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Operation mouth protector, Cobb County, Georgia, 1962
O peration m outh protector, C o b b County, Georgia, 1962
Thomas A. McDermott,* D.D.S., M.P.H., Marietta, Ga. The National Alliance Football Rules Committee has made mandatory the wearing of mouth protectors by all foot ball players in high schools, junior col leges and colleges. The Cobb County, Georgia, Dental Society decided to pro vide custom-fitted mouth protectors for all high school football players in Cobb County. The members of the society vol unteered their time to take upper arch impressions of the more than 500 boys who take part in the organized football programs. A fee of $1 for each impres sion was charged to cover the cost of the materials used. Senior dental students from Emory University School of Den tistry volunteered to pour the impressions in stone. The dentists trimmed and out lined the models. The processing of the mouth protectors was made the responsi bility of the school personnel who were instructed in the procedures by members of the dental society. Through this pro gram, all the high school football players were able to obtain custom-made mouth protectors for the 1962 football season. Protective equipment for football players has improved tremendously over the last two decades. Because of better training methods, better equipment, and better
actual playing conditions, injuries on the football field have been decreasing steadily. There has been no concomitant decline of injuries to the teeth and mouth, how ever. Over 50 per cent of all injuries received on the football field occur in the region of the oral cavity.1'3 An attempt was made to offer some manner of pro tection to the mouth by using face guards as standard pieces of equipment, but this proved inadequate.4 Much research and testing has shown that nearly all injuries to the teeth and mouth can be prevented by the wearing, on the playing field, of properly fitted mouth protectors.6'7 The joint report on mouth protectors8 indicates that the custom-made, individu ally fabricated mouth guards meet all the criteria for mouth protection better than any of the other mouth protectors avail able. The National Alliance Football Rules Committee9 has made mandatory, effec tive in 1962, the wearing of mouth pro tectors by all football players in high schools, junior colleges and colleges. With these facts in mind, the Cobb County Dental Society, at their February 1962 meeting, adopted a resolution to provide custom-fitted mouth protectors (prepared over a model of the mouth) for all high school football players in the county. A committee of dentists was appointed to study ways of implementing this resolu
M cD ER M O T T . . . V O L U M E 66, FEBRU ARY 1963 • 85/223
tion and carrying the project out suc lighting, and running water is avail cessfully. able. It has straight-backed, nonattached chairs. It was decided to use this audi torium for the impression taking. Chairs PRELIM INA RY PREPARATIONS were set up with approximately six feet Cobb County, Georgia, has a population of space in front, behind and on each of approximately 125,000 people. It is side to give every dentist ample working located northwest of Atlanta and is in area. A time schedule was sent to each high cluded in the five counties that comprise Metropolitan Atlanta. There are eight school informing them of the place the high schools in the county, with football students were to come, the date, and the squads averaging from 35 to 100 mem time they had to be there. The schedule bers. Slightly more than 500 boys take was staggered so as to average approxi part in the organized football programs mately 70 impressions per hour. Emory University School of Dentistry of these high schools. Members of the mouth-guard commit agreed to send senior dental students to tee of the Cobb County Dental Society the health department for the day to pour contacted the head football coach of each the impressions in stone. Eighteen stu high school to determine whether all the dents volunteered. The dentists brought schools would participate in the program, their assistants to aid in the handling of subject to a nominal fee to cover the cost patients and the mixing of the impression of materials used. All the dental society material. A charge of $1 was made for members had volunteered their time to each impression taken; none were taken unless this fee was paid in advance. The take impressions. All the high schools in the county Cobb County Dental Society used the expressed a desire to take part in the pro money to cover the cost of the materials gram. The mouth-guard committee de used for impressions, models and finished cided that the impressions of all the high mouth protectors. school football players would be taken on the same day, so as to utilize the dentists’ M ETH O D OF IM PR ESSIO N TAKING time most effectively. ( p h a s e i) Early in March the dental committee selected May 2, 1962 as the date for the Sixteen dentists were present at the Cobb impression taking. Letters were sent out County Health Department on the morn to all members of the dental society, in ing of May 2, 1962; one member was out forming them of this so that they would of town and another member was in the have ample time to arrange their appoint hospital. Two sizes of plastic disposable impres ment schedule and insure their presence at the appointed time and place. sion trays were used, large and medium The Cobb County Health Department, (Fig. 1). Each high school boy wrote his located in Marietta, was selected as the name on a slip of paper /
86/224 • T H E J O U R N A L O F T H E A M E R IC A N DEN T A L A S S O C IA T IO N
Fig. I • Placing im pression material in plastic disposable tray
entire name with the tape so that it would not be destroyed or obliterated while the impression was being poured. Fast-Set Jel-Trate was used, and an impression of only the upper arch was taken unless an extreme malocclusion was found which prohibited the wearing of an upper mouth protector (Fig. 2). On
removal of the impression material, the boy left the chair and another one im mediately took his place and the process was again completed. The average time from seating to dismissal was just under three minutes. The impressions were placed on a tray which was on a table at the front of the auditorium. They were covered with a wet towel to keep them moist until they were poured. A dental student picked up the trays of impressions and carried them to an other area of the health center for the “pouring up in stone” phase. Approxi mately 12 dental students poured the impressions; five vibrators were used for this purpose (Fig. 3). After the stone hardened, the models were separated from the trays by the dental students (Fig. 4), and the names Scotch-taped on the handles of the trays were duplicated on the model. The model then was placed in the box labeled with the name of the school which the boy attended. The pupils from only one school were processed at a time so there was no chance that a boy’s impression would be placed in the wrong box. Five hundred and two impressions were taken during the day, poured up in stone and separated. The dentists felt that they could have taken three times that number of impressions during the
Fig. 2 • Dentists of C o b b C o u n ty Dental Society taking im pressions of local high school football players
M cD ER M O T T . . . V O L U M E 46, FEBRU ARY 1963 • 87/225
Fig. 3 * Dental students from Em ory University Dental School p o u rin g the im pressions in stone. A n instructor from the dental school is supervising the procedure
cedure, as a certain amount of digital dexterity is required. Each high school football coach was also requested to be present to learn what is involved in the manufacture or repair of protectors. Four dentists who had had consider able experience in the fabrication of mouth guards volunteered to train the school personnel. The night after the im pression taking they spent about two and a half hours in orientation and instruc tion. Actual models were used to demon strate, and the different steps in the cur ing procedures were explained. Detailed printed instructions were given to all present and were explained by the den tist. It was felt that with the two and a half hour instruction period and the printed instructions, the school personnel should have no difficulty in completing the mouth protectors. PREPARATION OF MODELS FOR PROCESSING (PH A SE III)
It was hoped that the outlined models time allotted, but no more could have could be turned over to their respective been poured because of limited space and manpower. PREPARATIONS FOR PROCESSING OF M OUTH PROTECTORS (P H A SE II)
The Cobb County Dental Society decided that the processing of the mouth pro tectors should be the responsibility of the schools. All the models would be outlined by member dentists and turned over to the schools for processing by personnel trained by dentists in the correct pro cedures. Prior to the impression taking, all the schools involved were requested to send three or more volunteers to the health center on May 3, to be instructed in the proper method of fabricating and processing the mouth protectors. It was suggested that girls from home economics classes or future allied medical profession groups be utilized for this pro
Fig. 4 • Separation o f m odels from trays
88/226 • THE J O U R N A L O F THE A M E R IC A N DEN T A L A S S O C IA T IO N
schools at the end of the orientation period. This proved impossible, however, because of the time required to trim and outline the models. In some instances, minor repair was needed, such as filling in air bubbles, before the mouth protec tors could be fabricated. The volunteer dentists trimmed the models to the peripheral margins of the impressions. Local dental laboratory per sonnel helped by trimming about a half of them. All the models were outlined by the dental society members and then were turned over to the respective schools for processing. It took about ten days to complete these various procedures. All the schools were asked to make a report on the problems encountered in the •fabrication and processing of the protec tors and on the comments of the football players who wore them. It was antici pated that these reports would be re ceived by the Cobb County Dental Soci ety in the fall of 1962.
model can be outlined. The critical step in the whole process seems to be the pour ing of the model. If this is accomplished with precision and diligence, it will greatly facilitate the whole project. Un trained, volunteer help, if they possess some digital dexterity, can be trained in the processes of fabrication of the protectprs. It was felt that it was imperative to evolve a comprehensive method for the production of individual mouth guards so as to insure adequate protection for all Cobb County high school football players for the 1962 fall football season. The custom-made mouth protector was the one which has been shown to give adequate protection and be most easily tolerated.8 Costs of the protectors had to be considered so that all the players would be assured of receiving a mouth protector. Therefore, this method of utilizing vol unteer personnel and charging only for the materials used was evolved. 410 Fairground Street
CO N CLU SIO N S
It was found that one dentist, using a fast-set impression material, can take up to 15 impressions per hour. Models could not be poured in stone as fast as the impressions were taken so care should be taken that adequate personnel is avail able to pour the models. The personnel should be well trained in pouring models so as to eliminate defects. If the impres sion is not poured correctly, much time can be lost in repair of the stone model or in retaking the impression. When poured, the stone should just cover the periphery of the impression and be no more than inch thick in the palatal area. This will eliminate the ne cessity of lengthy trimming before the
*Dîstrict dental director, C o b b County Health De partment. 1. Cathcart, J. F. Mouth protectors for contact sports. D. Digest 57:346 A ug. 1951. 2. Vanet, R. Gridiron challenge. D. Survey 27:1258 Sept. 1951. 3. Banks, Oree. The occurrence of dental injuries re* suiting from varsity football during the football season of 1959-1960 academic year. Manhattan, Kansas State University, I960. Typed thesis. 4. Wisconsin Interscholastic Athletic Association, M a ri nette, Wisconsin. Report of a study of face guards and mouth protectors, A p ril 22, 1956. 5. Heintz, W . D. Maximum mouth protection for contact sports. J. Pros. Den. 9:874 Sept.-Oct. 1959. 6. New mouth guards score with high school teams. D. Times 1:6 Oct. 15, 1958. 7. Schoen, G. H. Report of committee on mouth pro tector project (Nassau County Dental Society). Nassau Co. D. Soc. Bui. 30:12 Jan. 1956. 8. American Association for Health, Physical Educa tion and Recreation and the American Dental Associa tion. Report of joint committee on mouth protectors. Chicago, American Dental Association, I960. 9. National Alliance Football Rules Committee. Tr. Jan. 1961.
Thomas A. McDermott,* D.D.S., M.P.H., Marietta, Ga. The National Alliance Football Rules Committee has made mandatory the wearing of mouth protectors by all foot ball players in high schools, junior col leges and colleges. The Cobb County, Georgia, Dental Society decided to pro vide custom-fitted mouth protectors for all high school football players in Cobb County. The members of the society vol unteered their time to take upper arch impressions of the more than 500 boys who take part in the organized football programs. A fee of $1 for each impres sion was charged to cover the cost of the materials used. Senior dental students from Emory University School of Den tistry volunteered to pour the impressions in stone. The dentists trimmed and out lined the models. The processing of the mouth protectors was made the responsi bility of the school personnel who were instructed in the procedures by members of the dental society. Through this pro gram, all the high school football players were able to obtain custom-made mouth protectors for the 1962 football season. Protective equipment for football players has improved tremendously over the last two decades. Because of better training methods, better equipment, and better
actual playing conditions, injuries on the football field have been decreasing steadily. There has been no concomitant decline of injuries to the teeth and mouth, how ever. Over 50 per cent of all injuries received on the football field occur in the region of the oral cavity.1'3 An attempt was made to offer some manner of pro tection to the mouth by using face guards as standard pieces of equipment, but this proved inadequate.4 Much research and testing has shown that nearly all injuries to the teeth and mouth can be prevented by the wearing, on the playing field, of properly fitted mouth protectors.6'7 The joint report on mouth protectors8 indicates that the custom-made, individu ally fabricated mouth guards meet all the criteria for mouth protection better than any of the other mouth protectors avail able. The National Alliance Football Rules Committee9 has made mandatory, effec tive in 1962, the wearing of mouth pro tectors by all football players in high schools, junior colleges and colleges. With these facts in mind, the Cobb County Dental Society, at their February 1962 meeting, adopted a resolution to provide custom-fitted mouth protectors (prepared over a model of the mouth) for all high school football players in the county. A committee of dentists was appointed to study ways of implementing this resolu
M cD ER M O T T . . . V O L U M E 66, FEBRU ARY 1963 • 85/223
tion and carrying the project out suc lighting, and running water is avail cessfully. able. It has straight-backed, nonattached chairs. It was decided to use this audi torium for the impression taking. Chairs PRELIM INA RY PREPARATIONS were set up with approximately six feet Cobb County, Georgia, has a population of space in front, behind and on each of approximately 125,000 people. It is side to give every dentist ample working located northwest of Atlanta and is in area. A time schedule was sent to each high cluded in the five counties that comprise Metropolitan Atlanta. There are eight school informing them of the place the high schools in the county, with football students were to come, the date, and the squads averaging from 35 to 100 mem time they had to be there. The schedule bers. Slightly more than 500 boys take was staggered so as to average approxi part in the organized football programs mately 70 impressions per hour. Emory University School of Dentistry of these high schools. Members of the mouth-guard commit agreed to send senior dental students to tee of the Cobb County Dental Society the health department for the day to pour contacted the head football coach of each the impressions in stone. Eighteen stu high school to determine whether all the dents volunteered. The dentists brought schools would participate in the program, their assistants to aid in the handling of subject to a nominal fee to cover the cost patients and the mixing of the impression of materials used. All the dental society material. A charge of $1 was made for members had volunteered their time to each impression taken; none were taken unless this fee was paid in advance. The take impressions. All the high schools in the county Cobb County Dental Society used the expressed a desire to take part in the pro money to cover the cost of the materials gram. The mouth-guard committee de used for impressions, models and finished cided that the impressions of all the high mouth protectors. school football players would be taken on the same day, so as to utilize the dentists’ M ETH O D OF IM PR ESSIO N TAKING time most effectively. ( p h a s e i) Early in March the dental committee selected May 2, 1962 as the date for the Sixteen dentists were present at the Cobb impression taking. Letters were sent out County Health Department on the morn to all members of the dental society, in ing of May 2, 1962; one member was out forming them of this so that they would of town and another member was in the have ample time to arrange their appoint hospital. Two sizes of plastic disposable impres ment schedule and insure their presence at the appointed time and place. sion trays were used, large and medium The Cobb County Health Department, (Fig. 1). Each high school boy wrote his located in Marietta, was selected as the name on a slip of paper /
86/224 • T H E J O U R N A L O F T H E A M E R IC A N DEN T A L A S S O C IA T IO N
Fig. I • Placing im pression material in plastic disposable tray
entire name with the tape so that it would not be destroyed or obliterated while the impression was being poured. Fast-Set Jel-Trate was used, and an impression of only the upper arch was taken unless an extreme malocclusion was found which prohibited the wearing of an upper mouth protector (Fig. 2). On
removal of the impression material, the boy left the chair and another one im mediately took his place and the process was again completed. The average time from seating to dismissal was just under three minutes. The impressions were placed on a tray which was on a table at the front of the auditorium. They were covered with a wet towel to keep them moist until they were poured. A dental student picked up the trays of impressions and carried them to an other area of the health center for the “pouring up in stone” phase. Approxi mately 12 dental students poured the impressions; five vibrators were used for this purpose (Fig. 3). After the stone hardened, the models were separated from the trays by the dental students (Fig. 4), and the names Scotch-taped on the handles of the trays were duplicated on the model. The model then was placed in the box labeled with the name of the school which the boy attended. The pupils from only one school were processed at a time so there was no chance that a boy’s impression would be placed in the wrong box. Five hundred and two impressions were taken during the day, poured up in stone and separated. The dentists felt that they could have taken three times that number of impressions during the
Fig. 2 • Dentists of C o b b C o u n ty Dental Society taking im pressions of local high school football players
M cD ER M O T T . . . V O L U M E 46, FEBRU ARY 1963 • 87/225
Fig. 3 * Dental students from Em ory University Dental School p o u rin g the im pressions in stone. A n instructor from the dental school is supervising the procedure
cedure, as a certain amount of digital dexterity is required. Each high school football coach was also requested to be present to learn what is involved in the manufacture or repair of protectors. Four dentists who had had consider able experience in the fabrication of mouth guards volunteered to train the school personnel. The night after the im pression taking they spent about two and a half hours in orientation and instruc tion. Actual models were used to demon strate, and the different steps in the cur ing procedures were explained. Detailed printed instructions were given to all present and were explained by the den tist. It was felt that with the two and a half hour instruction period and the printed instructions, the school personnel should have no difficulty in completing the mouth protectors. PREPARATION OF MODELS FOR PROCESSING (PH A SE III)
It was hoped that the outlined models time allotted, but no more could have could be turned over to their respective been poured because of limited space and manpower. PREPARATIONS FOR PROCESSING OF M OUTH PROTECTORS (P H A SE II)
The Cobb County Dental Society decided that the processing of the mouth pro tectors should be the responsibility of the schools. All the models would be outlined by member dentists and turned over to the schools for processing by personnel trained by dentists in the correct pro cedures. Prior to the impression taking, all the schools involved were requested to send three or more volunteers to the health center on May 3, to be instructed in the proper method of fabricating and processing the mouth protectors. It was suggested that girls from home economics classes or future allied medical profession groups be utilized for this pro
Fig. 4 • Separation o f m odels from trays
88/226 • THE J O U R N A L O F THE A M E R IC A N DEN T A L A S S O C IA T IO N
schools at the end of the orientation period. This proved impossible, however, because of the time required to trim and outline the models. In some instances, minor repair was needed, such as filling in air bubbles, before the mouth protec tors could be fabricated. The volunteer dentists trimmed the models to the peripheral margins of the impressions. Local dental laboratory per sonnel helped by trimming about a half of them. All the models were outlined by the dental society members and then were turned over to the respective schools for processing. It took about ten days to complete these various procedures. All the schools were asked to make a report on the problems encountered in the •fabrication and processing of the protec tors and on the comments of the football players who wore them. It was antici pated that these reports would be re ceived by the Cobb County Dental Soci ety in the fall of 1962.
model can be outlined. The critical step in the whole process seems to be the pour ing of the model. If this is accomplished with precision and diligence, it will greatly facilitate the whole project. Un trained, volunteer help, if they possess some digital dexterity, can be trained in the processes of fabrication of the protectprs. It was felt that it was imperative to evolve a comprehensive method for the production of individual mouth guards so as to insure adequate protection for all Cobb County high school football players for the 1962 fall football season. The custom-made mouth protector was the one which has been shown to give adequate protection and be most easily tolerated.8 Costs of the protectors had to be considered so that all the players would be assured of receiving a mouth protector. Therefore, this method of utilizing vol unteer personnel and charging only for the materials used was evolved. 410 Fairground Street
CO N CLU SIO N S
It was found that one dentist, using a fast-set impression material, can take up to 15 impressions per hour. Models could not be poured in stone as fast as the impressions were taken so care should be taken that adequate personnel is avail able to pour the models. The personnel should be well trained in pouring models so as to eliminate defects. If the impres sion is not poured correctly, much time can be lost in repair of the stone model or in retaking the impression. When poured, the stone should just cover the periphery of the impression and be no more than inch thick in the palatal area. This will eliminate the ne cessity of lengthy trimming before the
*Dîstrict dental director, C o b b County Health De partment. 1. Cathcart, J. F. Mouth protectors for contact sports. D. Digest 57:346 A ug. 1951. 2. Vanet, R. Gridiron challenge. D. Survey 27:1258 Sept. 1951. 3. Banks, Oree. The occurrence of dental injuries re* suiting from varsity football during the football season of 1959-1960 academic year. Manhattan, Kansas State University, I960. Typed thesis. 4. Wisconsin Interscholastic Athletic Association, M a ri nette, Wisconsin. Report of a study of face guards and mouth protectors, A p ril 22, 1956. 5. Heintz, W . D. Maximum mouth protection for contact sports. J. Pros. Den. 9:874 Sept.-Oct. 1959. 6. New mouth guards score with high school teams. D. Times 1:6 Oct. 15, 1958. 7. Schoen, G. H. Report of committee on mouth pro tector project (Nassau County Dental Society). Nassau Co. D. Soc. Bui. 30:12 Jan. 1956. 8. American Association for Health, Physical Educa tion and Recreation and the American Dental Associa tion. Report of joint committee on mouth protectors. Chicago, American Dental Association, I960. 9. National Alliance Football Rules Committee. Tr. Jan. 1961.