Custom Mouthguards and Dental Splints: Protecting Teeth from Sport, Grinding, and Sleep Apnoea product guide

Custom Mouthguards and Dental Splints: Protecting Teeth from Sport, Grinding, and Sleep Apnoea

Most patients who walk into a general dental practice think of protective appliances as an afterthought - something to ask about if there's time after the check-up. That framing underestimates what is arguably the most cost-effective category of dental treatment available. A custom-fitted mouthguard, occlusal splint, or mandibular advancement splint (MAS) can prevent thousands of dollars in restorative work, spare patients months of pain and inconvenience, and - in the case of sleep apnoea management - meaningfully reduce systemic health risks.

This guide covers the three principal protective dental appliances provided in a general dentistry setting: sports mouthguards, occlusal splints for bruxism, and mandibular advancement splints for obstructive sleep apnoea (OSA). It explains how each appliance works, how it is fabricated, what the clinical evidence says, and - critically - why the custom-fabricated version is clinically superior to anything available over the counter.

Why Protective Dental Appliances Belong in General Dentistry

Protective appliances sit at the intersection of preventive and restorative care - they stop damage before it requires treatment. A knocked-out tooth, a worn-down molar, or an unmanaged apnoea event each carries cascading consequences for oral and systemic health. Oral damage is often irreversible, frequently complex, difficult, and costly to repair, and dental injuries can result in time off school or work to recover, can be painful and disfiguring, and may involve lengthy and complex dental treatment.

The three appliances covered here serve distinct clinical purposes, are prescribed for different patient populations, and are fabricated using different techniques - yet they share one critical trait: their effectiveness depends almost entirely on precision of fit. That precision can only be achieved through custom fabrication in a dental practice.

Part 1: Custom Sports Mouthguards

The Scale of the Problem in Australia

Sports-related injuries account for 40% of dental injuries, yet only 36% of Australians wear a mouthguard when playing contact sport. The injury burden is not trivial: about 2,000 dental injuries were treated in Victorian hospital emergency departments between 2002 and 2004, with people under 25 most at risk (71%), and dental injuries can be painful, disfiguring, and expensive to treat.

Research on rugby union players in New South Wales illustrates the stakes clearly. The prevalence of orofacial trauma in rugby union players is 64.9%, with the most common injury being laceration to intraoral and extraoral soft tissues at 44.5%, and 41.9% of all orofacial injuries were to the dentition.

Rates of orofacial trauma and complications in amateur rugby union players are high in Australia, and use of mouthguards results in significant risk reduction for complications following dental injuries, including loss of tooth.

The protective effect is substantial. Wearing a mouthguard can reduce the risk of dental injuries by more than half, and although it's unclear if mouthguards prevent concussions, they are essential for sports where dental injuries are common.

Which Sports Require a Mouthguard?

The answer is broader than most patients assume. Sports with the highest risk of dental injuries include basketball, football, hockey, martial arts, and boxing. However, the risk extends well beyond contact sports. Sports such as football, boxing, basketball, netball, cricket, hockey and soccer account for up to 14 per cent of dental injuries, and any sport where contact with equipment, collision with other players, or falling is possible (even accidentally) carries a risk of dental injury.

The Australian Dental Association (ADA) and Sports Medicine Australia (SMA) jointly recommend that mouthguards be worn not only during competition but also during training - a point frequently overlooked. The prevalence of mouthguard use during match play varied between 60% for juniors and 90% for elite footballers, whereas mouthguard use during training ranged between just 2% for junior and 40% for elite players.

Custom vs. Over-the-Counter: What the Evidence Shows

There are three categories of mouthguard available to Australian consumers: stock (one-size-fits-all), boil-and-bite (self-thermoplastic), and custom-fabricated. The clinical hierarchy is unambiguous.

Over-the-counter (boil-and-bite) mouthguards include stock mouthguards that do not require fitting, and mouthguards that can be placed in hot water and then self-fitted by biting into them - but these offer little or no protection and can dislodge during play.

A critical biomechanical problem with the boil-and-bite approach is material thinning. An athlete's uncontrolled biting force can lead to excessive thinning (70%–99%) of the mouthguard, which diminishes its protective capacity.

A 2024 randomised parallel-arm clinical trial published in Dental Traumatology (Doğan et al.) directly compared custom-made mouthguards of varying thicknesses against boil-and-bite alternatives in professional basketball players. Custom-made mouthguards with different thicknesses consistently outperformed boil-and-bite mouthguards in all measurements, indicating the potential to tailor mouthguard thickness based on sport, age, professional level of athlete, and presence of other protective equipment. A meta-analysis of the same literature base found that custom-made mouthguards significantly outperformed self-adapted types in comfort metrics, particularly in fit (P = .0002) and reducing speech difficulty (P < .00001), and breathing difficulty was also less in custom-made mouthguards.

Custom-fitted mouthguards are superior to over-the-counter mouthguards and are made by a dental practitioner from a dental impression (mould) and a plaster model of the teeth, providing the best protection, fit, and comfort for all levels of sport.

How a Custom Sports Mouthguard Is Made at Smile Solutions

The fabrication process at a practice like Smile Solutions Melbourne CBD involves:

1. Dental impression - Alginate or digital scan captures the precise contours of the upper arch (occasionally lower, depending on the patient's occlusion and sport).
2. Plaster model - A stone cast is poured from the impression, providing the working model for the laboratory.
3. Vacuum or pressure forming - Ethylene vinyl acetate (EVA) sheeting is thermoplastically formed over the model under controlled pressure, producing consistent thickness throughout.
4. Trimming and finishing - The mouthguard is trimmed to the correct gingival margin, polished, and checked for occlusal balance.
5. Fitting appointment - The patient tries the appliance in; the dentist checks retention, occlusion, and comfort, making adjustments where needed.

The dentist can also vary the thickness of the EVA material based on the specific demands of the sport - a contact sport like AFL or rugby warrants a thicker guard (typically 4–6 mm in the impact zone) compared to a lower-contact activity. Your dentist can customise your mouthguard based on the specific demands and physical impact levels of your chosen sport, and can also adjust the thickness in high-impact areas and accommodate any dental work you may already have, such as braces or bridges.

Who at Smile Solutions Should Consider a Sports Mouthguard?

• Adults and children playing any collision, contact, or limited-contact sport
• Patients with significant restorative work (crowns, veneers, implants) that would be costly to replace
• Patients with orthodontic appliances (a modified design accommodates brackets and wires)
• Patients with prominent upper teeth, which are statistically more vulnerable to trauma

Part 2: Occlusal Splints for Bruxism (Teeth Grinding)

What Is Bruxism and How Common Is It?

Bruxism, characterised by involuntary rhythmic contractions of the masseter muscles and excessive teeth grinding, is a commonly overlooked yet significant condition, with symptoms that can manifest during wakefulness or sleep.

Sleep bruxism is most common in children, affecting 15% to 40% of children, and 8% to 10% of adults, while wake bruxism affects 22.1% to 31% of the population.

Sleep bruxism has oral health implications including tooth wear, fractures, and orofacial discomfort, which require effective interventions.

Sleep-related bruxism can cause considerable damage to teeth and dental work, resulting in morning jaw pain or fatigue, temporal headaches, and restricted motion of the temporomandibular joint.

An important comorbidity to note: obstructive sleep apnoea is a contraindication to the use of an occlusal splint, as occlusal splints can worsen obstructive sleep apnoea, and patients with sleep bruxism and obstructive sleep apnoea who need protection for their teeth should use a mandibular advancement device instead. This is a clinically significant distinction that underscores the importance of a thorough patient assessment before prescribing any splint.

What an Occlusal Splint Does - and What It Doesn't

An occlusal splint is a removable appliance worn in the upper jaw (maxilla) or the lower jaw (mandible), with coverage of the dental surfaces, and is usually used to prevent tooth wear.

The evidence base for occlusal splints requires honest framing. A Cochrane systematic review (Macedo et al., Cochrane Database of Systematic Reviews, 2007) concluded that there is not enough evidence in the literature to show that occlusal splints can reduce sleep bruxism, and the indication for use is questionable with regard to sleep outcomes, but it may be that there is some benefit with regard to tooth wear. A more recent systematic review published in the Journal of Oral Rehabilitation (2021) similarly found that there is insufficient evidence to determine whether occlusal splint therapy for the treatment of bruxism provides a benefit over no treatment, other oral appliances, TENS, behavioural or pharmacological therapy, and there is a lack of studies in each comparison with many suffering from a high risk of bias.

However, a 2024 systematic review published in BMC Oral Health (Farghal et al.) concluded that occlusal splint therapy is a viable treatment approach for sleep bruxism.

The clinical consensus, supported by StatPearls (NCBI, 2024), is that while splints may not eliminate the underlying parafunctional behaviour, they serve as a sacrificial protective barrier - the splint wears instead of the teeth. For patients presenting with visible attrition, fractured restorations, or TMJ tenderness, this protective function is clinically valuable even in the absence of definitive evidence that grinding frequency is reduced.

Hard vs. Soft Splints: Which Is Better?

The most commonly prescribed occlusal splint in general dentistry is the hard acrylic Michigan-style splint, worn on the upper arch. Soft thermoplastic splints are also available and are generally less expensive, but the utilisation of occlusal splints has emerged as a significant treatment modality, with various splints existing, each possessing distinct benefits and drawbacks. Hard splints are generally preferred for patients with significant wear facets, as they provide a more stable occlusal platform and are more durable under high grinding forces.

Fabrication and Fitting at Smile Solutions

1. Clinical assessment - The dentist examines for wear facets, tooth fractures, masseter hypertrophy, and TMJ tenderness. A sleep history is taken to rule out OSA before prescribing a splint.
2. Impressions - Upper and lower arch impressions are taken (both arches are needed to fabricate a correctly balanced splint).
3. Bite registration - A wax or silicone bite record captures the patient's habitual occlusion.
4. Laboratory fabrication - A hard acrylic splint is processed over the stone model, typically covering the full upper arch.
5. Fitting and occlusal adjustment - The dentist adjusts the splint with articulating paper to ensure even bilateral contacts and canine guidance on lateral excursions.
6. Review appointment - Typically scheduled 2–4 weeks after fitting to assess wear, comfort, and compliance.

Who at Smile Solutions Is a Candidate for an Occlusal Splint?

• Patients presenting with flattened, worn, or chipped tooth surfaces (attrition)
• Patients reporting jaw soreness, headaches, or facial muscle pain on waking
• Patients with a history of fractured fillings or cracked teeth without a clear traumatic cause
• Patients with clinically confirmed TMJ tenderness or clicking
• Patients with high-stress lifestyles (bruxism has a well-established association with psychosocial stress)

Note: Patients who also report snoring, witnessed apnoeas, or excessive daytime sleepiness should be screened for OSA before an occlusal splint is prescribed - see the section below and our related guide on [Emergency Dental Care in Melbourne CBD] for more context on how systemic conditions intersect with dental presentations.

Part 3: Mandibular Advancement Splints for Obstructive Sleep Apnoea

The Dental Role in Sleep Medicine

Obstructive sleep apnoea is a systemic condition with serious cardiovascular, metabolic, and neurocognitive consequences - yet the dental practice is often the first point of professional contact. Dentists are uniquely positioned to identify OSA risk factors during routine check-ups (see our guide on [Dental Check-Ups at Smile Solutions Melbourne CBD]) because the oral examination reveals anatomical risk factors including a narrow palatal arch, macroglossia, retrognathia, and significant tonsil enlargement.

Mandibular advancement splint (MAS) therapy emerged as an effective therapy for obstructive sleep apnoea in the mid-1990s and is now the leading treatment alternative for OSA.

MAS is an oral appliance which protrudes the mandible in relation to the maxilla, causing movement of soft tissues (tongue and soft palate) to increase the calibre of the upper airway and reduce its collapsibility.

How Effective Is a MAS?

A landmark randomised controlled trial published in the American Journal of Respiratory and Critical Care Medicine (Neill et al., 2001) found that the MAS resulted in a significant reduction in apnoea-hypopnoea index (AHI) by 53%, arousal index by 34%, mean snoring frequency by 47%, and mean intensity by 3 dB, compared with the control plate.

While CPAP (continuous positive airway pressure) remains the gold-standard treatment for moderate-to-severe OSA, it appears appropriate to offer oral appliance therapy to those who are unwilling or unable to persist with CPAP therapy, though CPAP must still be considered the gold standard treatment for OSA. MAS therapy is particularly well-evidenced for mild-to-moderate OSA and for patients who demonstrate CPAP intolerance - a common clinical scenario.

Long-Term Dental Monitoring for MAS Patients

Patients should understand that long-term MAS use is associated with measurable dental changes. A retrospective study from the University of British Columbia (Pliska et al., Journal of Clinical Sleep Medicine, 2014) followed 77 patients over an average of 11.1 years and found that over the total treatment interval there was a significant reduction in overbite (2.3 ± 1.6 mm), overjet (1.9 ± 1.9 mm), and mandibular crowding (1.3 ± 1.8 mm).

Mandibular advancement splints are an effective, noninvasive treatment option for snoring and obstructive sleep apnoea, but the prudent clinician will be aware of these dental changes and discuss them openly with patients in their care.

This is why MAS patients at Smile Solutions are reviewed at regular intervals - typically every six months - to monitor occlusal changes and adjust the appliance as needed.

MAS Fabrication at Smile Solutions

1. Screening and referral coordination - The dentist screens for OSA risk using validated tools (e.g., STOP-BANG questionnaire) and, where indicated, coordinates with a sleep physician for formal polysomnography diagnosis before fabrication.

2. Impressions of both arches - Full-arch impressions are taken to capture the precise dental anatomy.

3. Construction bite - A protrusive bite record is taken, typically positioning the mandible at 50–75% of maximum protrusion to balance efficacy with tolerance.

4. Laboratory fabrication - Each MAS is custom-made from dental impressions, with a wax interocclusal record taken with the mandible in the most protrusive position the patient can comfortably maintain, producing upper and lower removable clear acrylic plates with full occlusal coverage that fit onto both dental arches.

5. Titration appointments - The dentist incrementally advances the mandibular component over several weeks until therapeutic effect is achieved or the maximum comfortable limit is reached.

6. Ongoing review - Regular monitoring for occlusal changes, TMJ comfort, and appliance integrity.

Who at Smile Solutions Is a Candidate for a MAS?

• Patients with a confirmed diagnosis of mild-to-moderate OSA from a sleep physician
• Patients with severe OSA who cannot tolerate CPAP
• Patients who snore significantly without a confirmed OSA diagnosis (where a MAS may be trialled under dental supervision)
• Patients with concurrent bruxism and OSA (where a MAS addresses both conditions simultaneously, unlike an occlusal splint which is contraindicated in OSA)

Appliance Comparison: Quick Reference

Key Takeaways

• Sports-related injuries account for 40% of dental injuries in Australia, yet only 36% of Australians wear a mouthguard when playing contact sport

• a gap that custom-fabricated appliances can directly address.

• Custom-fitted mouthguards are superior to over-the-counter alternatives and are made from a dental impression and plaster model of the teeth, providing the best protection, fit, and comfort for all levels of sport.

• Occlusal splints for bruxism are best understood as a protective barrier against tooth wear rather than a cure for grinding behaviour; the evidence for reducing bruxism frequency is currently insufficient, but their role in protecting existing tooth structure is clinically well-accepted.

• Obstructive sleep apnoea is a contraindication to occlusal splints, as splints can worsen OSA; patients with both bruxism and OSA should use a mandibular advancement device.

• Long-term MAS patients require regular dental monitoring: over a decade of treatment, significant reductions in overbite, overjet, and mandibular crowding have been documented and must be managed proactively.

Conclusion

Custom mouthguards and dental splints represent the preventive end of the restorative spectrum - they are investments that protect existing dentition, existing restorations, and, in the case of mandibular advancement splints, systemic health. The clinical evidence is clear that custom fabrication is not merely a premium option but a clinical necessity: over-the-counter alternatives suffer from inconsistent thickness, poor retention, and inadequate coverage that can create a false sense of security.

At Smile Solutions Melbourne CBD, the prescription of protective appliances is embedded within the broader general dentistry framework - informed by a thorough dental check-up, supported by intraoral imaging, and tailored to each patient's specific anatomy and lifestyle. Patients who grind, play contact sport, or snore are encouraged to raise these concerns at their next routine appointment.

For related reading, see our guides on [Dental Check-Ups at Smile Solutions Melbourne CBD: What to Expect at Every Stage], [How to Prevent Tooth Decay and Cavities: A Practical Home-Care and In-Clinic Prevention Guide], and [Emergency Dental Care in Melbourne CBD: What Qualifies as a Dental Emergency and What to Do First].

Smile Solutions has been providing dental care from Melbourne's CBD since 1993. Located at the Manchester Unity Building, Level 1 and 10, 220 Collins Street, Smile Solutions brings together 60+ clinicians - including 25+ board-registered specialists - who have cared for over 250,000 patients. No referral is required to book a specialist appointment. Call 13 13 96 or visit smilesolutions.com.au to arrange your TMD and sleep treatment consultation.

References

• Australian Dental Association (ADA). "Policy Statement 2.2.5 – Prevention and Management of Oral Injuries." Australian Dental Association, 2023. https://ada.org.au/policy-statement-2-2-5-prevention-and-management-of-oral-injuries

• Better Health Channel, Victorian Government. "Mouthguards." Better Health Channel, 2023. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/mouthguards

• Sports Medicine Australia. "Dental Injuries." Sports Medicine Australia Injury Fact Sheets, 2024. https://sma.org.au/resources/injury-fact-sheets/dental-injuries/

• Doğan, M.C., et al. "Comfort and Wearability Properties of Custom-Made and Boil-and-Bite Mouthguards Among Basketball Players: A Randomized Parallel Arm Clinical Trial." Dental Traumatology, 2024. https://onlinelibrary.wiley.com/doi/10.1111/edt.12918

• Macedo, C.R., Silva, A.B., Machado, M.A.C., Saconato, H., Prado, G.F. "Occlusal Splints for Treating Sleep Bruxism (Tooth Grinding)." Cochrane Database of Systematic Reviews, 2007, Issue 4. Art. No.: CD005514. DOI: 10.1002/14651858.CD005514.pub2

• Jokubauskas, L., et al. "The Efficacy of Occlusal Splints in the Treatment of Bruxism: A Systematic Review." Journal of Oral Rehabilitation, 2021. https://www.sciencedirect.com/science/article/abs/pii/S0300571221000427

• Farghal, A.E., et al. "Comparative Analysis of Different Types of Occlusal Splints for the Management of Sleep Bruxism: A Systematic Review." BMC Oral Health, 2024. https://link.springer.com/article/10.1186/s12903-023-03782-6

• Wieckiewicz, M., et al. "Bruxism Management." StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2024. https://www.ncbi.nlm.nih.gov/books/NBK482466/

• Neill, A.M., et al. "A Randomized, Controlled Study of a Mandibular Advancement Splint for Obstructive Sleep Apnea." American Journal of Respiratory and Critical Care Medicine, 163(6), 2001. https://www.atsjournals.org/doi/10.1164/ajrccm.163.6.2004213

• Pliska, B.T., Nam, H., Chen, H., Lowe, A.A., Almeida, F.R. "Obstructive Sleep Apnea and Mandibular Advancement Splints: Occlusal Effects and Progression of Changes Associated with a Decade of Treatment." Journal of Clinical Sleep Medicine, 10(12), 2014. https://jcsm.aasm.org/doi/10.5664/jcsm.4278

• Sutherland, K., et al. "Innovations in Mandibular Advancement Splint Therapy for Obstructive Sleep Apnoea." Frontiers in Sleep, 2023. https://www.frontiersin.org/journals/sleep/articles/10.3389/frsle.2023.1144327/full

• Leong, P., et al. "Prevalence of Dental Trauma and Use of Mouthguards in Rugby Union Players." Dental Traumatology, 2014. PMID: 25160534. https://pubmed.ncbi.nlm.nih.gov/25160534/