The area of concussions has become a mainstay in the media and medical community for the past ten years. With the amount of professional athletes retiring from this particular condition, more and more emphasis is being placed upon prevention. Concussions have been around for centuries, but were better known as ‘bell ringers’ before the 80’s. You would often hear the play-by-play announcer on TV comment that a player was able to get up from the ice, “thank god it was only his head, and not a career ending knee injury”. It has only been the last twenty years that we have come to understand what effect concussions will have upon a player’s future, both on the ice and off.

A simplified definition of a concussion is when the brain is jarred or knocked against the cranium (skull), resulting in swelling of the brain. Anatomically, the brain will float in the cranium. This can lead to more damage, as the brain does not therefore have a nice protective rubber encasement to protect it from the hard outside bone.

At Canadian Sports Therapy, our motto was “Prevention is the Key to Success”, therefore the question is: How can we prevent concussions? The obvious answer that everybody looks to first is a proper fitting C.S.A. approved helmet. That is without a doubt the most important feature, but the medical community has also recently discovered another piece of equipment that may significantly reduce this condition, the mouth guard.

Although the primary function of mouth guard is to prevent dental injuries, a recent research study done by Notre Dame University showed a dramatic reduction of concussions once mouth guards were implemented for the football team in both practices and games. Dr. Cosmo R. Castaldi, a dentist, worked extremely hard to make mouth guards mandatory in Hockey in 1976, but it has unfortunately not been strictly enforced.

Years ago I was medical director with a Junior A team where the mouth guards were mandatory. Although we tried to strictly enforce this rule, several players were without them or would chew black gum and place it across the front of the teeth in case the referee ever was to ask. Needless to say, black gum hasn’t yet been proven to prevent concussions, but we are looking into it.
It has been proven that mouth guards can prevent dental injures, but how do they reduce the likelihood of a concussion? During sporting events, blows are continuously being given to the chin (jaw). When a heavy blow is administered to the jaw from underneath, the force will clang the teeth together and subsequently force the lower jaw into the jaw joint (in front of ear). At this level, the forces are transmitted to major nerves exiting the base of the brain, blood supplies to the brain, as well as the balance centres located near the jaw joint. The end result is leaving an athlete with a concussion, with symptoms including dizziness, impaired speech, headaches, nausea and earaches. The mouth guard will act as a cushion between the teeth to absorb the forces from the blow. The guard will also separate the lower jaw from the base of the skull, thereby reducing the collision between the two bones.

If it has been proven that mouth guards can prevent so many injuries, then why is it that so many players don’t like to wear them? I put this question forth to Dr. Allan Hawryluk, former Toronto Maple Leafs team dentist. He says, “Players won’t wear them because they say they gag on them and have trouble breathing”. In today’s modern medicine however, the new custom-made mouth guards will prevent these two problems from happening. Dr. Hawryluk states that he has offered every player a custom made mouth guard, but not one has yet to take him up on the offer.
There are three types of mouth guards on the market today. The first is the ‘Stock’. These are the kind you can find at any sporting goods store, but are the least effective. They are a rigid plastic, which are not form fitting to your mouth and can therefore offer a false sense of protection. The second form of a mouth guard is the ‘Boil and Bite’. This is often the most popular one players will wear in minor hockey. They are made from a thermoplastic material that once softened in hot water, will then form to the teeth. Like the Stock mouth guards, they are also cheap, but uncomfortable and can impair breathing and speech. The third form is the ‘Custom Made’ mouth guard. Dr. Hawryluk states that a dentist will take a plaster model of your teeth. Then a special shock absorbing acrylic sheet is heated and vacuumed sealed to the model. It is trimmed and will fit the athlete’s teeth perfectly. He states it is so well fitting; they will sometime have trouble getting it off the teeth following a game or practice. Players who wear them declare that these guards will not prevent breathing difficulties and if they were having gagging problems, they will not anymore. The custom guards are “totally formed to your teeth in a very specific way” says Dr. Hawryluk, “they are smaller and therefore more comfortable”.

Mouth guards can vary in price, but when it comes to the possible damage that may occur if not wearing one, money should not be an issue. Dr. Hawryluk states that custom mouth guards will vary from $80-$130, and that they may be covered by your extended health insurance company.
Please visit your local dentist to get more information on custom mouth guards and how to be fitted for one. Remember that you only have one brain, so protect it any way you can.

This was sent to me from Mark Kram. An extra little addition for the above article.

Dental device helps reduce concussion risk for athletes
By MARK KRAM
Philadelphia Daily News
kramm@phillynews.com
TO CLEAR UP any confusion that has surrounded the dental appliance he has developed, Dr. Gerald Maher stresses that it is only useful in preventing concussions up to a point. When a player takes a solid hit to the head, or experiences a jolt to the neck that produces a whiplash effect, he says there is "nothing" that his device would be able to do to avert head trauma. Chances are that player would end up with a concussion.
But it's the player who takes a blow to the jaw that "The Maher Mouth Guard" could conceivably help. By creating a more stable relationship between with the jaw and skull at the temporomandibular joint (TMJ), the appliance better enables players to dissipate the force that originates from a violent blow to the chin area. Without that shock absorber in place, a concussion and/or other neurological damage can occur when the jaw slams into the skull.
"This is not a panacea," says Maher, the team dentist for the New England Patriots. "What it is, is a TMJ device that places the teeth in better position to withstand a blow. That is what it does. And it has prevented some concussions."
Concussions have been an increasing concern in sports, chiefly in the NFL and NHL. Long range, they can been linked to the onset of chronic traumatic encephalopathy (CTE), a brain abnormality that leaves some former players battling memory impairment, emotional instability, erratic behavior and issues with impulse control. CTE has also been discovered in the autopsies of former NFL players Tom McHale and John Grimsley, both of whom died prematurely in their 40s last year - McHale of a drug overdose; and Grimsley of an accidental self-inflicted gunshot wound. While the NFL has formed a committee to study the effects of concussions, it has not yet endorsed "The Maher Mouth Guard" for leaguewide use. Maher has had better luck with the NHL, which he says has been "actively pursuing" a dialogue with him.
With the publication of a peer-reviewed paper that was released recently in the journal Dental Traumatology, Maher says there is now scholarly support for the anecdotal evidence he has accumulated since he developed the appliance back in the 1970s. Former boxing champion Marvin Hagler was an early success story for Maher, who has since used it with equal success in his work with the Patriots. Former players such as John Hannah and Lawyer Milloy both became advocates of it. So did Asante Samuel and Ellis Hobbs, both of whom played for the Patriots before signing with the Eagles.
Samuel is quoted on the Mahercor Laboratories Web site as saying that he has not had a concussion since he began wearing The Maher Mouth Guard for more than 3 years.
Hobbs says he had not had a history of concussion but believes it prevented him from having any. "Well, I have been hit before where I know that if I did not have it in, I know would have gotten one," says Hobbs. "Plus, it is not as bulky as some of the other appliances I have used, which allows me to breathe and communicate easier. It works."
Co-authored by Maher, Dave Singh, the director of continuing education for the SMILE Foundation, and Ray R. Padilla, lecturer at the UCLA School of Dentistry, the paper that appeared in Dental Traumatology focused on a 3-year study of high school athletes with a history of concussion. According to Maher, the high school players who participated in the study had to continue playing in college or beyond.
"We ended up with 31 players in the study who continued to play their sport in college," says Maher. "What we found was that between them they had approximatley 50 concussions before wearing the appliances. And they only had two between them after they began wearing the appliance."
Maher adds that high school athletes are especially prone to concussions. "In fact, high school athletes are more susceptible to concussions than NFL players," says Maher. "When you are young and you are still developing, your parts are still not lined up properly - especially your teeth or your neck. You are still growing and chances are you have not yet had your final growth spurt. Some [young people] have. But I would say over 50 percent of them have not, which is to say that the head, the jaw and the cervical are not yet perfectly aligned."
Maher says he plans to submit his paper to the NFL for review. He says that even if the appliance can lead to some decrease in concussion, it would be worthy, given the problems some NFL players have had with cognitive function in their later years. Says Maher: "Football players get beat up. And some of them become mentally impaired. Hopefully, something like this can help."
The NHL has been far more receptive to Maher, who has consulted with the Washington Capitals, San Jose Sharks, Minnesota Wild and others (but not the Flyers). According to Maher, the American Hockey League's Hershey Bears were fitted with the appliance last year and have experienced excellent results.
"They had had 11 concussions before they used the appliance," Maher says of the Washington affiliate. "Afterward, they did not have a single concussion."
Maher adds that he expects it to be widely used in the AHL this year.
"I am interested in prevention," says Maher. "I would like to intercept the concussion before it happens. And in cases where the jaw or chin is involved, we have proven we can do that."
And he says the players have been in large part receptive.
"They seem to love it," he says. "Not every single one of them, but the vast majority of them.
www.mahercor.com

Link to 08/09 Journal of Dental Traumatology study
http://www.mahercorlabs.com/pdf/Dental_Traumatology%20Publication.pdf