Team Dentist
Gwinnett
Gladiators
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Concussion Prevention and Athletic Mouthguards (Photos of Dr. Williams at the International Academy for Sports Dentistry Annual Symposium in San Juan, Puerto Rico: I II ) |
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TMJ Condyle at the compressed position in contact with the maxilla and temporal bone of the skull |
TMJ Condyle in its protected position held away from the undersurface of the skull |
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A clear multi-laminar
custom mouthguard offers superior protection
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A custom mouthpiece in place acts as a "spacer" between the lower jaw and the base of the skull |
| Concussion is an alteration of consciousness, disturbance in vision and equilibrium caused by a direct blow to the head, rapid acceleration and/or deceleration of the head, or direct blow to the base of the skull from a vertical impact to the chin. There are several levels of concussion according to a 1986 paper by Dr. R. Cantu: Asymptomatic: No headache, dizziness or impaired orientation, concentration or memory during rest or exertion. Grade 1 (mild): No loss of consciousness (LOC) and Post traumatic amnesia (PTA) less than 30 minutes. Grade 2 (moderate): LOC less than 5 minutes or PTA greater the 30 minutes. Grade 3 (severe): LOC greater than 5 minutes or PTA greater than 24 hours. According to E. Williams, DMD, concussive and subconcussive blows are continually transmitted to the jaw joint during athletic competition. Symptoms include headaches, earaches, facial pain, photophobia, vertigo, and impaired speech. During a blow to the chin, in most instances, the temporal bone is violated as it houses and ports cranial nerve trunks as they exit the base of the brain, blood supply to the brain, and auditory and balance mechanisms. In a classic paper by Stenger, in the Journal of the American Dental Association, as far back as 1964, he recognized that dental/facial injuries, concussions and head and neck injuries were dramatically reduced when mouthguards were worn by the Notre Dame football team. Other well-established papers by Heintz (Phys Sportsmed 1979 7:45-46) and Chapman (Aust J Sci Med Sport 1985 3:23-27) reported the properly fabricated custom mouthguards reduced the rate of concussion as well as dental and mandibular injuries. He further stated, "The use of mouthguards should be encouraged in all contact sports as the most important value of the mouthguard is the concussion saving effect following impact to the mandible. This fact alone should make the wearing of mouthguards compulsory in all contact sports". Hickey (JADA March 1967) showed both intracranial pressure and bone deformation were reduced with mouth protectors. When custom fabricated mouthguards are made by your dentist, all posterior teeth can be comfortably covered with a predicted and consistent prescribed thickness to properly separate the teeth from impact to the jaw. In turn, the force of impact can be absorbed and equally distributed throughout the mouthguard. With proper thickness in the posterior segment of the mouthguard, the mandible (lower jaw bone) and maxilla (upper jaw bone) are separated, and the force in not transmitted to the base of the brain. In football, when mouthguards are not worn, the mandible is placed in the most vulnerable position for injury and concussion, upwards and back into the fossa and base of the skull. It is no coincidence that the position that least wears a mouthguard (quarterback) is the position that sustains the most concussions from blows to the chin. Mouthguards can be properly made for speech and comfort and still fulfill the important job of concussion prevention. It is important to seek the treatment of a qualified sports dentist for proper mouthguard design and fabrication. Store bought over the counter mouthguards do not produce the fit and expected protection that a laminated pressure fabricated mouthguard delivers (see types of athletic mouthguards). According to Ray Padilla, DDS, in his 16 years of providing custom made athletic mouthguards for football players, while wearing a properly fabricated custom made mouthguard there has been a significant decrease in numbers and severity of concussions. More studies need to be done to further substantiate the relationship between mouthguards and concussion prevention, however, as Dr E. Williams has stated, "scientific research is difficult because we do not presently have a biofeedback articulated headform with injury sensing capabilities to provide realistic responses, injury assessment, and force tolerance of the jaw joint". However, practical experience has shown us a relationship is evident. |
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Info for this page generously shared from Sportsdentistry.com and Dr. Ray Padilla |
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Link to Sports Dentistry Web Site |
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