50. These are available at sporting goods stores, pharmacies, and online retailers. Look for products specifically labeled for use with braces or orthodontic appliances. These guards include extra room in the front to fit around brackets.
Custom-made mouthguards from an orthodontist or dentist typically cost $100 to $500 or more. The higher cost reflects the use of professional dental impressions or digital scans, laboratory fabrication, and a precisely fitted end product. Some orthodontic offices include a sports mouthguard as part of the overall treatment fee. Others charge separately. Ask your orthodontist about pricing before assuming it is or is not included.
Insurance Coverage
Most dental insurance plans do not cover sports mouthguards. Some plans may provide partial coverage for custom-made guards if they are prescribed by a dentist or orthodontist. Health savings accounts (HSAs) and flexible spending accounts (FSAs) may be usable for mouthguard purchases in some cases. Check with your insurance provider and benefits administrator for specific coverage details.
Even without insurance coverage, the cost of a mouthguard is typically far less than the cost of repairing broken brackets, replacing avulsed teeth, or treating a fractured jaw. A single bracket repair visit can cost $50 to $300, and emergency dental treatment for a knocked-out tooth can run into thousands of dollars.
What to Ask Your Orthodontist
Your orthodontist is the best resource for choosing the right mouthguard for your braces and your sport. [1]
Before your next appointment, prepare a few questions. Knowing what to ask helps you get specific guidance rather than generic advice. Your orthodontist sees sports-related bracket damage regularly and can offer practical recommendations based on your type of braces, the sport you play, and how far along you are in treatment.
Bring your current mouthguard to the appointment if you have one. Your orthodontist can check whether it still fits properly or whether it needs to be replaced. If you are getting braces for the first time and already play a sport, ask about mouthguard options during the initial consultation.
- Which type of mouthguard do you recommend for my braces and my sport?
- Do you make custom mouthguards in this office, and what is the cost?
- How often will my mouthguard need to be replaced or re-fitted as my teeth move?
- Should I wear a mouthguard on my lower teeth as well, or just the upper?
- Are there any specific brands of boil-and-bite guards you recommend for patients with braces?
- If I have a clear aligner instead of brackets, do I still need a separate mouthguard?
Find an Orthodontist Near You
An orthodontist can evaluate your braces, recommend the right type of mouthguard, and create a custom-fitted option if needed. To find a qualified specialist who can help protect your teeth during sports, visit the orthodontics page and search for providers in your area.
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