A mouth guard is a dental appliance designed to protect the teeth, gums, and jaw from trauma. The potential for a mouthguard to become dislodged and cause a breathing hazard is a valid safety concern for users. Though the risk is generally considered low, it does exist, particularly under specific circumstances that compromise the guard’s fit or stability.
The Mechanism of Airway Obstruction
Choking occurs when the mouthguard completely or partially blocks the airway. Once unsecured from the teeth, the guard becomes a foreign body that can move toward the throat. Since the throat serves as a common pathway for both air and food, a dislodged object can enter the esophagus or the larynx and trachea, leading to aspiration.
Aspiration, where the guard enters the trachea, creates a life-threatening obstruction by preventing air from reaching the lungs. The size and shape of a typical mouthguard cause a sudden and severe blockage because it is too large to pass easily. Smaller devices, such as splints used for temporomandibular joint (TMJ) disorders, have been noted in medical reports as being small enough to be swallowed or inhaled during sleep if they come loose.
Situational Factors That Increase Risk
The likelihood of a mouthguard becoming a choking hazard increases when the guard is poorly fitted or the wearer loses consciousness. During high-impact sports, a severe blow to the face or head can cause the wearer to lose muscle control, resulting in the mouthguard becoming unsecured. If this happens during an involuntary, deep breath, the guard can be inhaled into the airway.
A mouthguard that is too loose or improperly molded also presents a heightened risk, as it can be easily dislodged during speech, movement, or impact. For those who wear night guards, the natural muscle relaxation during sleep increases the hazard if the guard is not snugly fitted. Certain bulkier, over-the-counter guards require the wearer to actively clench their jaw to keep the device in place.
Proper Selection and Maintenance for Safety
Custom-fitted guards, created by a dental professional from an impression of the teeth, are the safest option. They conform precisely to the contours of the mouth and are difficult to dislodge. These guards stay firmly in place without the wearer having to bite down continuously.
Boil-and-bite mouthguards are more affordable but require careful adherence to molding instructions to achieve a reasonable fit. Stock mouthguards, which are pre-formed and offer the least customization, are the bulkiest and most likely to shift or become dislodged. Regularly inspecting the mouthguard for damage, such as rips or tears, is necessary, as wear and tear compromises stability. A damaged or worn guard should be replaced immediately.
Emergency Response for Dislodged Mouthguards
If a mouthguard is dislodged, immediate action is required, starting with calling for emergency medical help. If the person is conscious and can cough, encourage them to cough forcefully to try and clear the object. If the person cannot speak, cough, or breathe, the obstruction is severe, and first aid must be administered immediately.
For an adult or child over one year old, the standard protocol involves alternating between five back blows and five abdominal thrusts (the Heimlich maneuver). Back blows are delivered firmly between the shoulder blades. Abdominal thrusts are performed by placing a clenched fist above the navel and pulling inward and upward. This cycle should be repeated until the obstruction is cleared or the person becomes unconscious. If the person loses consciousness, immediately begin cardiopulmonary resuscitation (CPR), and check the mouth for the object only if it is visible.