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

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  I honestly want to know why this “peer-reviewed” article has not been retracted.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

Advertisements

#tbt Mouth Guard BS Research!

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)

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

Mouth Gear 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

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