Custom mouth guard

[fenderdude]

Hello, I'm a predent looking for some way to make some income during school. I've worked at a dental lab for over a year but can not continue to work during this senior school year. I was thinking about starting a custom mouth guard business using the self-impression kits. Is there a market for these products since I can do them much cheaper than a dental office? Any advice or reasons why this would be a bad idea.

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[armorshell]

Practicing dentistry without a license would be a concern.

 

[reapply2007]

Why not open a tooth whitening booth at the mall?

Either way, you don't want to practice without a license, as this may prevent you from getting a license after dental school.

 

[fenderdude]

I believe that as long as I do not perform the impression, the procedure is legal. Currently, there are online businesses that will send impression material through the mail and have it shipped back to be made-up.

 

[dentstd]

No one here knows the answer to your question. We're all just guessing.

The procedure of making a mouth guard or anything of the like is relatively simple. It can be made by anyone, really. Doesn't need to be by a dental professional. It can be made by a dental assistant, and lots of dental assistants throughout the country are trained but uncertified. My guess is that it's okay for you to make them, but I'd stay shy of doing it in large scale.

 

[ODEP PEDO]

The completion exercise anyone could do it, but what about potential calibration and any needed adjustment or follow up if a discomfort or ill fit subdue, who would be responsible? the UPS guy that delivered the kit?

 

[dentstd]

The completion exercise anyone could do it, but what about potential calibration and any needed adjustment or follow up if a discomfort or ill fit subdue, who would be responsible? the UPS guy that delivered the kit?

The answer could be that you just don't adjust it. Kinda like the generic mouth guard you buy at the store. If it's an imperfect fit, then oh well. You get what you paid for.

In this case, you get something better than generic, over-the-counter; but less than an adjusted dental clinic version. And it's priced accordingly.

 

[mike3kgt]

I believe that as long as I do not perform the impression, the procedure is legal. Currently, there are online businesses that will send impression material through the mail and have it shipped back to be made-up.

I know, you should compose this thought into an application essay for dental school. The Admissions committee will really like your insight into how smart of a businessperson you are and will win you big points. You can let them know that you will use the school's lab to fabricate the mouthguards while you are in school as a way to finance your education. You can offer to cut them a deal on your custom mouth guards for their kids if you can get favortism in the applicant selection process.

If that work dries up, you can always enter the fabulous world of internet occlusal guard manufacturer. Sounds easy right... it's just a piece of hard acrylic covering the teeth... how much damage could it do?

Sounds like a plan!!

 

[NAVY DDS 2010]

Hello, I'm a predent looking for some way to make some income during school. I've worked at a dental lab for over a year but can not continue to work during this senior school year. I was thinking about starting a custom mouth guard business using the self-impression kits. Is there a market for these products since I can do them much cheaper than a dental office? Any advice or reasons why this would be a bad idea.

First of all, this would be illegal. You would be doing dental work without a license of any type - whether it be as a dentist or a lab. If you got caught, you not only run the risk of facing legal action, you run the risk ruining any chance you may have had of being accepted into dental school.

Next, if anyone who is wearing one of YOUR mouth guards gets injured or loses teeth after wearing one of YOUR mouthguards, you run the risk of getting sued. Labs and dentists carry malpractice insurance to cover their butts. You won't be able to do this. You run the risk of bankrupting yourself before even becoming a dentist.

This is a VERY BAD idea. It is not worth the risk. But, should you pursue this, I would find out what the laws are in your state regarding this issue. Most likely you will find out you could face legal action of some sort should you get caught.

 

[dentstd]

The big concern is whether it's illegal. I don't know if it's "practicing dentistry," because any lab tech or uncertified dental assistant can make it. It may just be that people don't want you to do it, so they say a bunch of potentially wrong things to deter you. There are actually several indirect indications that it may be legal. But no one on here can confirm anything.

Dental students make stuff for ourselves and our friends all the time. And the school knows that. But we usually stop short of selling it.

Concerning liability, you technically have liability issues with any product. The good thing is that no products liability lawyer working on contingency would ever sue a broke student. The customer can shop around for a lawyer all they want. None will ever take the case.

 

[NAVY DDS 2010]

Dental students make stuff for ourselves and our friends all the time. And the school knows that. But we usually stop short of selling it.

Just because you make something for friends or yourself and the schools don't do anything about it doesn't make it legal or right. In dental school, we are working directly on the license of the faculty who are staffing the clinics. When you make things on the side, you are not working under the license fo anyone, thus you are performing dental care as an unlicensed practitioner. That is illegal. As long as no one gets hurt, no one really will do anything about it most likely. But, if something does happen as a result of your 'on the side' dental work, I can guarantee your butt will be in the sling and the school will be on your butt if not the dental boards and courts if severe enough.

 

[tinman831]

The big concern is whether it's illegal. I don't know if it's "practicing dentistry," because any lab tech or uncertified dental assistant can make it. It may just be that people don't want you to do it, so they say a bunch of potentially wrong things to deter you. There are actually several indirect indications that it may be legal. But no one on here can confirm anything.

A laboratory technician may fabricate the appliance, but it is the licensed dentist who ultimately makes the final decision as to whether or not the product is deemed fit for use. Like Navy said, in dental school, you are working under the license of the clinical instructors.

Dental students make stuff for ourselves and our friends all the time. And the school knows that. But we usually stop short of selling it.

However minor the procedure, it is still called practicing without a license.

The good thing is that no products liability lawyer working on contingency would ever sue a broke student.

You don't need to have money to be sued. They will sue you just to prove a point.

 

[dentstd]

Nothing was said that I haven't already thought of or know. Speaking from the dental student's point of view, I'd say everything you guys have said. However, I'd acknowledge that it'd all be guesses based on everyday experience, or even "common sense." I won't really know if it's actually true.

I'd imagine that not everything we do, every procedure, every lab product we crank out requires a dental license. Drilling requires a license, but what doesn't? Do we need a license to put alginate in someone's mouth? Do we need a license to advise someone to use Act rinse? Do we need a license to hand someone a cup of Listerine to rinse? All this is within the scope of dentistry, but some acts are very innocent and won't need special permission. The question is, without guessing does anyone of us really know where this line is drawn?

On the one hand, you're making a contraption that goes in someone's mouth, and it's custom fitted. On the other hand, the procedure's 100% non-invasive, and generic versions can be obtained easily over-the-counter. I'll say flat out that I don't know the answer, but I stay shy of asserting guesses.

 

[Istr8nthem]

Nothing was said that I haven't already thought of or know. Speaking from the dental student's point of view, I'd say everything you guys have said. However, I'd acknowledge that it'd all be guesses based on everyday experience, or even "common sense." I won't really know if it's actually true.

I'd imagine that not everything we do, every procedure, every lab product we crank out requires a dental license. Drilling requires a license, but what doesn't? Do we need a license to put alginate in someone's mouth? Do we need a license to advise someone to use Act rinse? Do we need a license to hand someone a cup of Listerine to rinse? All this is within the scope of dentistry, but some acts are very innocent and won't need special permission. The question is, without guessing does anyone of us really know where this line is drawn?

On the one hand, you're making a contraption that goes in someone's mouth, and it's custom fitted. On the other hand, the procedure's 100% non-invasive, and generic versions can be obtained easily over-the-counter. I'll say flat out that I don't know the answer, but I stay shy of asserting guesses.

Here's the deal.... We as dentists, carry malpractice insurance for a reason. If I, as an orthodontist, make a patient of mine a "custom mouthguard" and that said mouthguard is worn by the patient and the patient occludes funny on it and develops symptoms of TMD, etc and decides that I am the one who "made" the mouthguard and wants to sue for damages, they are entitled to do so. If the court decides that I, as the dentist who made the mouthguard am responsible for their pain and suffering, I could very likely lose in court and be sued... plain and simple! So, if a person with no license is making "custom mouthguards," even without ever touching the patient, taking impressions, etc, they are responsible for seeing that the mouthguard fits correctly, occludes correctly and will not cause harm. This person is then prescribing an appliance without a license that could be causing harm, both legal issues. Even though it may not be spelled out on paper, this is how it is. DON'T DO IT! Not worth it!

 

[tinman831]

Nothing was said that I haven't already thought of or know. Speaking from the dental student's point of view, I'd say everything you guys have said. However, I'd acknowledge that it'd all be guesses based on everyday experience, or even "common sense." I won't really know if it's actually true.

I'd imagine that not everything we do, every procedure, every lab product we crank out requires a dental license. Drilling requires a license, but what doesn't? Do we need a license to put alginate in someone's mouth? Do we need a license to advise someone to use Act rinse? Do we need a license to hand someone a cup of Listerine to rinse? All this is within the scope of dentistry, but some acts are very innocent and won't need special permission. The question is, without guessing does anyone of us really know where this line is drawn?

On the one hand, you're making a contraption that goes in someone's mouth, and it's custom fitted. On the other hand, the procedure's 100% non-invasive, and generic versions can be obtained easily over-the-counter. I'll say flat out that I don't know the answer, but I stay shy of asserting guesses.

I can make all the dentures and mouth guards I want to in the lab, but when you insert that appliance, you better be sure you are under the supervision of a licensed dentist. Before anything goes in a patients mouth, you better have that license. Yes even alginate. Who is going to manage that patient who has an sensitivity reaction to it or has chemical burns from overuse of such alginate.

Providing medical advice can also be construed as practicing without a license since the patient may assume that this is your educated and professional opinion. Although this tends to be more of a gray area. Telling someone they should brush their teeth and use mouth rinse, probably not that big of a deal. Telling someone that red patch on their tongue is nothing to worry about, a bigger deal.

You say that a lot of this is guess work, and yes it's open to interpretation, but you're better of erring on the side of caution. While you're in dental school, you do not want to give the school any ammunition to expel you from the program.

 

[dentstd]

Here's the deal.... We as dentists, carry malpractice insurance for a reason. If I, as an orthodontist, make a patient of mine a "custom mouthguard" and that said mouthguard is worn by the patient and the patient occludes funny on it and develops symptoms of TMD, etc and decides that I am the one who "made" the mouthguard and wants to sue for damages, they are entitled to do so. If the court decides that I, as the dentist who made the mouthguard am responsible for their pain and suffering, I could very likely lose in court and be sued... plain and simple! So, if a person with no license is making "custom mouthguards," even without ever touching the patient, taking impressions, etc, they are responsible for seeing that the mouthguard fits correctly, occludes correctly and will not cause harm. This person is then prescribing an appliance without a license that could be causing harm, both legal issues. Even though it may not be spelled out on paper, this is how it is. DON'T DO IT! Not worth it!

Problem is, this exact same scenario (and complications thereof) applies to generic mouth guards sold over-the-counter too. Everything you've described falls under the realm of "products liability." If over-the-counter products cause medical problems for the consumer, the manufacturer's subject to liability. Likewise for EVERY single product on the market.

The question is: can custom mouth guards only be made and sold by licensed practitioners or those under supervision of licensed practitioners? Is there a regulation that prohibits manufacturing or sale of custom mouth guards by other groups of people? (Ex. Contact lens sales are regulated.)

 

[ODEP PEDO]

Even if you have a gap of regulations for who manufactures and sells the mouthguard. The point is if something goes wrong (TMJ, Malocclusion, or whatever) "patients" potentially will come after the person/company that they purchased from, some would indeed sue just to make a point (and stop you from harming others) and not just for the money and on top of that I don't believe that any SOD would look favorably or even support one of their students running a side business, using ,to say the least, their facilities, equipment and perhaps materials because a kiddo wants to make extra money. Even if there is a bunch of disclosures that could release him from liability (for argument's sake) he still would be doing that at his SOD and I don't think the faculties or the institution as a whole would enjoy this side business happening in their grounds. The consequences would not be lightly and especially when he would have to use the facilities at off hours to not be on the way of students with real lab assignments. Sounds hush hush to me and that says a lot. If he wants to make extra money, go tutor,get any job, loans, military, etc, I bet he is not the first one to think on those lines for a side business during dental school and will not be the last, but how many were not smart enough to actually do it and luck enough to not get caught or in trouble is my point. We could type here back and forth all day just for the argument. but the final take home message is when you have several folks at this thread giving the unbiased advise to not do it because is not worthy and still the argument of what if comes up, is just dumb, perhaps one should consider going to law school instead

 

[dentstd]

The sad reality still remains that we don't graduate from dental school as dental experts. There are countless procedures that we've done just a few times. Think back to how many procedures you've done just once and the slew of procedures you've never even touched. Even a new dental graduate would be guessing on how to produce and adjust a custom mouth guard, doing on-the-job learning so to speak.

Liability issues are unavoidable for every product in the market. What could save you is instructing the patient that the mouth guard isn't designed to prevent something from happening. It's designed to reduce the likelihood that it happens. Regardless, given that a person wearing a mouth guard typically would be in situations that expose them to rough contact (ie boxing, tackling), a lawsuit has a very steep hill to climb. For example, it's more likely that getting hit by a boxing glove caused the injury, not the mouth guard. The patient is 1000x more likely to blame that right hook for the injury. My guess is that you're safe from legal attacks.

Bottom line: So far, no one on here's ever heard of any regulation prohibiting manufacturing of custom mouth guards by non-dentists (that's not to say that it's not out there), but we still caution anyone from doing so.

 

[tinman831]

Bottom line: So far, no one on here's ever heard of any regulation prohibiting manufacturing of custom mouth guards by non-dentists (that's not to say that it's not out there), but we still caution anyone from doing so.

Here's some info on statutes as far as the state of Mississippi is concerned.

http://www.msbde.state.ms.us/msbde/msbde.nsf/webpages/FAQ_scope?OpenDocument

They consider fabrication of guards to be practicing dentistry.

 

[dentstd]

Here's some info on statutes as far as the state of Mississippi is concerned.

http://www.msbde.state.ms.us/msbde/msbde.nsf/webpages/FAQ_scope?OpenDocument

They consider fabrication of guards to be practicing dentistry.

A step in the right direction, but the wording is poor. This says that once the dentist takes the impression, he is obligated to fabricate, adjust, and deliver the mouth guard. In other words, once he takes the impression, he has to carry through and do everything else. Members of the athletic dept can't do it. I have a hunch what they're trying to say, but what they actually said is something completely different. Mississippi, Mississippi...

Interestingly, this page also says that it's illegal for orthodontists to place sealants. Yea, like orthodontists don't know how to put sealants on. Something's up with Mississippi, I tell you.

 

[jmick101]

I have to agree with a lot of what dentstd is saying. In a sense, the water is muddy as to the exact legality of the mouth guard proposition. The original question though was if it was a bad idea or not. Based on what we have seen so far (albeit limited) would suggest that making these appliances before you are technically licensed to practice dentistry in the fullest legal sense (either under your own license or the schools) would be bad form professionally speaking. I think that qualifies as a bad idea.

If you are looking to make some scratch cash during dental school, get a job as a night organ harvester or something.

 

[tinman831]

A step in the right direction, but the wording is poor. This says that once the dentist takes the impression, he is obligated to fabricate, adjust, and deliver the mouth guard. In other words, once he takes the impression, he has to carry through and do everything else. Members of the athletic dept can't do it. I have a hunch what they're trying to say, but what they actually said is something completely different. Mississippi, Mississippi...

Interestingly, this page also says that it's illegal for orthodontists to place sealants. Yea, like orthodontists don't know how to put sealants on. Something's up with Mississippi, I tell you.

The wording is perfectly clear. " this is construed as practicing dentistry without a license in the State of Mississippi." As far as orthodontists placing sealants, the ADA code of ethics states that once you advertise yourself as a specialist, you are limited to that scope of practice. Mississippi simply defines sealants as being outside the realm of orthodontics.

 

[dentstd]

The wording is perfectly clear. " this is construed as practicing dentistry without a license in the State of Mississippi." As far as orthodontists placing sealants, the ADA code of ethics states that once you advertise yourself as a specialist, you are limited to that scope of practice. Mississippi simply defines sealants as being outside the realm of orthodontics.

The wording ISN'T perfectly clear. At least that part, because it's not a part of the question being answered. Look at the Mississippi Code Annotated and it explicitly allows unlicensed people to practice dentistry at least in a few cases.

Look at Section 73-9-3(h) that was cited. It allows the dental student to make, adjust, and deliver the custom mouth guard without the presence of a licensed dentist, but he can't do it for profit. However, it doesn't say that you can't recoup costs (charge enough money to break even), since there would be no profits. Regardless, there are conditions placed on this rule, and the situation in question doesn't meet those conditions. So, no. You aren't allowed to make and sell custom mouth guards on your own as an at home operation. It's true in the state of Mississippi, and it'll likely be true for other states as well.

I know that sealants are outside the scope of orthodontics. I just think it's ******ed that they can't do it, because it requires about 3 seconds of training to learn it.

 

[tinman831]

"Dentistry" is [snip] provided by a dentist, within the scope of his or her education, training and experience, in accordance with the ethics of the profession and applicable law, provided that nothing in this section shall be so construed as to prevent:

Dental or dental hygiene students enrolled in accredited dental or dental hygiene schools from participating in off-site training recognized and approved by the board, but those activities shall not be carried on for profit;"

It does NOT allow a dental student to fabricate/deliver an occlusal guard at all. The clause simply allows a dental student to participate in training outside of dental school. Sometimes interpretation can be open for debate, however, this clause prevents such interpretation from interfering with a dental students training. The Miss. State Board has already explicitly stated that making a nightguard is practicing dentistry, end of story.

The wording ISN'T perfectly clear. At least that part, because it's not a part of the question being answered. Look at the Mississippi Code Annotated and it explicitly allows unlicensed people to practice dentistry at least in a few cases.

Look at Section 73-9-3(h) that was cited. It allows the dental student to make, adjust, and deliver the custom mouth guard without the presence of a licensed dentist, but he can't do it for profit. However, it doesn't say that you can't recoup costs (charge enough money to break even), since there would be no profits. Regardless, there are conditions placed on this rule, and the situation in question doesn't meet those conditions. So, no. You aren't allowed to make and sell custom mouth guards on your own as an at home operation. It's true in the state of Mississippi, and it'll likely be true for other states as well.

I know that sealants are outside the scope of orthodontics. I just think it's ******ed that they can't do it, because it requires about 3 seconds of training to learn it.

 

[dentstd]

It does NOT allow a dental student to fabricate/deliver an occlusal guard at all. The clause simply allows a dental student to participate in training outside of dental school. Sometimes interpretation can be open for debate, however, this clause prevents such interpretation from interfering with a dental students training. The Miss. State Board has already explicitly stated that making a nightguard is practicing dentistry, end of story.

I don't even know how to respond to this. There's conflicting info as to whether you understood what was said. Parts said you understood, while parts said you didn't. So I stop here on this thread. I already said what needed to be said earlier on. A dental student is allowed to make custom mouth guards when certain conditions are met (namely when it's part of a "off-site training recognized and approved by the board" and that it's not for profit). A discreet operation using the school's facilities isn't one of them.

 

[NAVY DDS 2010]

Tinman,

No matter what you do or don't say, you aren't going to change the opinion of DentSTD. Most state boards feel that the practice of making custom mouthguards fall in the realm of dentistry and thus making a nightguard without being a dentist, without doing so under the direct supervision of a dentist or without being a certified lab making a custom nightguard without a dental prescription is considered practicing dentistry without a dental license. There may be some states where this is acceptable, but most states this is not. Unless it is found in writing that someone outside the forementioned positions may make a custom made mouthguard, then you are pretty safe assuming that it is illegal in that state for any Joe Blow off the street or even a dental student practicing without credentialed faculty from making them! Don't waste your breath trying to prove it otherwise as it will be time wasted that you can never get back trying to prove to him otherwise.

"Dentistry" is [snip] provided by a dentist, within the scope of his or her education, training and experience, in accordance with the ethics of the profession and applicable law, provided that nothing in this section shall be so construed as to prevent:

Dental or dental hygiene students enrolled in accredited dental or dental hygiene schools from participating in off-site training recognized and approved by the board, but those activities shall not be carried on for profit;"

It does NOT allow a dental student to fabricate/deliver an occlusal guard at all. The clause simply allows a dental student to participate in training outside of dental school. Sometimes interpretation can be open for debate, however, this clause prevents such interpretation from interfering with a dental students training. The Miss. State Board has already explicitly stated that making a nightguard is practicing dentistry, end of story.

 

[tinman831]

I don't even know how to respond to this. There's conflicting info as to whether you understood what was said. Parts said you understood, while parts said you didn't. So I stop here on this thread. I already said what needed to be said earlier on. A dental student is allowed to make custom mouth guards when certain conditions are met (namely when it's part of a "off-site training recognized and approved by the board" and that it's not for profit). A discreet operation using the school's facilities isn't one of them.

I'd like to clarify my statement saying that the "it does NOT allow a dental student to fabricate/deliver an occlusal guard at all" was referring to the OP's question about making your own nightguards on the side. But, the wording is still perfectly clear, making nightguards falls within the realm of practicing dentistry, unlike what you keep alluding to. In the end, I still think we're probably arguing for the same thing.

 

[dentstd]

There's a course here where dental students go and make mouth guards for the football team. So yes, I do think dental students are allowed to fabricate and deliver mouth guards, and I think they're doing so under (h). I think (h) was specifically designed to allow courses like this.