Mouthguards: Do they affect athletic performance?

The use of mouthguards helps reduce injuries to the mouth particular to the upper teeth during sporting activity and have been recommended by the American Dental Association since 1950. However, there is concern among some athletes that they have a detrimental impact on athletic performance.

The aim of this review was to determine the effect of mouthguards on athletic performance and if the type of mouthguard influences this factor.


Searches were conducted in the Pubmed, Web of Science, Scopus, Cochrane Library and Opensigle databases.  ( Randomised-controlled trials, cross-over clinical trials and controlled clinical trials assessing the effect of on athletics, breathing, strength, speed and performance in athletes were considered.

Two reviewers selected studies and the following sources of bias were assessed random sequence generation; allocation concealment; blinding of participants and personnel; blinding of outcome assessment; incomplete outcome data; and selective reporting.  A narrative summary was presented.


  • 15 studies involving a total of 312 participants were included.
  • 9 studies were considered to be at high risk.
  • There was great variability in the tools used for assessing the effect of mouthguards on performance in athletes.
  • A comparison between custom-made mouthguards with a control group (without mouthguard) was reported in 12 trials; 3 studies demonstrated improvement in performance , 7 studies  found no difference and 2 studies showed impaired performance in at least one of the applied tests.
  • Custom-made mouthguards showed the smallest range of changes in players’ performance compared with other types of mouthguards.


The authors concluded: –

the use of custom-made mouthguards does not interfere with sport practice. The scientific evidence should be interpreted carefully because there is a great variability of outcome measures and lack of important methodological criteria.


A good range of relevant databases have been searched for relevant studies. while two reviewers have selected studies and undertaken the risk of bias assessment it is not explicitly stated whether this was carried out independently. Good summary tables of the performance tests and primary outcomes measure in the individual studies are presented. The authors indicate that all the studies were randomised.  They have assessed 9 studies  at high risk of bias as they have only given high risk status to those studies with at least two domain of the risk of bias tool considered to be at high risk. Some may consider this a generous assessment as 14 studies have at least one domain assessed as being at high risk of bias.

While the available studies do suggest that mouthguards do not affect performance the available studies are small and are of very low quality so the findings need to be interpreted with caution.


Primary Paper

Ferreira GB, Guimarães LS, Fernandes CP, Dias RB, Coto NP, Antunes LAA,Antunes LS. Is there enough evidence that mouthguards do not affect athletic performance? A systematic literature review. Int Dent J. 2018 May 29. doi: 10.1111/idj.12406. [Epub ahead of print] Review. PubMed PMID: 29808910.

Original review protocol on PROSPERO

Other references

Dental Elf – 2nd Feb 2012

Custom-made mouthguards had no detrimental effect on athletic strength and performance



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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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