Mouth Gear Controversy (UPDATED)

8 Nov

Courtesy of Jonathan Harford via Flickr

It is called “mouth gear” because many outfits are trying to cash in on the concussion issue. This is certainly a hot topic and one that I am not afraid to wade into. I also feel that it is good time to bring it up because, well, my inbox is slammed full of information.

It began with an email from Mark (REDACTED), EVP of (REDACTED) who makes mouth “orthotics” and mouth guards.  For the purposes of this discussion, we will call anything inserted to the mouth, mouth gear.  I was presented some research material that showed that using such mouth gear that concussions could be reduced(Dental_Traumatology%20Publication).  In the discussion it presented that more information and study is needed to look into this orthotic for the mandible area.  But what they are using to base that on is a very limited and uncontrolled subject pool.  28 subjects that have not only grown in age, but in size, and awareness of concussions.  This subject pool only was defined as “competitive” seasons as the longevity of the study.  Did that mean the subjects went from high school sports to college, or just competitive intramural sports in college?  Did the subject stop playing football during that time and pick up golf?  It does not say, all limitations to the study and huge factors in reducing concussions.

Heck even the website has some misinformation on it, look for yourself (unlinked) the text says;

“I previously had 3 concussions.  I started wearing the Maher Mouth Guard 3 years ago and have not had a concussion since.  I feel very comfortable wearing The Maher Mouth Guard and recommend it for any contact sport.  It is perfect!” -Assante Samuel, New England Patriots.

Well that statement is not exactly truthful as Assante Samuel was listed on the official NFL Injury report Week 5 with a Concussion and was Out.

Granted, properly fit mouth gear (top and bottom) could, STRESS COULD, help with diminishing an “upper cut” like blow to the jaw, that would translate forces into the base of the skull via the mandible (jaw bone).  In fact I think it does help with the mandible slamming the tempromandibular joint (TMJ) area.  But that does not even address the force of the hit and where this force goes.  The Law’s of Physics tell us that force and energy just does not disappear.  Any shot to the head or body will translate forces some being distributed to the brain case.  As we have seen in the Purdue study even an accumulation of sub-symptomatic hits can cause damage.  How can mouth gear help with that when there has been NO CONCLUSIVE studies to indicate the claims of such companies.

Sure, making an effort to study it more is a wonderful idea, it is needed, but to blast organizations and others for not considering something that has zero definitive research on it makes no sense.  And to claim that there are devices out there that WILL reduce concussions is just as dangerous as not investigating the possibilities of it working.

To the defense of Mark (REDACTED) and (Company REDACTED) he did present this in an email;

The following is true, Guskewicz has shown in research, mouth guards do nothing to prevent concussion. This is because, common non jaw positioning mouth guards arbitrarily position the jaw, the main reason is because the appliances are always the same thickness on each side. There is no balancing of the bite in relation to the position of each jaw joint. This leaves you with a poor position the majority of the time, giving you arbitrary results in both concussion research and strength tests. Athletes with a good bite, should do well with these common types of guards, the problem is, they are uncomfortable and some even cut the molar area off the guard, causing a ramp effect. We have found in review of a few H.S. teams, most kids have poor jaw health, orthodontics and prior injury in most cases is the cause.

If in fact this is the case to solving some of our concussion issues, then “good on ya” Mark and (Company REDACTED), and a thank you in advance.

I am not done……………………………………………………………………………………….

In the time Mark and I were engaged in a great conversation another email came to the inbox about the “(Product REDACTED)”, (please visit their website (unlinked) for this product) from VP of Sales, Bill (REDACTED).  Bill sent me a nondescript, standard online flier about his product (by the way I fully endorse as the choice of mouth pieces at this point, but not for what they claim, rather the potential, I now endorse TapouT Mouthguards, highlighted by the DeSean Jackson/Dunta Robinson hit.  Here is the resulting email conversation

Me;

Thanks Bill,

As an athletic trainer I have used the mouthguards and believed in them for a long time, but for dental and jaw injuries.

I do agree that the correct guard can protect the mandible from slamming the skull, however the blow in most sports outside of boxing is very limited.  Most of the concussive episodes are a direct result of the forces applied to the skull in varying planes.

I have used and promoted the brain pad in the past and still to, however if one is to ask me if mouthguards help prevent concussions, I respond simply with there is no research to suggest it.

df

Mr. (REDACTED);

Dustin,

I appreciate your quick response. You say there has been no research to suggest it. Are you familiar with our 2 head drop studies that show a decrease of imact energy to the TMJ and base of the skull as much as 40% when wearing the dual arch Brain-Pad. I can send the complete testing details and results but you may want to take a look at this link (link REMOVED)

Regards

Bill

Me;

Bill,

I am familiar with that study, however how it relates to concussions is pragmatic at best…  Yes it can help, but is it the force of the jaw/TMJ area slamming into the skull or the force distributed to the brain case in the impact…  Great conversation…

df

Mr. (REDACTED);

Dustin,

We realize no one thing will prevent concussions. However the base of the brain sits right on the glenoid fosa (the thinnest bone in the body about 1/16th on an inch thick) at the TMJ. If the condyle is hammered up into the TMJ area these forces have direct access to the brain.Helmets fail if 300 lbs of force passes through the helmet

We have readings of over 400 being delivered to the base of the skull without a Brain-Pad ! If we can reduce these forces by as much as 40% we have to be reducing at the least the risk of a concussions. see Jaw position attached.

Regards

Bill

Me;

Bill,

I have never said that a mouthguard may not help with the prevention of concussions, however this injury cannot be completely prevented…  Even if you can reduce the force via the (Product REDACTED), where is that force going?  Into the pad itself?  Or is it being transmitted elsewhere, like the skull then into the brain?  Are you telling me that the brain pad can absorb nearly 200lbs of force?  Are you trying to tell me that a lateral blow to the head with a brain pad in, this will reduce the chance of a concussion?  Are you telling me that the brain pad helps with any other direction of trauma?  How does a brain-pad help when a player hits their head on the floor/ground?  How often are their hits directly under the chin in football?

To promote something as a way to reduce concussion it should have solid background and research in all arenas…  Not just with one type of force in one sport…

Again my opinion…

df
I have yet to receive an email back regarding the last message I sent to Mr. (REDACTED) on November 4th.  I have never claimed to be a smart guy but I do want to be informed and inform others, especially from my experiences as a medical professional.  However I can sum this up with people much smarter than I.  B.W. Benson, G.M. Hamilton, et al composed this study published in the British Journal of Sports Medicine.

And finally I also believe that if you put a band-aid on your forehead it may reduce the chance of a concussion.

Any comments???
UPDATE 7/25/11 – Removal of names and identifying features of companies and products, reason being that I do not want them to get any web traffic.
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7 Responses to “Mouth Gear Controversy (UPDATED)”

  1. Joe Manzo November 9, 2010 at 07:54 #

    A Revolutionary Change
    The design of the Revolution helmet is based on the findings of a long- term study of professional football players conducted by Biokinetics & Associates, an independent engineering consulting firm, and several universities. The research revealed that of all the hits that resulted in a concussion, nearly 70 percent were to the side, face or jaw area.
    The new Revolution helmet includes innovative features specifically designed to help reduce the risk of concussion. The Tru-Curve(TM) protective shell extends to the jaw area and has been computer designed around the head’s center of gravity to offer superior front-to-back fit and stability. The new Z-pad design provides protection to the side of the head and the jaw — helping to lessen the energy of impact on these areas if a collision occurs. The patented VSR Air-Fit(TM) System features padding that can inflate to offer a custom fit to every player’s head shape.
    With the Revolution, Riddell has increased the distance from the helmet shell to the player’s head – allowing for greater room to manage the types of hits that can cause concussion. The Isolator(TM) faceguard system is designed to isolate the attachment points of the faceguard from the shell – reducing jarring to the player from low-level impacts to the faceguard. Riddell maintains its commitment to producing a lightweight product without compromising protection.
    Research-Based Protection
    Learning more about the “hows and whys” of concussion led Riddell to this current model. Scientists from Biokinetics & Associates analyzed videotapes of football field head collisions to determine the details of motion and contact. These same conditions were re-created in the lab, where special sensors inside helmeted crash dummy heads measured the impact forces.
    “Our study helped demonstrate how head traumas really happen, which provided the industry with new insight,” said Dr. James Newman of Biokinetics & Associates. “We helped correct some misconceptions about concussion and demonstrated that impacts to the side of the head have more significance in causing concussions than impacts taken on top. Additionally, rotational forces seem to play a big role in the biomechanics of concussion. While no helmet can fully prevent concussion, we hope this new research will bring us one step closer in reducing the number of concussions players suffer on the field.”
    Riddell is making the new research available to other helmet manufacturers in the hopes that more companies will adapt this new technology to help reduce the rate of concussions.

    • Joe Manzo July 21, 2011 at 13:31 #

      I never wrote the article above on Riddell.

      Joe Manzo

      • Dustin Fink July 22, 2011 at 11:41 #

        Then who did? Care to source?

  2. Mark Picot November 17, 2010 at 19:48 #

    It’s imperitive that researchers investigate this “unknown” factor in concussion. Dr. Cantu stated in congressoinal testimoney that the chin/jaw is a contributing factor to concussion. Then why is there not a rush to investigate a potential solution to this specific type of trauma to the brain. Any new research on this theory must be done by an independent institution, not the NFL. Only an institution with a history of tmj study, peer reviewed by well known, respected neurologists, will gain attention. This has been the problem, without this type of support, it may never be accepted.

  3. Mark Picot November 17, 2010 at 19:56 #

    http://www.newswise.com/articles/education-and-rule-enforcement-reduce-neurological-brain-and-spine-injuries-in-rugby

    The College of Neurosurgeons are standing their ground, protecting their territory, which is anything to do with the brain. To them dentists are not even doctors.

  4. Jeffrey Rovell January 26, 2011 at 00:46 #

    Brain Pad reduces the impact to the TMJ.
    Braiin Pad Jaw Joint Protector mouth guard is a dual arch upper and lower jaw configuration that can potentially reduce concussions in football players which are due to Jaw or Face Mask hits.

  5. Mark May 23, 2011 at 06:55 #

    Comparison of mouth guard designs and concussion prevention in contact sports: a multicenter randomized controlled trial.
    Barbic D, Pater J, Brison RJ.
    Source

    Department of Community Health and Epidemiology, Queen’s University, Kingston, Ontario, Canada. 8db@qlink.queensu.ca
    Abstract
    OBJECTIVES:

    To compare the effectiveness of the WIPSS mouth guard to other currently used mouth guards in the prevention of concussion injuries in athletes participating in varsity football and rugby.
    DESIGN:

    : Multicenter, cluster-randomized, controlled trial comparing the WIPSS Brain-Pad mouth guard against the standard use mouth guard of choice. Teams were monitored by their respective athletic therapist, trainer, or sports physician for 1 playing season to diagnose and record incident concussion injuries and dental trauma. Concussion symptoms were also recorded at the time of injury.
    SETTING:

    Five Ontario universities.
    PARTICIPANTS:

    University male football (394) and university male (129) and female (123) rugby athletes reporting to 2003 fall training camps.
    MAIN OUTCOME MEASUREMENTS:

    The primary end point was the incidence of any diagnosed concussion events during the 2003 playing season as defined by the American Academy of Neurology Concussion Guidelines. Secondary endpoints included the incidence of dental trauma events and observed concussion symptoms.
    RESULTS:

    There was no significant difference in the number of concussions observed between the intervention and control arms of this trial (P = 0.79; odds ratio, 1.06, in favor of controls; 95% CI, 0.51, <<1.61). No dental trauma events occurred. The 5 most common symptoms experienced by concussed athletes were dizziness, general headache, nausea, loss of visual focus, and personality changes.
    CONCLUSIONS:

    In this study, concussion rates were not significantly different f

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