Exploring the use of mouth guards in Muay Thai: a questionnaire survey

Muay Thai is a high-risk contact sport involving strikes with fists, feet, knees and elbows, with rising global participation. Head and facial injuries are common among participants, and mouth guards are recommended to prevent dental trauma and oral soft tissue injuries. Three main mouth guard types exist: prefabricated (stock), mouth-formed ('boil and bite'), and custom-made by dental practitioners. Prior studies have paid limited attention to dental trauma in Muay Thai specifically, though combat sports show substantial rates of maxillofacial and dental injuries. This study aims to identify Muay Thai participants' attitudes toward mouth guard use and their experiences of dental trauma, to inform prevention strategies.

Prior research indicates notable injury burdens in Muay Thai and other combat sports. Head and facial injuries are among the most common in Muay Thai, with injury rates varying by ability level. A Thai study of 260 Muay Thai participants reported 23.5% experiencing dental/jaw injuries, while an Iranian study of 120 male contact sport participants (including Muay Thai) found 95 with at least one facial injury requiring treatment and 53 with dental injuries (displacement, luxation, fracture, avulsion), with higher maxillofacial injury rates in professionals versus amateurs. Mouth guards are advocated by dental bodies to mitigate dental and maxillofacial trauma, with types differing in fit, comfort, and protection (custom-made generally superior to stock or mouth-formed). Prior UK work in grappling sports showed higher use of mouth-formed than custom-made guards. Overall, literature underscores substantial dental trauma risk in combat sports and suggests potential protective value and improved comfort/fit with custom-made guards.

Design: Cross-sectional online survey with anonymous questionnaire. Instrument: Questionnaire designed per best-practice recommendations, included quantitative (multiple choice, categorical) and Likert-scale items plus open-ended responses. Content domains: (i) demographics; (ii) Muay Thai involvement, mouth guard use, and dental health issues; (iii) perceptions/opinions on risk-taking, responsibility, influences, and behavior change after injury. Patient and public involvement: Reviewed by Newcastle University Oral and Dental PCPI group and a Muay Thai participant group; piloted before deployment. Recruitment: Invitation posted on a Muay Thai gym’s Facebook page (Northern Kings, Newcastle upon Tyne, UK); snowball recruitment encouraged to reach participants from other gyms. Data collection: Online link for activation, completion, and electronic return; two reminders over first two weeks; survey open for four weeks. Sample size: Target ~100 respondents; 92 completed questionnaires received. Ethics: Newcastle University Research Ethics Committee approval (reference 7899/2018). Analysis: Data exported to SPSS v23; descriptive frequency distributions; cross-tabulations; chi-squared tests for associations; no a priori power calculation due to limited prior data.

- Sample: 92 respondents (71.7% male). Age: 26.1% 18–24, 21.7% 25–29, 14.1% 30–34, 17.4% 35–39, 20.7% ≥40. High representation of advanced/coaches/professionals (78.3%); 28.2% trained ≥10 h/week; 37.0% active ≥10 years; 41.3% had ≥10 competition fights; 44.6% competed nationally/internationally. - Mouth guard use: 3.3% had never worn a mouth guard. Usage reported during sparring by 88.0% and during fights by 60.9% (abstract figures: 3% never, 61% fight use). Four participants (4.3%) wore one during warm-up. - Type used: Mouth-formed ('boil and bite') most common (59.8%); custom-made dentist-provided 31.5%; prefabricated stock 3.3%. - Comfort: Extremely/very comfortable wearing during sparring 70.7% and fighting 73.2%; warm-up 19.5%. - Choice factors: Protection, breathing, good fit, and comfort rated extremely/very important by >90% each; cost, speech, appearance, trendiness less important. - Costs: Stock: all <£20. Mouth-formed: 83.6% <£20; 12.7% £20–£50; 3.6% free/sponsored. Custom: 17.2% free/sponsored; 3.4% <£20; 37.9% £20–£50; 41.4% >£50. - Age differences in fight use: 18–29 years (n=44) 72.7% used during fights vs ≥30 years (n=48) 50.0%; chi-squared p=0.026 (abstract: 73% vs 50%, p<0.05). No significant age differences for warm-up or sparring. - Awareness and dental care: 36% aware of regulations/advice on mouth guards in Muay Thai. 80% registered with a dentist; 41 had told their dentist they participate; among these, 12% brought their guard for checking; 73% were recommended a custom-made guard. - Attitudes: 57% would definitely recommend a custom-made mouth guard from a dentist. 84% agreed mouth guards should be mandatory for children in Muay Thai. Responsibility for use: participants 62%, coaches 11%, governing bodies 10%. - Dental injuries: 14% (13 respondents) reported injuries; most common chipped/broken teeth (n=10); also broken crown (n=1), avulsion of a primary tooth (n=1), locked jaw (n=1). Post-injury behavior change toward mouth guard use: 8 definitely, 3 to some degree, 2 not at all. - Performance impact: Warm-up: 75.6% no impact. Sparring: 53.6% much/somewhat better; 4.9% worse. Fighting: 51.2% much/somewhat better; 6.1% worse. - Risk perception with guard: Warm-up: 69.1% no change, 28.4% reduced risk. Sparring: 60.5% lower risk; 22.2% perceived increased risk. Fighting: 64.2% lower risk; 20.9% perceived increased risk. No significant differences in increased-risk perception by age, gender, skill level, or guard type (all p>0.05).

Findings indicate generally positive attitudes toward mouth guards among Muay Thai participants, high comfort during sparring/fighting, and recognition of protection, breathing, fit and comfort as key selection criteria. Despite this, a substantial proportion (approximately 39%) did not wear a mouth guard during fights, when risk is highest. Younger athletes were more likely than older athletes to wear mouth guards during fights, suggesting generational differences in risk perception, habit formation, or comfort with mouth guard use. Reports that some participants perceive increased dental risk with a mouth guard during high-intensity activity may reflect issues with poor fit or movement of mouth-formed devices, highlighting the potential benefits of custom-made guards. The observed 14% dental injury rate is lower than in some prior studies, possibly reflecting higher mouth guard adoption, yet remains clinically meaningful given potential preventability. The data support proactive dental professional involvement in recommending and fitting custom mouth guards, and targeted educational interventions—particularly for older or more experienced participants—to improve fight-time adoption without adversely affecting performance.

Mouth guards are generally well tolerated in Muay Thai and perceived as beneficial for protection; however, only 60.9% reported wearing them during fights, with older participants less likely to use them compared to younger participants. Although dental injury prevalence reported was relatively low (14%), Muay Thai presents a clear dental trauma risk. Dentists should proactively recommend mouth guard use—particularly custom-made guards fabricated and fitted in clinic—and individuals with prior dental injury may serve as advocates to increase awareness and adoption, especially among those not routinely wearing guards.

- Sampling bias toward experienced participants (approximately 80% advanced/coaches/professionals), potentially limiting generalizability to beginners. - Slightly below target sample size (92 vs ~100), limiting power for subgroup analyses. - Online distribution centered on one gym’s network may introduce selection bias and limit representativeness. - Cross-sectional, self-reported data subject to recall and response biases. - Limited qualitative data precluded in-depth exploration of reasons for non-use; future purposive and qualitative studies are warranted.