Jul 16, 2015

New Studies Reveal How Mouthguards Can Reduce Concussions

A new study reveals the role of a mouth guard in reducing concussions while another shows how the device can increase upper and lower isokinetic muscle function.

By Michael C. Hutchison, DDS

The use of an athletic mouth guard to protect the dentition from injury and tooth fracture has been a norm in contact sports since the early 1960’s. The growing amount of concussions in modern day sports has led to the claims that mouth appliances can be utilized as a protection against concussions. This continues to be a question now being asked by the sporting world, especially for high-impact sports such as hockey and football. Numerous minor hockey leagues and youth football leagues have introduced mouth guard rules as a possible prevention of concussion, rather than dental concerns.

Mainstream concussion studies have been directed to acceleration impact studies on surrogate subjects such as crash dummies or cadaver subjects. Very little research can be found on live human subjects as a cause and effect study. The present observations from the data of an ongoing 9-year study of athletes using the PowerPlus Mouthguard in live sports competition has shown to reduce the concussion incidents to 0.2 % of athletes when fitted correctly. There are at least three possible theories on the potential benefits of mouth guard fitted to the physiologic rest position of the mandible and the reduction of the incidence or severity of concussions. Some of the theories being postulated are the direct dissipation and/or absorption of force when taking a blow to the jaw, the increased separation of the head of the condyle of the mandible and glenoid fossa of the skull leading to reduced g-force impact to the brain and the increased head stabilization by balancing, activating and strengthening neck muscles. It should be noted that much more study needs to be done on live subjects in their athletic environment, but this study shows a definite promise in reducing the incidence of concussions in contact sports.

Introduction

The US Center for Disease Control reports that children aged 0 to 4 years, older adolescents aged 15 to 19 years, and adults aged 65 years and older are most likely to sustain a TBI. They report that almost half a million (473,947) emergency department visits for TBI are made annually by children aged 0 to 14 years. In every age group, TBI rates are higher for males than for females. Direct medical costs and indirect costs such as lost productivity of TBI totaled an estimated $76.5 billion in the United States in 2000. They estimate that upwards of 20% of athletes per years suffer from concussions, which are reported and not reported. Helmet manufacturers have continued to make improvements in their helmets but the rate of concussion incidence has remained the same for the last several years. Many studies have been conducted and have reported the strength benefits of placing the lower jaw in the physiologic rest position (PRP) but none have been conducted, to the knowledge of this author, of any affect the PRP has on the rate of concussions. The data used in this study will demonstrate the use of the human physiologic rest position of the mandible and associated musculature in reducing the incidence of concussions in football, hockey and basketball players tested from youth sports, high school, college and professional levels of contact sports competition. The PowerPlus Mouthguard ™ was used in this ongoing study of 847 athletes over the past 9 years. The hypothesis is that the 20% of concussions reported come from an unstable lower jaw and that placing the mandible in the PRP stabilizes the jaw against the potential concussion causing impact.

Method

Appliance fitting: Over a period of 9 years the PowerPlus Mouthguard appliance design has changed but the PRP has remained constant. The athletes were fitted with a lower PowerPlus Mouthguard ™ (Traverse City) according to the instructions provided. The PowerPlus Mouthguard is a patent-pending mandibular repositioning appliance that is designed to place the lower jaw in the PRP of each subject. Each subject’s vertical dimension of occlusion was measured and the mouth guard thickness adjusted to the optimal vertical dimension of occlusion of 19mm and the PRP.

Data Collection

Individual subjects and teams were fitted with the PowerPlus Mouthguard and instructed to use it in practice and game competition throughout their respective seasons of competition. Individual athletes were tract on their progress individually throughout the season and personally interviewed for the results. Teams were asked to fill out a report form showing how many concussions were diagnosed by a health care professional, and forms were submitted at the end of the season. Data was processed and tallied over the 9-year period for all 868 athletes. There were no verbal instructions as to how the PowerPlus Mouthguard should be used, except for the players to use it as they would a traditional mouth guard.

Data Analysis

Percent of concussions were calculated for the data proved remarkable. The subjects who wore the PowerPlus Mouthguard showed a 0.34% concussion rate compared to the CDC’s report of 20% per year with any or no mouth guard.

Discussion

These results over 9 years indicate that positioning the jaw in the PRP can reduce the incidence of concussion in contact sports. It is important to note that the results are dependent on the correct vertical dimension placement of the jaw in its unique PRP for the result to be reproduced.

Continued studies must be conducted to examine the long term effects of PRP and concussions.

Conclusion

These data indicate that positioning an athletes jaw in its physiological rest position can dramatically reduce the incidence of concussions in contact sports. The results indicate that not all mouth guards are equal, and greater safety can be achieved by applying normal human physiology to position the mandible for improved safety in athletic competition.

References

1. Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010.

17. Wisniewski, J., Guskiewicz, K. , Trope, M., Sigudsson, A., (2004) Incidence of cerebral concussion associated with types of mouth guard used in college football. Dental Traumatology, 20(3):150-6.

Click here to read Mouth Guard Study: Acute Effects of Dental Appliances on Upper and Lower Isokinetic Muscle Function