One of the most important pieces of equipment on the football field is often overlooked. It's not a helmet, nor a pair of cleats, not even shoulder pads, but rather a mouthguard.

A mouthguard protects against a concussion — by helping absorb the force from a hit to the jaw — among other injuries.

The American Dental Association estimates more than 200,000 injuries are prevented each year in high school and college football alone by wearing mouthguards.

Mililani High School athletic trainer Troy Furutani recognized the importance of a proper mouthguard. Five years ago, Furutani approached Dr. Danny White with a plan to move away from boil-and-bite mouthguards to custom-fitted mouthguards.

"It gives the players better protection as far as dental injuries," said Furutani, citing a previous injury in which a football player lost a tooth on the field. "It also provides better comfort."

Furutani and White began as a two-man operation, outfitting the football team, but the requests for custom mouthguards began growing. "Troy's also done basketball, soccer, softball, baseball and wrestling," White said.

According to Sports Dentistry Online, more than 90 percent of mouthguards worn are the boil-and-bite type, with custom mouthguards making up the other 10 percent.

White said a custom mouthguard can cost from $20 to several hundred dollars.

Initially, Furutani offered the custom mouthguards as a $10 option. "He was eventually able to work it into the budget so the athletes don't pay anything," White said.

"(The mouthguard's) value greatly outweighs the cost as tooth replacement can easily be a thousand dollars," said White.

Boil-and-bite mouthguards can be bought at sporting goods stores and fitted at home. Athletes place the mouthguard into hot water for about 10 seconds and bite into it.

There are several advantages to the custom mouthguards.

"(The boil and bite) fits nowhere near as well as the custom mouthguard," White said.

Aaron Kia, a former Mililani lineman and current UH reserve center, prefers the custom mouthguard.

"I kind of like the fitted ones — the ones they mold to your mouth," Kia said. "You can just keep it in your mouth and don't have to worry about it falling out."

Added Furutani: "The kids like it because it's more comfortable than the boil and bite."

Getting fitted for a custom mouthguard is another story.

"Felt kind of weird," said sophomore lineman Sonny Westbrook. "Gushy and stuff. Nasty."

A paste-like mold of the athlete's teeth is held in place for about two minutes.

"It's kind of cool. You can feel the mold in your teeth," said Curtis Murakami, a senior safety. "It gets hard after you leave it in for a while. It doesn't taste bad."

Others don't quite echo his sentiments.

"Feels super weird. First time, I almost gagged,"Kia said. "It takes getting used to."

Custom mouthguards last longer than the boil-and-bite variety, White said.

"When you bite down on the boil-and-bite, it compresses the material and players tend to chew on them," he said.

A football player will probably go through a couple boil-and-bite mouthguards per season.

At Mililani the players are fitted for a new custom mouthguard every year. "They tend to wear down, too," Furutani said.

According to Furutani, Radford, Castle and McKinley also provide custom mouthguards for their athletes.