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From the National Federation of State High School Associations

Mouth Guards in High School Sports: NFHS Position Statement

  • Prior to implementation of the NFHS mouth guard rule an athlete participating in contact sports had a 10% chance of sustaining a significant oral-facial injury each season and better than a 50% chance during their secondary school careers.
  • Multiple studies by the American Dental Association, the American Academy of Pediatric Dentistry, and the American Academy of Sports Dentistry convincingly show the reduction of oral-facial injuries with the use of mouth guards.
  • Properly fitted mouth guard use has been shown to reduce the oral-facial injury rate significantly in sports where it has been mandated. For example, prior to the use of properly fitted mouth guards and facemasks, over 50% of football players’ injuries were oral-facial. They now represent less than 1% of injuries.

  • NFHS currently mandates the use of mouthguards in football, field hockey, ice hockey, lacrosse and wrestling (for wrestlers wearing braces).
  • Intra-oral mouth guards should include an occlusal (protecting and separating the biting surfaces) and a labial (protecting the teeth and supporting structures) and cover all of the upper teeth.

  • Mouth guards which cover the lower rather than the upper teeth may be used if recommended by a dentist for a specific student- athlete. It is recommended that mouth guards be properly fitted and not be altered to decrease protection.

  • It is recommended that the mouth guard be properly fitted by: (1) being constructed from a model made from an impression of the individual’s teeth or (2) being constructed and fitted to the individual by impressing the teeth into the mouth guard itself. Mouthguards used in wrestling must be designed to cover upper and lower orthodontic appliances. Mouthguards must be of any visible color other than clear or white to allow for easy rule enforcement by officials (except wrestling).
  • The Sports Medicine Advisory Committee of the NFHS recommends to all NFHS sports rules committees that they consider a rule for the use of properly fitted unaltered mouth guards for participation in any sport where there is potential for oral-facial injury from body contact.
  • Current research does not support the use of mouth guards in reducing the occurrence of Mild TraumaticBrain Injury (Head Trauma/Concussion). The Sports Medicine Advisory Committee of the NFHS encourages further research in this important area.
  • A properly fitted and unaltered mouthguard has been shown not  to impede communication, breathing, or create any hazards to the airway or oral cavity.

Below are shown the types of mouthguards, which comply with NFHS rules and the relative advantages, and disadvantages of each.

Mouthguard Type Advantages Disadvantages
Boil and Bite
Form fitted
Deteriorate over time
May not last entire season
Pressure on cheeks and gums if not fitted well

Custom fit Most accurate fit
Most comfortable
Most protection
Most expensive
Several trips to dentist required

Easily fits over orthodontic appliances

Poor fit or easily dislodged


Source: National Federation of State High School Associations

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