Fabrication Of Mouthguards Research Articles

Influence of Using a Puncturing Method and Cooldown Period Before Pressing the Second-Layered Sheet on the Final Thickness of Double-Layered Sports Mouthguards: An Experimental Study.

The thickness of the mouthguard is a crucial factor in its protective ability for athletes. This study aimed to investigate the final thickness of double-layered sports mouthguards, which were fabricated using different methods before pressing the second layer. Seven upper working models (n = 7 per group) were prepared for mouthguard fabrication. The first 3-mm mouthguard sheet underwent heating, pressing, and vacuuming onto the model, followed by various protocols before the second 3-mm sheet was pressed. Group 1: The second sheet was pressed immediately. Group 2: The first sheet underwent a 1-h cooldown period before pressing the second sheet. Group 3: The interproximal areas of the first sheet were punctured followed by immediate pressing of the second sheet. Group 4: The first sheet was punctured followed by a 1-hcooldown before pressing the second sheet. After 24 h, the mouthguard thickness was measured at various points on the left and right central incisors and first molars using a digital caliper. The thickness analysis was performed using SPSS 29.0 with one-way ANOVA and Tukey post hoc analysis. At the labial surface of the central incisors, Group 4 exhibited the highest thickness, while Group 3 had the lowest (p < 0.001). Groups 1 and 2 did not show significant differences in thickness. At the incisal edges, Group 3 again had the lowest thickness (p < 0.05), with no significant differences observed among the other groups. There were no significant differences in thickness across all areas at the first molars, including cusp tips, pits, and buccal surfaces (p > 0.05). Group 4 demonstrated greater uniformity at the central incisors in thickness compared with the other groups. Using the puncturing method at interproximal areas combined with a cooldown period could enhance mouthguard thickness at the labial surfaces of the central incisors and improve its thickness uniformity.

Enhancing sports mouthguards with PLA + and PC: stress reduction, energy absorption, and topology optimization.

The objective of this paper was to compare the effectiveness of different materials for mouthguards in preventing oral and maxillofacial injuries during sports activities. The present study compares the stress-reduction and energy absorption capabilities of two other fused filament materials - poly(lactic-acid plus) (PLA+) and polycarbonate (PC), with Ethylene-vinyl acetate (EVA), which is the most commonly used material for mouthguard fabrication. Two human skulls were modelled, and a boxing glove simulated punches along the x, y, and z-axes with 5mm displacement with 1 kN force. Firstly, the maximum principal stress curve in the skull was compared for forces along the three perpendicular directions. Furthermore, the present study examines materials energy absorption properties, including their specific energy absorption characteristics and initial peak von Mises stresses. Additionally, a topology optimization approach is used to create an alternative design for a mouthguard to improve specific energy absorption. The model without a mouthguard showed the highest stress concentration of 32.298MPa in the teeth, followed by the EVA material, which resulted in a maximum principal stress of 28.525MPa. Fused filament 3D materials, such as PLA + and PC, on the other hand, showed better mechanical effectiveness in both lower jaw dislocation and lower maximum principal stress by 30.82% and 51.25% in the mandibular and maxillary teeth. Though EVA comparatively shows better specific energy absorption capability at 2.24kJ/kg post-optimization than PLA + and PC, the peak principal stress experienced in the mandibular region was comparatively higher. The topology optimization, however, improved the energy-absorbing capabilities of PLA + by 4.5 times, reaching 1.37kJ/kg and PC from 0.165kJ/kg to 0.38kJ/kg. This study demonstrates that PLA + and PC have better stress reduction capabilities than EVA and could be promising materials for the fabrication of mouthguards in sports activities. This study highlights the importance of topology optimization in dental materials science and engineering to develop safer and more effective mouthguard designs.

Effect of surface treatment of ethylene vinyl acetate on the delamination of custom-fitted mouthguards.

Contamination of ethylene vinyl acetate (EVA) during mouthguard fabrication can cause delamination. The study evaluated the effects of different EVA surface treatments on the contact angle, laminate bond strength, and elongation capacity. Specimens of two bonded EVA plates were prepared (n=30). The Shore A hardness of standardized EVA plate specimens was measured before and after thermo-plasticization. The EVA plates were randomly allocated to one of five different surface treatment groups: no treatment (control); isopropyl alcohol, 100%; chloroform, 99.8%; self-cure acrylic resin monomer (methacrylate, ethylene glycol dimethacrylate, and chemical initiator-amine type); and ethyl alcohol, 70%. The maximum breaking force and elongation at the site of fracture were recorded using a universal testing machine. The contact angle surface was measured using ImageJ software. Scanning electron microscopy of the EVA surface was performed. The laminate bond strength was obtained by dividing the maximum breaking force by the bonding area between the two EVA plates. The laminate bond strength and maximum elongation data were analyzed by one-way ANOVA, followed by the Tukey's and the Dunnet test. The failure mode data was analyzed using the chi-square test (α=.05). EVA surface treatment significantly influenced the laminate bond strength and maximum elongation (p < .001). The control group had a higher contact angle and significantly lower laminate bond strength and maximum elongation than the other groups (p < .001). The acrylic resin monomer and chloroform-treated specimens had similar laminate bond strength and maximum elongation. The acrylic resin monomer group had a significantly lower contact angle (p < .001). All treatments had a significantly higher laminate bond strength and maximum elongation than the control group. The acrylic resin monomer and chloroform groups had a significantly higher laminate bond strength and maximum elongation and the acrylic resin monomer group had a lower contact angle than the other groups. The chloroform should be avoided due its hazardous effects.

Evaluation of dental status using a questionnaire before administration of general anesthesia for the prevention of dental injuries.

Dental evaluation and protection are important for preventing traumatic dental injuries when patients are under general anesthesia. The objective of the present study was to develop a questionnaire based on dentition-related risk factors that could serve as a valuable tool for dental evaluation and documentation. We developed a questionnaire for dental evaluation before administration of general anesthesia, investigated the association between patient-and-dentist responses and mouthguard fabrication, and assessed response agreement between 100 patients. Protective mouthguards were fabricated for 27 patients who were identified as having a high risk of dental injury. There was a strong association between dentists' responses and mouthguard fabrication, depending on the general oral health status, use of ceramic prosthesis, presence of masticatory pain related to periodontal diseases, gingival edema, and implants (P < 0.05). Response agreement between patients and dentists for items related to dental pain, loss of dental pulp vitality, root canal therapy, dental trauma, aesthetic prosthesis, tooth mobility, and implant prosthesis was high (Cohen's kappa coefficient κ ≥ 0.6). A high agreement was observed between patient-dentist responses and a strong association with mouthguard fabrication for items pertaining to ceramic prosthesis, masticatory pain, and dental implants. Patients with a "yes" response to these items are recommended to undergo a dental evaluation and use a dental protective device while under general anesthesia.

Influence of different ethylene-vinyl acetate brands used for custom-fitted mouthguard fabrication on the stress and strain during an impact.

The use of custom-fitted mouthguards can effectively prevent dentoalveolar trauma during sports practice. The aims of this study were to (1) Evaluate the elastic modulus of different EVA commercial brands used for custom-fitted mouthguards, and (2) Evaluate whether the different EVA brands can influence the stress and strain generated during an impact simulated by three-dimensional finite element analysis. The elastic modulus of five EVA commercial brands (Essence® , Bio-Art® , Proform® , PolyShok® , and Erkodent® ) were calculated through uniaxial tensile tests. The obtained values were evaluated statistically by Kruskal-Wallis and Dunn's test. A three-dimensional model of the anterior maxilla was created using the Rhinoceros 5.0. A 3mm custom-fitted mouthguard was simulated. The three-dimensional volumetric mesh was generated using the Patran software (MSC.Software) with isoparametrics, 4-noded tetrahedral elements, and exported to Marc/Mentat (MSC.Software) as element number 134. A non-linear dynamic impact analysis was performed in which a rigid object struck the central incisor at a speed of 5m/s. The stresses were evaluated by the modified von Mises criteria, and the strains were also recorded. Statistically significant differences were observed for elastic modulus values (p<.001). Median values and the results of the Dunn's test were Essence® (38.1 A), Bio-Art® (34.9 AB), Proform® (20.8 BC), PolyShok® (17.4 CD), and Erkodent® (15.0 D) (different capital letters mean statistical differences among the groups). Stresses and strains generated in the model with mouthguards were significantly lower than the model without a mouthguard regardless of the commercial brand. There was no significant difference in the stress and strain on the enamel and dentin with the different EVA brands. The shock absorption ability was high for all the brands (more than 80%). The custom-fitted mouthguards, independently of the commercial brand, reduced stresses and strains during the impact.

Fabrication of Mouthguard in Patient with Severe Mouth Opening Limitation for Autoimmune Encephalitis before Electroconvulsive Therapy (Case Report)

Mouthguards have been fabricated for protecting oral structures from outer forces. The best type of mouthguard is custom-made by dentists with impression technique. But boil-and-bite mouthguards have been also used, because of economic cause or difficulty in impression taking or emergency of the case. Author has found-ed that rigid boil-and-bite mouthguard can provide a suitable retention when it is moulded by dentist. There is a case that rigid boil-and-bite mouthguard was successfully used to provide mouth protection of a patient with severe mouth opening limitation due to autoimmune encephalitis during electroconvulsive therapy. In conclu-sion, the rigid boil-and-bite mouthguard moulded by dentist can be one of the effective treatment options when impression taking is difficult or mouthguard is urgently needed.

The clinical fabrication of polyolefin mouthguards formed over fixed orthodontic appliances

Abstract Using a new polyolefin material without impressions and models, fifty-two mouthguards were fabricated at chairside by a dental professional. Patient acceptance, operator assessment, mouthguard retention and fabrication time were assessed. The study demonstrated the practicality of custom-made mouthguard fabrication over fixed orthodontic appliances and recommends the procedure as a useful adjunct to orthodontic practice.

Bruxism and Stress Among Veterans With Gulf War Illness.

This study explores perceived stress and experience with bruxism among veterans with Gulf War Illness (GWI). Stress may manifest physically as bruxism, a parafunctional oral activity that consists of teeth grinding and/or clenching. An online survey of GWI veterans (n = 28, 27.7% response rate) assessed perceived general stress and self-reported behaviors, symptoms, and outcomes associated with bruxism. Survey questions also collected basic demographic data and past military experience. The appropriate Institutional Review Board approved this study (IRB-300001376). Statistical analyses utilized both analysis of variance and linear regression techniques in addition to descriptive statistics. This sample of GWI veterans reported higher levels of perceived stress (M = 20.2, SD = 7.0) than general population males (M = 12.1, SD = 5.9). A majority of GWI veterans reported both grinding (77.8%) and clenching (85.2%) teeth on a weekly or daily basis. Grinding frequency did not predict perceived stress scale values (F = 2.38, P = .11). Clenching frequency did significantly predict perceived stress scale values (F = 4.07, P = .03). Those who reported daily clenching had significantly higher perceived stress scores (M = 22.17, SD = 5.87) than did those who reported never clenching (M = 12.00, SD = 5.35). Length of military service did not significantly predict perceived stress or bruxism experience. GWI veterans reported higher levels of perceived stress in comparison with that of general population males. Both the high frequency of teeth grinding and clenching in these patients is a potential physical manifestation of the high perceived stress levels reported. It is imperative that both military and civilian dentists and physicians are aware of the potential for increased stress and consequently bruxism in this patient population as it can have negative impacts on oral and mental health. Treatment of these patients can include but is not limited to behavior modification, stress reduction training, and the fabrication of mouth guards. The dental and medical implications of bruxism and stress in veterans with GWI should be further investigated.

3D Printed customized sports mouthguard

The conventional mouthguard fabrication process consists of elastomeric impression taking and followed gypsum model making is now into intraoral scanning and direct mouthguard 3D printing with an additive manufacturing process. Also, dental professionals can get various diagnostic data collection such as facial scans, cone-beam CT, jaw motion tracking, and intraoral scan data to superimpose them for making virtual patient datasets. To print mouthguards, dental CAD software allows dental professionals to design mouthguards with ease. This article shows how to make 3D printed mouthguard step by step.

Present Status in Polymeric Mouthguards. A Future Area for Additive Manufacturing?

Athletes from contact sports are more prone to orofacial injuries because of the exposure to possible shocks and collisions derived from physical proximity. The use of protector polymeric mouthguards proved to be useful in the prevention of the described injuries. There are different types of mouthguards with varying ranges of protection and prices, but they are all made from polymers and share the same propose: to absorb and dissipate the impact energy resulting from the shocks. As they are used inside the mouth, they should not impair breathing and speaking nor compromise the comfort of the athlete. However, the ideal mouthguard is yet to be created. The choice of the most appropriate polymeric material and the standard required properties have not yet been reported. Regardless of the numerous studies in this field, normalized control parameters for both material characterization and mouthguard fabrication are absent. This paper aims to present a review of the current types of available mouthguards and their properties/characteristics. Moreover, a detailed description of the most common polymers for the fabrication of mouthguards, together with the manufacturing techniques, are discussed.

Forming temperature of ethylene vinyl acetate sheets for fabrication of vacuum-formed mouthguards.

The appropriate heating temperature for the fabrication of mouthguards using ethylene vinyl acetate sheets is reported to be 80-120°C. However, the measurement side of the heating temperature has not been determined. The aim of this study was to investigate the influence of the measurement side of the heating temperature when fabricating mouthguards. Mouthguard sheets of 3.8mm ethylene vinyl acetate were vacuum-formed on working models until the sheet was heated to 120°C. The sheet temperature was measured at the upper side and the lower side. The thickness of the mouthguard was measured at the labial surface of the central incisor, and the buccal and occlusal surfaces of the first molar. The fit of the mouthguard was examined at the central incisor and the first molar by measuring the distance between the mouthguard and the cervical margin of the working model. Differences in the thickness and fit of the mouthguards were analyzed by two-way analysis of variance. Mouthguard thickness varied among the measured regions of the central incisors and first molars (P<.01). The thicknesses at the labial surface of the central incisor and buccal surface of the first molar were larger when the sheet temperature measured at the lower side was 120°C compared to when the sheet temperature measured at the upper side was 120°C (P<.01). The fit of the mouthguard was better when the sheet temperature measured at the lower side was 120°C (P<.05). The sheet temperature should be measured at the lower side of the sheet and it should be 120°C for fabricating mouthguards.

Controlling Softened State of Mouthguard Sheet during Thermoforming to Ensure Thickness

Mouthguard thickness is affected by the softened state of the sheet during thermoforming. The aim of this study is to establish an effective method for controlling the softened state of the sheet to prevent the mouthguard thickness from decreasing during mouthguard fabrication using a vacuum-forming machine. Mouthguards were thermoformed using an ethylene-vinyl acetate sheet (thickness: 4.0 mm) and a vacuum-forming machine. The working model was trimmed to the anterior height of 25 mm and the posterior height of 20 mm. The following two heating methods were compared: 1) the sheet was formed when it sagged 15 mm below the level of the sheet frame at the top of the post (condition T); and 2) the sheet frame was lowered to and heated at 50 mm below its usual height and the sheet was formed when it sagged 15 mm below the level of the sheet frame (condition L). For each heating method, the vacuum was applied immediately (T0, L0) or 5 s (T5, L5) after the sheet frame was lowered to the forming unit. The sheet surface temperature immediately before the vacuum was applied under each condition was measured. The differences in mouthguard thickness due to forming conditions were analyzed by one-way ANOVA and Bonferroni’s multiple comparison tests. The temperature difference between the center and the posterior depending on the condition decreased in the order T0 > T5 > L0 > L5, and that was 20°C or higher for T0 and T5, and 10°C or less for L0 and L5. At the incisal edge and the cusp, L0 and L5 were significantly thicker than T0. No significant differences were observed between conditions L0 and L5 at any measurement points. For the labial and buccal surfaces, significant differences in thicknesses among all conditions, except L0 and L5, were observed and were in the order T0 < T5 < L0 and L5. This study was suggested that the lowering the sheet frame and heating was more effective than adjusting the vacuum timing for uniform softening of the sheet.

Vacuum-formed mouthguard fabrication to obtain proper fit using notched sheet.

Mouthguards should be provided with appropriate thickness and proper fit to exert their effects. However, mouthguard thickness becomes thinner after forming. The aim of this study was to examine the effect of using a notched mouthguard sheet and forming as the heated surface of the sheet contacts the surface of the working model. The material used was a 3.8-mm-thick Sports Mouthguard. Notches with a length of 90 and 80mm were cut into an ethylene vinyl acetate sheet 20mm from the anterior and posterior margins and 15mm from the right and left margins, respectively, and the sheet was compared with the original. The sheets were then formed using a vacuum former. Original and notched sheets were heated until the temperature of the sheet reached 80°C, and the non-heated surface of the sheet was sucked down over the model. Both sheets were also heated at first until the sheet temperature reached 80°C, then turned upside down, and the heated surface of the sheet was sucked down over the model. The thickness and fit of the mouthguard were measured at the central incisor and first molar. Differences in thickness and fit according to the measurement parts and the sheet conditions were analyzed by two-way ANOVA. The thickness of the mouthguard significantly differed by the measurement parts and the sheet conditions (P<0.01), and the notched sheet maintained the required thickness. Fit differed between the measurement parts and the sheet conditions (P<0.01), and the sheets formed as the heated surface contacted the working model showed better fit. These results suggest that the ideal mouthguard with appropriate thickness and proper fit can be fabricated by notching a sheet and contacting the heated surface of the sheet to the working model.

Fabrication of Mouthguard Using Digital Technology

Background: Frequent re-fabrication of sports Mouthguards (MGs) due to breakage, loss, etc., causes reimpression taking and model storage problems. Problems with reproduction accuracy also occur because of thickness differences resulting from a variety of effects during fabrication. Therefore, we suspected that an MG with a high level of reproduction accuracy can be fabricated through digital technology to solve these problems. The purpose of this study is to investigate whether high elastic rubber MG can be manufactured using a 3D printer and its accuracy. Materials and Methods: In this study, the same ready-made plaster model was used as the master model. We used a dental scanner to scan a plaster model, and obtained an STL data of the plaster model. Then, we used software to design an MG which has 2.5 mm thickness onto the STL data, and fabricated high-elastic silicone rubber MGs (Digital-MGs) using a 3D printer. We made Conventional Mouthguards (CMGs) which were made from 4 mm thickness EVA sheet as controls. We measured the thickness of the left and right medial-tooth labial side and occlusal surface, first molar buccal side, and occlusal surface, totaling eight places. Each thickness was expressed as mean ± standard deviation (mean ± SD) and statistical analysis carried out in each group. Results: The result of measurement was 2.49 ± 0.22 mm in CMGs group, 2.51 ± 0.04 mm in Digital-MG group. We found area-specific significant differences in the CMGs group, but there was no difference in the Digital-MG group. Digital-MGs were shaped as designed. Discussion and Conclusion: Due to the problem of model storage and re-impression, application of digital technology such as optical impression and 3D printer to MG fabrication is considered to be useful, and it seems that there is no problem with fabrication accuracy. We believe this will enable the fabrication of MGs with high reproducibility and lead to greater accuracy in MG research.

The effect of decontamination procedures on elastic polymeric materials used in dental mouthguards fabrication

Mouthguards are commonly used in the prevention of head and mouth injuries in many sport disciplines. Elastic polymeric materials used in their fabrication absorb the energy of impact. However, decontamination procedures may cause damage to their surface causing deterioration of their properties and favouring pathogen colonization. The aim of the study was to determine the impact of different cleaning methods on mouthguard materials, surface quality. The material for the research consisted of 81 samples made from polymeric materials used for custom mouthguard fabrication - Impak, Corflex Orthodontic and Erkoflex. Samples were viewed under a scanning electron microscope after exposure to different cleaning methods. Statistical analysis of tested decontamination procedures and disinfecting agents showed statistically important ( p < 0.05) results for the presence of small and big separated pieces, grooves and holes. Out of all the cases the lowest indicator for occurrence was in the disinfecting spray - Aftermat. Considering the importance of the surface material of the mouthguard, disinfection should be the method of choice for maintaining its hygiene. Impak material samples, cleaned with the Aftermat spray, showed the lowest range of damage.

Effect of mouthguard design on retention and potential issues arising with usability in sport.

Mouthguard retention could potentially increase an athlete's motivation to wear the device, due to potential improvements in physical comfort. The aim of this study was to examine the retentive properties of selected customised mouthguard designs, during normal conditions (dry) and within the presence of artificial saliva (wet). Additionally, the correlation between thickness and retention was investigated. Six different custom mouthguard designs (MG1-MG6) reported in previous studies, were pressure-formed with 2 and 4mm blanks accordingly. Thickness was measured 10 times at seven anatomical points and the mean (±SD) was recorded. A novel rig was fabricated to connect the mouthguards to a Hounsfield H10KS Tensometer, which was used to fully displace each device from the model at a constant rate of 50mm/min. The test was repeated under both dry and wet conditions. Retention forces recorded at the anterior region demonstrated higher measurements under wet conditions than dry (P<0.001). The total retention of the mouthguards was influenced by alterations in their design. Trend analysis indicated that 64% of MG retention could be explained by their thickness under dry conditions and 55% when wet. Design and thickness of mouthguards are key factors in retention. Mouthguard fabrication techniques should be considered in order to minimize dislodgment of the devices as well as potentially increasing the wearability of mouthguards during sport.

Mouthguard and Sports Dentistry: a perspective for the future

Conventional mouthguard fabrication process which consists of elastomeric impression taking and followed gypsum model making is changing into intraoral scanning and dental model printing with 3D printer. In addition, new 3D printing materials for mouthgurad, 3D Computer-Aided Design(CAD) software for dental appliance, evaluation of a virtual dentoalveolar model for testing virtually 3D designed mouthguard, and lightweight sensor technology will lead dental professionals to the new era of Sports Dentistry, including information technology integrated custom mouthguard fabrication and creating value with analytic data acquired from sensors in mouthguard.

Appropriate fabrication method for pressure-formed mouthguards using ethylene vinyl acetate sheets.

Fabrication of mouthguards should be performed properly. However, the appropriate heating temperature for fabricating a pressure-formed mouthguard has not been determined. The aim of this study was to examine the influence of the heating temperature on the fabrication of a pressure-formed mouthguard. Mouthguard sheets of 3.8mm ethylene vinyl acetate were pressure-formed on a working model at three heating temperatures: 80, 100, and 120°C. The thickness of the mouthguard was measured at the labial surface of the central incisor, and the buccal and occlusal surfaces of the first molar. The fit of the mouthguard was examined at the central incisor and first molar by measuring the distance between the mouthguard and the cervical margin of the working model. Differences in the thickness of the mouthguards according to the heating temperatures were analyzed by two-way analysis of variance, and differences in the fit were analyzed by one-way analysis of variance. Mouthguard thickness varied among the measured regions of the central incisors and first molars (P<.01). The greatest thickness was found at the labial surface of the central incisor and the buccal surface of the first molar in mouthguards fabricated at the heating temperature of 120°C (P<.01). Mouthguard fit varied among the heating temperatures of the central incisors, and the greatest fit was obtained in mouthguards fabricated at the heating temperatures of 100 and 120°C (P<.01). Heating the ethylene vinyl acetate sheet until the temperature reached 120°C was the best fabrication method to maintain the pressure-formed mouthguard thickness with proper fit.

A Girl with No Pain: Congenital Insensitivity To Pain and Anhidrosis (HSAN) Type IV - A Case Report.

Sir, Absence of pain may sound pleasing, but can lead to great problems as pain is a warning signal about the onset of disease or tissue damage. Congenital insensitivity to pain was first described in 1932 by Dearborn and later named as “The hereditary sensory and autonomic neuropathies (HSAN)” [1]. The cases of Congenital Insensitivity to Pain with Anhidrosis (CIPA) are an extremely rare and only a handful of this condition is being reported in India [2–8]. We here by presenting one similar case. An 11-year-old girl accompanied with her parent visited us with a concern of damage to oral structure due to her masochistic habit of biting her tongue and lips. They wished for appliance which could prevent this. The parents gave a history of consanguineous marriage with negative family, prenatal and antenatal history. When the child was few month old she stared suffering from spikes of fever which depended on the environmental temperature and did not responded to antipyretic drug and also she did not sweat. With the eruption of milk teeth she started biting her tongue vigorously. Worried about her condition the parent visited National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore were she was diagnosed with Hereditary Sensory Neuropathy Type IV/ CIPA. Parents reported to our college when the child was 7-and 8-year-old; her teeth were rounded off and mouth guard was given which later got damaged. At the age of 9 parents visited a local dental surgeon who extracted her deciduous teeth. Presently, the child is 11-year-old and parents demanded fabrication of another mouth guard. Examination showed low IQ where patient had a delayed response to commands, scars on skin [Table/Fig-1], deformed interphalangeal joints of fingers [Table/Fig-1] and missing big toe of left foot [Table/Fig-2]. Attrited lower incisors [Table/Fig-3] causing loss of support for lower lip resulting in lip trap and deep labio-lingual sulcus [Table/Fig-4]. Tongue was severely affected with the loss of the tip with irregular margins [Table/Fig-5]. Permanent first molars required extraction to which the parents didn’t agree [Table/Fig-3]. Thus, an impression was made of upper and lower arch to fabricate a mouth guard [Table/Fig-6,​,7].7]. Try-in was done and the parents were given instructions regarding the care of the mouth guard. The patient is on follow-up. [Table/Fig-1]: Multiple wound scars on hands. [Table/Fig-2]: Partial Loss of big toe and secondary infection of soft tissues. [Table/Fig-3]: Unerupted permanent teeth after extraction of primary teeth. [Table/Fig-4]: Frontal view of patient showing Labial deformity of the patient due to biting. [Table/Fig-5]: Bitten and scarred tongue with irregular tip. [Table/Fig-6]: Maxillary casts used for the fabrication of mouth guard. [Table/Fig-7]: Mouth guard placed in the maxillary arch. Out of the 5 types HSAN IV is the second most common. Mutation of genes like Neurotrophic Tyrosine Kinase Receptor type 1 (NTRK1) inhibit formation of Nerve growth factor (NGF) leading to destruction of small sensory and sympathetic neurons [3]. CIPA is one such unique human genetic disorder affecting the neurotrophin-signal–transduction system along with anhydrosis due to improper input oftemperature sensation from peripheral nervous system. Apart from delayed development subjects shows scarring or stripping of the skin of finger tips caused by excessive self- biting, multiple fractures, joint dislocations and deformities, skin infections, bruises, corneal ulcerations, and aggressive behaviour [2]. Cutaneous examination may reveal dry gangrene or cellulitis commonly involving tips of fingers and toes [4]. Fractures are slow to heal or show osteomyelitis, while large weight-bearing joints frequently develop Charcot’s joints [3]. As the first teeth erupts subjects starts biting on oral soft tissue resulting in wounds and ulcers or scar. Unawareness of temperature of food or drink may result in oral scalds. Teeth might be affected by severe bruxism or auto extraction. High incidence of caries is prevalent, partially due to lack of pain which can spread to osteomyelitits and fracture of bone [9,10]. Since, there are few cases being reported no protocols are established for HSAN IV. As the disorder is incurable only supportive treatment can be offered. Treatment option includes extraction of the teeth followed by full denture therapy or elimination of the sharp edges of teeth by grinding or addition of composite on teeth or use of mouth guards. Parents must to be given clear instruction about maintenance of guards. Regular follow-up should be doneto check the appliance for damage or need for replacement with the growth of the child [4]. Without pain there is no suffering, without suffering we would never learn from our mistakes as seen in this case. As well as we as dentist should be aware about the condition and treatment option available because these children mainly us their teeth to hurt themselves.

Sports dentistry: contributing to performance and health of athletes

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