Microbiota found in protective athletic mouthguards

Abstract

Background: Protective athletic mouthguards (PAM) produce oral mucosal injuries and may be associated with other systemic conditions.

Hypothesis: With wear, PAM become contaminated by a range of microorganisms. The number of microorganisms in PAM can be reduced by daily use of an antimicrobial solution.

Study type: Case series.

Study design and methods: Sixty-two division I football player volunteers were divided into 4 groups, using PAM for varying lengths of time before surrendering them for microbial analysis. One group had their PAM soaked in an antimicrobial solution between uses. The PAM were analyzed qualitatively and quantitatively for bacteria, yeasts, and fungi, using previously accepted methods.

Results: The 62 football players surrendered a total of 81 PAM for microbial analysis. The PAM yielded 154 gram-positive cocci, 150 gram-positive bacilli, 21 gram-negative cocci, 31 gram-negative bacilli, 22 yeasts, and 107 molds. The most common species of gram-positive cocci were Staphylococcus spp. and Micrococcus spp. Only 3 PAM (4%) were positive for Staphylococcus aureus. The most common species of gram-positive bacilli were Brevibacterium spp. and Cellulomonas spp. The most common species of yeasts were Candida parapsilosis and Rhodotorula mucilaginosa, while the most common species of mold were Cochliobolus spp. and Penicillium chrysogenum. Soaking the PAM in an antimicrobial solution between uses substantially reduced the numbers of microorganisms.

Conclusions: Substantial microbial contamination of PAM occurs with use. The microbial load can be reduced by soaking in an antimicrobial solution between uses.

Clinical relevance: PAM are contaminated by microorganisms that have the potential to produce oral and systemic diseases. They should be sanitized daily and changed when they become sharp and/or jagged.

Keywords: contamination; disease transmission; microorganisms; mouthguard care; oral infections; protective athletic mouthguards; systemic infections.

Figure 1.

Scanning electron microscopy of a typical protective athletic mouthguard. Note the large crevices that allow for deep penetration of microorganisms and produce difficulties in the mechanical removal of the microbes. Original magnification, 1000×.

Figure 2.

Scanning electron microscopy of a protective athletic mouthguard demonstrating large accumulations of a variety of microorganisms forming a complex network (biofilm), as well as areas that appear completely free of any microbes (no biofilm). Original magnification, 1000×.

Figure 3.

Typical protective athletic mouthguard after a season of wear. Note the rough, jagged edges capable of creating a microbial portal of entry into the tissues.

Figure 4.

Typical position of the protective athletic mouthguard in between plays (arrow), allowing for substantial environmental contamination.