Mouth Gear

Mouth Guards (5/5/14) — How is this study not retracted?

Dustin Fink5 Comments

It has been nearly a year since I wrote this up, but it has been making the rounds again.  I honestly want to know why this “peer-reviewed” article has not been retracted.  This is one of the most blatant oversights I have witnessed in publications, and that is not hyperbole.  Read the following for yourself:

==========

Is it a bombshell or is it just a plain dud?  I say bombshell, but not in a good way for anyone involved with this “research”.

Last week I was inundated with emails regarding this “new” research about mouth guards and concussions.  There were roughly 16 emails in a one hour time span; some wanting comment, some telling me I have been wrong all along, some promoting the research.  This was a “huge” development in my area and my little corner in the blogosphere.  To fully understand perhaps some history is needed (“mouth gear” search on this blog) when it comes to my feelings on mouth gear and concussions.  Here are some selected comments attributed to me;

The basic fundamentals we should be cognizant of here are: concussion is a BRAIN injury, the BRAIN floats inside skull, Physics dictates that the BRAIN will move depending on the forces applied to the skull/head (not always from a blow to that area), mouth gear cannot stop the BRAIN from moving, mouth gear cannot attenuate any forces to the skull/head that are not in the oral region, mouth gear does nothing for the skull/head when forces are placed on it in rotational, angular, acceleration or deceleration fashion.

Now that we have that all out-of-the-way this is the General Dentistry article I was asked to comment on.  On face value and from a “peer-reviewed” angle itseems all good.  A significant finding between custom mouth gear (noted as LM MG in article) and over the counter “boil and bite” mouth gear (noted as OTC MG).  However once you take a deeper look there are some peculiar problems, in my humble opinion – that comes later.

First, we should look at the possible limitations of this study that seems well populated and well thought out (honestly these were my first concerns before finding the real issue):

  • Were the injuries controlled for by football position? (we have documented this issue here)
  • Were the injuries controlled for by size of players/school they were playing?
  • Were the injuries controlled for by playing time? (more exposure more risk)
  • Were the injuries controlled for by game vs. practice?
  • Were all the injuries seen and recorded by a single MD or was it the ATC at each school?
  • Did any of the players have a previous history of concussion?
  • Was the study controlled based on practice habits of the teams? (do some hit more than others)
  • How do we know that every player complied with the “no wedging or chewing” rule? (this plays a massive role later)
  • The study says that all 412 subjects wore the same exact helmet, I find that: A) hard to believe and B) was the fit on every player the relatively the same?
  • Who funded this research? (no disclosure)

As you can see there is a litany of reasons I would have dismissed this research, if I were peer reviewing because those limitations are extremely real and realistic Continue reading →

#tbt Mouth Guard BS Research!

Dustin Fink4 Comments

This was originally posted in May, not a long throwback, but since football started I have been hit up with this question a lot.  So here is the “truth” about this research.  I love the effort and attempt to find a reason; however when you have a critical and FUNDAMENTAL flaws then present it in a way that could be considered fraudulent I have a major problem.  I would also like to add that this research has not been pulled by the publisher.  This is exactly how we get in trouble, the Academy of General Dentistry needs to address this, now, as this peer-reviewed “science” is getting run in media…

==========

The basic fundamentals we should be cognizant of here are: concussion is a BRAIN injury, the BRAIN floats inside skull, Physics dictates that the BRAIN will move depending on the forces applied to the skull/head (not always from a blow to that area), mouth gear cannot stop the BRAIN from moving, mouth gear cannot attenuate any forces to the skull/head that are not in the oral region, mouth gear does nothing for the skull/head when forces are placed on it in rotational, angular, acceleration or deceleration fashion.

Now that we have that all out-of-the-way this is the General Dentistry article I was asked to comment on.  On face value and from a “peer-reviewed” angle it seems all good.  A significant finding between custom mouth gear (noted as LM MG in article) and over the counter “boil and bite” mouth gear (noted as OTC MG).  However once you take a deeper look there are some peculiar problems, in my humble opinion – that comes later.

First, we should look at the possible limitations of this study that seems well populated and well thought out (honestly these were my first concerns before finding the real issue):

  • Were the injuries controlled for by football position? (we have documented this issue here)
  • Were the injuries controlled for by size of players/school they were playing?
  • Were the injuries controlled for by playing time? (more exposure more risk)
  • Were the injuries controlled for by game vs. practice?
  • Were all the injuries seen and recorded by a single MD or was it the ATC at each school?
  • Did any of the players have a previous history of concussion?
  • Was the study controlled based on practice habits of the teams? (do some hit more than others)
  • How do we know that every player complied with the “no wedging or chewing” rule? (this plays a massive role later)
  • The study says that all 412 subjects wore the same exact helmet, I find that: A) hard to believe and B) was the fit on every player the relatively the same?
  • Who funded this research? (no disclosure)

As you can see there is a litany of reasons I would have dismissed this research, if I were peer reviewing because those limitations are extremely real and realistic to control for in this type of study.  I wrote to the public relations group handling this research and was unable to get a straight answer on those questions I raised.  In the meantime I sent out the article to some better than average “stat nerds” and awaited a response.

While waiting I noticed something really troubling, as in a fatal flaw with the research.  In some places an oversight like this is intolerable, because Continue reading →

General Dentistry Publishes a Bombshell About Mouth Guards (ADDENDUM)

Dustin Fink2 Comments

Is it a bombshell or is it just a plain dud?  I say bombshell, but not in a good way for anyone involved with this “research”.

Last week I was inundated with emails regarding this “new” research about mouth guards and concussions.  There were roughly 16 emails in a one hour time span; some wanting comment, some telling me I have been wrong all along, some promoting the research.  This was a “huge” development in my area and my little corner in the blogosphere.  To fully understand perhaps some history is needed (“mouth gear” search on this blog) when it comes to my feelings on mouth gear and concussions.  Here are some selected comments attributed to me;

The basic fundamentals we should be cognizant of here are: concussion is a BRAIN injury, the BRAIN floats inside skull, Physics dictates that the BRAIN will move depending on the forces applied to the skull/head (not always from a blow to that area), mouth gear cannot stop the BRAIN from moving, mouth gear cannot attenuate any forces to the skull/head that are not in the oral region, mouth gear does nothing for the skull/head when forces are placed on it in rotational, angular, acceleration or deceleration fashion.

Now that we have that all out-of-the-way this is the General Dentistry article I was asked to comment on.  On face value and from a “peer-reviewed” angle it Continue reading →

AAP Confirms What We Have Been Saying For Some Time

Dustin Fink5 Comments

This past Monday, the American Academy of Pediatrics released their findings of a research project on helmets and mouth guards in high school aged football players, the lead was this;

High-tech helmets and custom mouth guards do not reduce concussion risk for high school football players any more effectively than low-cost helmets or off-the-shelf mouth guards, a new study says.

This is a point we have been trying to hammer home since the inception of the blog; simply Physics does not allow for current technology to reduce or attenuate the true forces that cause concussion in the vast majority of the cases.  Those would be: acceleration, deceleration, rotation and angular vectors that cause the brain to shift inside the skull.

The most important thing about a helmet is that it’s well-maintained (regularly reconditioned) and has a proper fit.  Certainly there is some merit to the newer helmets padding designs for helping with the true linear forces reaching the skull; however helmets are doing what they’re designed for – preventing skull fractures and facial injuries.

It is unlikely that a helmet – as we currently know it – will abate those pesky forces attributed to concussion.  In reality if that is where the fix needs to come from then we will most likely be looking at some sort of apparatus that is attached to the shoulders that basically harnesses the head down.  The issue there, of course, is the range of motion to allow a player to see and move in a safe way.  Regardless this information presented by the AAP is nothing new but wonderful because it comes from a group that has “clout”.

What is more interesting to me – and a bit of an endorsement of our words – is that simple Continue reading →

Helmets Aren’t the Answer

Dustin Fink9 Comments

So says a group of researchers from Wisconsin.  After gathering data on over 1300 football players the overall theme was that there was no correlation between expensive helmets and reduction of concussion incidence.  On first inspection the design of the study looks sound, especially since high school athletic trainers were involved, and the results appeared to be sound according to Timothy McGuine;

“We found the actual incidence of concussion was not more for players wearing the newest helmets versus wearing helmets 3, 4 or 5 years old,” McGuine said. “We also looked at [concussion] severity by helmet model. No difference there, either.”

This finding is absolutely logical based upon today’s helmet technology.  McGuine is correct the exterior shell has achieved its goal to a tune of 99.9999% – prevention of skull fractures – however, the issue of concussions is really something a helmet was/is not designed to combat.

Think about this; the brain rests within fluid inside your skull, the primary protection for our brain, thus allowing our “noodle” to move “freely” for everyday tasks like walking, running, jumping.  In fact, it is an amazing process Continue reading →

More Mouthguards Make Our List

Dustin Fink2 Comments

This is not a prestigious list by the way, it is more of a “beware of list”, and two different companies/mouthguards have now found my ire.  Perhaps I was “Pollyanna-ish” about companies continuing to claim that this particular piece of equipment can attenuate concussions or even reduce problems; it should have been fair warning with the FTC’s decision on Brain-Pad.

Any device placed in the mouth is for oral-dental protection, nothing more.  Any claims otherwise are not based on any scientific evidence, because none exists to my knowledge.  If you want to prevent what you see in the picture you must wear a mouthguard/device.  If you want to prevent concussions, don’t participate in collision or contact sports, period.

If I told you that one company says;

“A serious blow to the head can leave you with significant physical and mental problems years after you’ve hung up your equipment. Gladiator® may prevent or reduce the severity of concussion.”

What would you say to that?  But they are not the only one;

“By wearing a Guardian Mouthguard, you are helping to protect yourself against concussions!”

That will be the last time I mention those companies.  I don’t like to send traffic their way, but if you do not believe me Continue reading →

Mouth Gear Comments

Dustin Fink12 Comments

If you have not been following the comment section you have missed a debate on mouth gear and concussions (Please feel free to enter into the conversation).  I believe that the information about how there is no current evidence that any oral device can attenuate concussions or help with symptoms related to the injury of concussions.  Here is a statement from the National Federation of State High School Associations (NFHS) Sports Medicine Handbook – 4th Edition;

“The effectiveness of mouthguards for preventing or reducing the risk of sustaining a concussion remains controversial. Research continues to be done on the different mouthguards and their properties to answer this question, but there is currently no reproducible evidence supporting the use of any mouthguard to protect against concussion in any sport.”

For a health care professional dealing with sports injuries this should be a telling statement.  However there are those out there trying to push a product and make money on the misinformation about concussions.  Below you will see some of the exchange and the prime example of why there continues to be a problem. Continue reading →

Mouth Gear Information

Dustin Fink9 Comments
Courtesy of Jonathan Harford via Flickr

Back in November I took on the mouth gear issue by showing some emails that I had with a few of the prominent companies invested in oral/facial protection.  I use the term “mouth gear” to isolate any device that is placed in your mouth, this is a very hot topic, especially since the football season is about to begin.  If you have read that post you know my stance on the issue at hand; buyer beware.

Lets begin with some video footage of athletes wearing mouth gear;

  • The first KO is textbook mechanism of injury that the mouth gear companies say they can protect against; a blow to the jaw, where the jaw bone (mandible) would slam into the skull.
  • The third KO is a blow to the jaw, in a rotational axis, again companies claim they can protect against concussive injuries when a blow is received on the jaw.
  • The fourth KO is a straight right to the jaw.
  • The fifth KO a left to the jaw in a rotational axis.
  • Should I keep going????  I think you get the point.

It’s not so much that the companies in question Continue reading →

Mouth Gear Controversy (UPDATED)

Dustin Fink7 Comments
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. Continue reading →