Mouthguard wearing and athletic performance


Mouthguards are widely used by people participating in contact sports, and a recommended as essential protective equipment by some. While studies have demonstrated that use of a mouthguard reduces dental trauma (Dental Elf – 2nd Nov 2018) other studies have suggested that athletic performance may be negatively affected by use of a mouthguard.

The aim of this review was to assess the impact of wearing a mouthguard on athletic performance.


A review protocol was registered in PROSPERO. Searches were conducted in the Cochrane Library, PubMed/MEDLINE, Embase, and Scopus databases up to August 2022 with supplementary searches in Open Sigle and the WHO International Clinical Trials Registry Platform. Randomised controlled trials, cross-over clinical trials or controlled clinical trials with randomisation conducted in physically active, high-standard or recreational athletes were considered. Two reviewers independently selected studies and extracted data, with quality being assessed using the Cochrane risk of bias tool. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the certainty of evidence.


  • 41 studies published between 2005 to 2022 were included.
  • 17 studies were considered to be at high risk of bias, 7 studies a low risk with 17 having an unclear risk.
  • A total of 852 athletes were included with sample sizes ranging from 6-50 with an age range of 13 to 34 years.
  • 30 studies used a custom-made mouthguard, 21 studies a mouth-formed type and 2 a standard type.
  • 38 studies compared the use of mouthguards with no mouthguards, with 20 studies evaluating more than one type of mouthguard.
  • There was great variation in the aspect of athletic performance evaluated including strength, breathing, flexibility, agility, balance, and performance.
  • 21 studies reported positive effects and 5 studies negative effects on athletic performance.


The authors concluded: –

Wearing mouthguards should be advocated by athletes not only for the prevention of orofacial and dental trauma but also for their potential improvements in athletic performance in specific actions. However, caution must be exercised in interpreting these findings due to the variability in outcome measures and the lack of important methodological details.


We last looked at a review addressing this question in 2018 (Dental Elf – 22nd Jun 2018). That review included 15 studies and suggested that custom-made mouthguards did not interfere with performance. However, the quality of the included studies was low with a majority at high risk of bias. This new review has searched a good range of databases and included 42 studies. Many of the included studies are small with only 7 of the included studies being at low risk of bias with description of the randomisation generation and allocation concealment poorly reported. Variability with the types of mouthguards used and materials used along with the aspects of athletic performance measures means that only simple counting of the studies demonstrating positive and negative findings was presented. The findings suggest that use of a mouthguard may improve some of the aspects of athletic performance measured although the quality of the available evidence means that this should be interpreted very cautiously.  Further work in this area would benefit by agreeing a set of common outcomes to measure and conducting high quality trials of appropriate size that are reported following the CONSORT statement.


Primary Paper  

Cao R, Zhang X, Xu Y, Zhao W, Qiu P, Liu W. Influence of wearing mouthguards on performance among athletes: A systematic review. J Sci Med Sport. 2023 Sep;26(9):493-503. doi: 10.1016/j.jsams.2023.07.006. Epub 2023 Jul 20. PMID: 37524627.

Review protocol on PROSPERO

Other references

Dental Elf – 22nd Jun 2018

Mouthguards: Do they affect athletic performance?

Dental Elf – 2nd Nov 2018

Mouthguards: Do they reduce dental trauma in contact sports?

Picture Credits

Photo by John Torcasio on Unsplash


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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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