Advantages of a Custom made Mouth Guard

There are a number of advantages to using a custom fit mouthguard or mouthpiece. While more expensive than traditional self-fitting appliances the benefits are far greater.

Benefits of Custom fit appliance:

  • The perfect custom fit on patients’ teeth and gums. Leads to increased retention and use.
  • Custom Trim. Appliances are meticulously cut, trimmed and polished to ensure retention
  • Performance enhancement – Studies show that athletic performance is increased while using.
  • Personalization. Guard can be made with team logos, names and individual colors.

These benefits should be considered by everyone considering a mouth guard or mouthpiece for athletics or physical training.

Understanding each one of these benefits will help dental practices, patients and athletes choose the right dental appliance to fit their needs.

The Perfect Fitting Mouthpiece: Increased patient Use

Patient compliance is one of the most difficult aspects of dentistry.   

Dental professionals are constantly asking patients to brush their teeth, floss, use mouthwash, wear their retainer, use a night guard, teeth whitening maintenance, etc.  

When patients follow these guidelines they experience greater dental health and a brighter smile.  

Patient compliance increases when two criteria are met.

  • Ease of Patient Use
  • Comfort for Patient

A custom made mouth guard or mouthpiece accomplishes both criteria necessary to increase patient compliance.

Ease of use: By fabricating a custom appliance athletes receive a perfect fitting mouth guard.  This makes the appliance much easier for athletes to use while training. Also, unlike a boil and bite self fitting appliance, custom fit guards require no re-fitting or re-boiling.

Comfort for Patient: The fit is exact and the flanges are trimmed to allow the cheeks and tongue to move with minimal interference. Comfort increases and patients are more likely to keep the appliance in when needed. This in-turn increases protection. 

The greatest advantages of a custom mouth guard’s exact fit is increased patient use and retention to teeth when impacts occur.

Retention to the teeth has a lot to do with how the appliance is trimmed or cut.

Custom Trim. Athletes and patients can specify exactly how they want the guard cut.

Retention is an important part of any mouthpiece. If the appliance does not stay in place when needed what is the point of wearing it.  

Many self fitting guards have thick flanges / edges and are ill fitting on the gum areas, especially near the vestibule. Custom-made mouthpieces should avoid this issue.

We spend a lot of time cutting, trimming and polishing Power-Up Mouthwear so the flanges are smooth and angled properly.  This allows the tongue and cheeks to move without interference. 

Also, dental offices and patients can request specific cuts of the appliance that help reduce gag reflexes and avoid sensitive areas in the dentition. 

This along with the perfect fit, maximizes comfort and patient use.

Beyond the amazing comfort, Power-Up mouth appliances provide an additional benefit: performance enhancement. 

How Does a mouth guard improve athletic performance?

Since early times human beings have known something is happening with our jaws when we begin to strain. We clench our teeth but never figured out what is actually happening until recently.  

Think about trying to open a jar’s lid that is stuck. A majority of people will clinch their teeth while twisting. But why?   

There are numerous examples over thousands of year:

  • Greek and Roman soldiers used a leather strap to bite on during battle to increase focus
  • Civil War soldiers would “bite the bullet” literally when under extreme pain. This is where the term originated. 
  • Pregnant women would clench down on birthing sticks to remain conscious

Common sense says these methods are done to avoid damaging the teeth and this is true.  

But why are we clenching down so much and so hard under stress in the first place? 

The answer is found in our evolution. As an evolving species we needed a quick trigger response to danger. Also known as the flight or fight response. 

Turns-out the trigger for this is our jaw and temporomandibular joint (TMJ).  

Similar to a turbo button in a video game. We hit this “booster” button by gnashing our teeth. Physically our condyle hits the fossa firing off nerves that send a signal to the brain that it is fight or flight time.  

This causes our body to release a cascade of hormones into our bloodstream.  The most influential of these hormones in cortisol. Cortisol is known as the stress hormone.

Cortisol can be beneficial in the short term by increasing energy and alertness. Unfortunately it has a big downside over time. This downside is fatigue. 

This fatigue is caused by an overload of cortisol and it helps make us tired and hungry. Our bodies and muscles now know that it is time to rest and recover after a physically stressful situation.

Essentially after we would fight or flight for our lives we need to recover. 

In today’s modern world though we have trained our bodies to continue.  We try to push our bodies and muscles to the limit, past and through the fatigue caused by cortisol. 

Where does a mouth guard come into play?

What if we could short circuit our body’s cortisol response to stress. Reduce overall exposure to cortisol in physically stressful situations.  

A mouthpiece can do this by reducing the number of times the condyle hits the fossa. By placing a wedge between the teeth, just like we have done throughout human history, we reduce the cortisol in our bodies.

The Power-Up mouth guard and mouthpiece wedge moves the lower jaw down and forward. 

This slight opening prevents the constant activation of the “fight or flight” response reducing cortisol and increasing endurance, strength and reaction time.

Has it been proven?  Yes. Studies show that cortisol is reduced when wearing mouth guards and mouthpieces. 

Cortisol reduction is not the only benefit.  Higher VO2 max levels and lower lactic acid levels have also been found in clinical studies.

Lactic acid levels are lower because athletes wearing the appliance breath easier.  There is a better exchange of oxygen which helps muscles perform better. 

The power wedge opening provides a better VO2 Max also.  

VO2 max in the amount of oxygen someone can utilize when exercising.  This measurement is used to figure out athletic endurance.

The benefits and clinical implications can not be overlooked by dental professionals:

“Dental care professionals have an obligation to understand the increasing research evidence in support of mouthpiece use during exercise and athletic activity and to educate their patients”

These aspects of custom fit appliances are clinical but a less clinical benefit might be the biggest factor for patients considering a custom appliance.  That is the personalization characteristics available in customization.  

Personalization. Guard can be made with team logos, names and individual colors.

When speaking to potential users it is important to share the aforementioned benefits but also the more fun aspects that will get them to “buy-in” to wearing a protective appliance.

One of the coolest parts about getting a custom mouth guard is the personalization that can be done.

Patient’s can pick from multiple color combinations, logos, names and numbers to fit their personality and team.  These can all be customized into the mouth guard.

In turn, patients want to show off their personalized mouth guard. The best way to do this is wear it during practices and games, accomplishing exactly what dentists recommend.  

There are numerous customization options when it comes to personalizing Power-Up Mouthwear but knowing which appliance to recommend is crucial. 

Which Power-Up Mouthwear to prescribe?

Recommending a mouth guard or a mouthpiece to your patient depends on which sport or activity they need it for.

In dental lab terms there is a difference between a mouthguard and mouthpiece.

Power-Up Mouthguards:

A mouth guard is made of a softer material known as ethyl-vinyl acetate (EVA). This is the ADA recommended material for mouth guards. 

Power-Up Mouthpieces:

A mouthpiece is made of a combination of hard-soft material.  Similar to some night guards, there is a hard layer on the occlusal surface and a soft layer underneath that rest on the surface of the teeth. This softer side provides a more comfortable fit on the teeth and gums.

Understanding what each is used for will help you recommend the proper appliance to your patients.  

Mouth Guards – Major Protection and Performance

Mouth guards provide protection with a softer material.  The softer EVA material is recommended because it absorbs impact better than a harder material.  A harder material can transmit the force of impact through it, onto the teeth and jaw.

While uncommon, mouth guards are sometimes made for the lower teeth arch per patient request. These still provide protection and are made by our dental lab upon request. 

A mouth guard is used for sports when there is a higher risk of contact or impact to the head or neck area.  This impact could cause damage to the teeth and jaw.

Examples of contact sports and activities when a mouth guard is most beneficial:

  • Football
  • Basketball
  • Hockey
  • Boxing
  • Mountain Biking
  • Snowboarding / Skiing

Protective appliances used while participating in these sports provides an additional safeguard against tooth damage and oral injury. 

Beyond that, the Power-Up Mouthwear adds another benefit – Performance enhancement.

As discussed above, cortisol and lactic acid levels are lowered when using an appliance with wedge technology.  Power-Up appliances have power wedges at no additional cost. 

This performance boost also makes it easier for athletes to breath increasing the available oxygen their bodies need. 

Power-Up appliances are great for in game use but that may not be the only appliance a patient would need.  Training and exercising will be part of every contact sports athletes routine. For this they would most likely need a gym appliance.  That is where the Power-Up mouthpiece works the best.

Mouthpieces – Performance and Minor Protection

Mouthpieces provide minor protection using a hard-soft material.  This allows for greater comfort on the teeth and gums with the softer side. The hard side provides a solid material for the occlusal (biting) surface.

Sealed between these layers is the power wedge which improves performance.  The wedge is placed over the first molars on each side of the lower arch.

This appliance is always made on the mandibular teeth (bottom teeth). When a patient bites down the wedge in the Power-Up mouthpiece moves the jaw slightly down and forward resulting performance benefits.

As for impact protection, there is very little.  The appliance will limit the amount of contact between the teeth because of the separation it creates.  This could help reduce the possibility of the teeth chipping or cracking the opposing tooth but the lower mouthpiece is not recommended for contact sports.

While we do not recommend the appliance for contact sports, some or our professional athletes still use it during games.  This is because the trim or cut of the appliance allows for a high level of communication compared to an upper mouth guard.

The labial strap on the lower Power-Up mouthpiece was revolutionary. Instead of the appliance interfering with speech it is trimmed so there is no interference on the lingual.  

Standard lower appliances would normally completely or partially cover the back of the lower anterior (front) teeth.  

This made it more difficult to clearly speak because the tongue was constantly hitting the appliance. 

Just try it out.  Say – “Count the number of times your tongue hits the back of your lower teeth when you say this sentence”.  It’s a lot…15-20 times at least. Speech is inhibited.  

With the lingual portion of the appliance removed the tongue can move normally, unimpeded and speech is clear.  

This increased clarity in communication actually leads to pilots, military personnel, soldiers and emergency workers using the Power-Up mouthpiece.  

Being able to speak without hindrance from an appliance allowed them to reduce their cortisol levels on the job.  They can be more focused, alert and less stressed.

The benefits of the Power-Up mouthpiece goes beyond just these professions.  The mouthpiece is also used for non-contact activities to improve performance and lower stress.

Examples of non-contact sports where a mouthpiece is most beneficial.

  • Baseball
  • Tennis
  • Golf
  • Training
  • Running
  • Gaming
  • Skiing
  • Yoga
  • Pilates

This list of possible uses is endless.  Some Doctors actually prescribe the appliance off label for the treatment of all kinds ailments.  

Since an appliance is completely removable and usage is completely reversible the downside for attempting to help their patients is extremely low. 

How should dental practices present this to patients?

Research has shown the benefits of specialized custom made appliances but it can be a difficult discussion for dental teams to have with their patients.  Presenting an idea that seems far fetched causes many to avoid the discussion altogether.

Surprisingly, in the case of performance enhancing Mouthwear, referencing the proven peer-reviewed research is less effective with patient than just discussing the anecdotal evidence. 

Talking to patients first about these three anecdotal topics is the most effective Mouthwear conversation starter.

First ask your patient

“Did you know a mouthpiece can improve your performance and lower stress?”

If they are interested reference one to three of these topics:

  • Pregnant mother’s bite birthing sticks during labor
  • Roman soldiers bit down on leather straps during battle
  • The term “Bite the bullet” for the Civil war.  Soldiers would actually bite a lead bullet to endure pain.

Then mention the recent proven research that qualifies these anecdotal, more familiar points.

Patients are more likely to say “yes” to getting fit with a custom appliance with this presentation strategy.  

In the end their custom Power-Up Mouthwear is more beneficial to their overall health and well-being. At a minimum this will provide a patient’s teeth and jaw protection from impact and the damage caused by clenching in stressful situations.


Author: William L Balanoff DDS, MS, FICD

Dr. William L. Balanoff graduated from Northwestern University and received a postdoctoral masters in cranio-facial research from Nova Southeastern University. Dr. Balanoff practiced clinical dentistry for 30 years. He was on staff at two hospitals in South Florida. Dr. Balanoff has taught at numerous academic institutions worldwide. Dr. Balanoff is published and sits on two different peer reviewed journal editorial boards both in dentistry and medicine. Dr. Balanoff has testified before the US Congress and helped craft public policy initiatives in the US as well as Russia, the Ukraine, Belorussia, Japan, Spain and England. Dr. Balanoff holds a number of patents for unique medical devices. Currently Dr. Balanoff is a science consultant for Abova Health, Executive Clinical Director of Orthodontic Care of Georgia and the CEO of Oral Care Perfected. Dr. Balanoff has appeared on the CBS show “The Doctors” for his groundbreaking research with respect to an oral appliance mitigating the motor and vocal tics associated with Tourette Syndrome.