The intraoral scanner changed what's possible here. Twenty athletes and a box of alginate was a nightmare. Twenty athletes and a scanner is an afternoon.

Here's how to actually do it.

Before you go

Pick the right team first. Your best first target isn't the biggest program in town — it's the one where you already have a relationship. A parent in your practice who coaches. A patient who's an athletic director. Start where you have a door.

Get the coach, not the parents. One conversation with a coach or club director reaches every family at once. Parents individually are thirty conversations; the coach is one.

Decide your fee posture in advance. Team pricing, a package rate, or at-cost as a community investment — all defensible. Decide deliberately, communicate it clearly, and don't improvise on site.

Send consent and health history forms ahead. You need medical history, allergy information, and parental consent for minors before anyone sits down. Chasing paperwork in a gymnasium is how a two-hour event becomes four.

Let's talk about money, honestly.

A custom mouthguard is a modest-fee appliance with minimal chair time. Taken alone, it will not transform your production. Many doctors deliberately price it at or near cost precisely because they've understood something about it.

The appliance is not the business. The appliance is the diagnostic entry point.

The clinical prerequisites are the practice economics

Here's what must happen before you can responsibly deliver a custom mouthguard. Read this list as a clinician first and then read it again as a practice owner.

A comprehensive examination. You cannot design protection for a mouth you haven't fully evaluated. Many of these patients — adolescent athletes, adults in recreational leagues — are exactly the demographic that has drifted out of regular care.

Caries treatment completed first. The caries process can be accelerated under a guard worn over untreated lesions, so restorative work has to precede fabrication. This isn't a sales technique; it's a genuine clinical sequencing requirement, and it converts a "we should watch that" into "we need to address this before your son's season starts." Seasons are deadlines. Deadlines close treatment plans that watchful waiting does not.

Most mouthguard cases now arrive at the laboratory as intraoral scans. Alginate impressions poured in hard stone remain completely acceptable and are processed identically — nothing about your existing workflow has been invalidated.

But if you're scanning, there's one thing you need to know, and it's the thing we see done wrong most often.

These guards are tissue-borne, not tooth-retained

Retention doesn't come from the teeth. It comes from intimate contact between the guard and the soft tissues — the vestibular tissues high above the mucogingival junction, and the palatal tissues.

A scan that captures the dentition beautifully and stops at the gingival margin produces a guard retained by tooth undercuts alone. That is a different appliance than the one that was designed, and it will not perform the way you told the patient it would.

Here's a conversation that goes badly in dental offices every week.

Parent: "He's got a mouthguard. We got it at the sporting goods store."

Dentist: "Those are worthless. You need a custom one."

Parent: (hears "you wasted your money and I want more of it")

You lost that one before you finished the sentence. Let's fix it, because the correction is also more accurate than what most of us were taught.

The four categories, honestly described

Stock guards are purchased ready-to-wear and require no alteration. There's no retention — they're held in place only by biting down. At impact they typically dislodge. Speech is difficult. This category genuinely should not be recommended by a health professional, and you can say so plainly.

Mouth-formed ("boil and bite") guards are the most prevalent guards in use today. The material is thermoplastic at low temperature so it can be adapted in the athlete's mouth. Because the athlete bites down during forming, occlusal thickness is reduced, and adaptation degrades further with repeated wear. Fit quality depends entirely on the user's technique.

Here's the correction. For years, publications — including ours — stated flatly that boil-and-bite guards should never be recommended by a health professional.     

If you learned about mouthguards from continuing education delivered before roughly 2019, some of what you learned is out of date — and at least one thing you may still be telling parents is a regulatory liability.

Here's the good news before the caution: the newer literature gives you a better story than the old one did. You no longer have to defend a speculative biomechanical mechanism. You can point to actual human populations. 

Start with what is settled

Mouthguards reduce dental and orofacial injuries. That evidence is strong.

• Non-users carry 2.33 times the risk of orofacial injury compared with users (95% CI 1.59–3.44), across twelve cohort trials in a 2019 meta-analysis in Sports Medicine.
• Dental trauma prevalence was 7.5 to 7.75 percent among mouthguard users versus 48.31 to 59.48 percent among non-users in a 2019 systematic review and meta-analysis in Dental Traumatology — users were 82 to 93 percent less likely to sustain a dentofacial injury.
• The IADT and the Academy for Sports Dentistry jointly state that mouthguards are effective in preventing dental injuries and are recommended across the many sports carrying increased risk.
• The European Association for Sports Dentistry identifies custom-made sports mouthguards as the most effective means of preventing these injuries, providing protection and comfort without impairing athletic performance.

Say this category of claim without hedging. It is well supported and the ADA has promoted it for more than fifty years.    

There is a question that takes four seconds to ask, that almost no dental practice asks routinely, and that opens more legitimate treatment than any other four seconds in your hygiene appointment.

"Do you play any sports?"  

That's it. That's the question.

Here's why it matters more than it sounds like it should.

Traumatic dental injury has been described as the fifth most prevalent disease condition worldwide, and as being actively neglected by public health organizations. More than one billion living people have sustained a traumatic dental injury. Among twelve-year-olds, the prevalence is 18.1 percent.

Read that last number again with your schedule in mind. Nearly one child in five, before they finish middle school.

And sport is where a great deal of it happens. The National High School Sports-Related Injury Surveillance Study recorded 619,714 injuries during competition in the 2020–2021 school year alone. Of those, 117,820 — 19 percent — were injuries to the head and face. Another 73,818 injuries occurred during practice.

That last figure deserves its own sentence. Injuries happen at practice, not just on game day. A mouthguard worn only at games is a mouthguard worn a fraction of the time it's needed.

If you read only one post in this series, make it this one — because there's a population sitting in orthodontic chairs across your referral area, at documented elevated risk, that essentially nobody is protecting.

Start with the numbers

Fixed appliance treatment is concentrated in adolescence, which is a period of high dental injury incidence from leisure and sporting activity. The appliance makes things worse in both directions: it compromises the fit of a mouthguard — both by its own presence and through the tooth movement treatment produces — and it increases the extent of damage after an orofacial injury, through bracket debonding, archwire deformation, and soft tissue laceration.

And only about 35 percent of orthodontic patients report routinely wearing a mouthguard during sport.

Why so low? Because there's been almost no evidence-based guidance in this area, so orthodontists differ significantly in the advice they give. Some have expressed concern that a custom guard might be too adaptive and could prevent desired tooth movement — a concern that, as the trial authors themselves note, has never been formally studied.

So the field defaulted to the "ortho channel" guard and the instant-fit silicone guard.

What the data says about those products

Two papers, both published in the European Journal of Orthodontics in 2022, both open access. Read them. Then forward them.

The impact study. Researchers tested seven mouthguards on a typodont bonded with a 0.022 × 0.028 appliance and 0.017 × 0.025 stainless steel archwire. Three of the seven — including the pre-fabricated instant-fit type — were displaced from the typodont after every single impact, and had to be excluded from load comparison entirely on that basis. All three custom-made designs stayed retained throughout.

Every patient is unique...and so is their airway.

WHEN SNORING IS THE PROBLEM, "SLEEP DIVORCE" is not a solution.

If your patients are considering separate bedrooms because of SNORING ISSUES, consider this…snoring and Obstructive Sleep Apnea (OSA) often occur when airway tissues collapse during sleep, blocking airflow.

Fortunately, the right oral sleep appliance can help open and stabilize the airway — gently repositioning the tongue and soft tissues -- to promote quiet, healthy breathing ALL NIGHT LONG.

SO...Before your patients choose sleep divorce, help them rediscover peaceful, restorative sleep — together. SML can help.

THE GOOD NEWS

SML has a full selection of dental sleep appliances and solutions available to you in the express interest of ensuring your success with snoring and OSA issues.

ARCH DEVELOPMENT IS NOT A ONE-SIZE-FITS-ALL PROPOSITION…

Whether you’re treating crossbites in kids or aligning narrow adult arches, selecting just the right appliance can make all the difference between total success and “not-so.”

Removable or fixed? Lateral or AP?  Relieving anterior crowding? Developing underdeveloped pre-maxillas?

Proper planning yields predictable results. And SML is proud to offer innovative solutions – today and every day – in support of the dental community.

Digital dentistry is transforming how orthodontists and dentists deliver care—and Space Maintainers Laboratories is leading the way with advanced digital services designed to streamline case submissions, improve appliance accuracy, and boost patient satisfaction.

Through our digital platform, practitioners can upload digital impressions, access case tracking, and collaborate with our skilled lab technicians in real time. These tools eliminate delays, reduce errors, and ensure every dental appliance is made to precise specifications.