Brain Concussion or Tooth Loss:
Elite Mouthguards Protect Against Both
Protect Those Pearly Whites –
And Maybe Your Sanity – With Professionally- Made,
Custom Mouthguards
(Photos of Dr. Williams at the International Academy for Sports Dentistry Annual Symposium in San Juan, Puerto Rico: I II )
Testimonial: Custom Sports Mouth Guards
Last week, 49er quarterback Steve Young got his bell rung again, sandwiched by
two Cardinals midway through San Francisco’s 24-10 victory.
After briefly losing consciousness, Young walked off the field but did not return
because of a concussion. He was examined by a neurosurgeon and underwent
brain scans to determine any long-term neurological injuries. The neurosurgeon
advised that Young sit out the next game and maybe the next one after that.
Young’s response: “Are you kidding? I want to play!”
Maybe there was brain damage after all.
Young’s comments seemed a little cavalier to some health care professionals,
especially those who work with athletes. Just two years ago, Young
contemplated retirement after suffering three concussions in a 10-month period.
But he’s a professional athlete with lots of money riding on his presence on the
field. Still, team dentists and physicians thought they saw this popular sports
figure give youngsters a bad example. And some have fought too long and too
hard to educate kids in ways to prevent sports injuries.
Two or more significant blows to the head received while participating in sports
can harm a teen-ager’s ability to think for years, and young athletes with learning
disorders appear to suffer even worse long-term problems, say researchers.
Those findings, in a September issue of The Journal of the American Medical
Association, are buttressed by two other new studies that find such injuries to be
more serious and common than some coaches and parents might believe.
One study finds that nearly 63,000 high school athletes suffer mild concussions
each year.
“This is a major public health issue that has been given short shrift,” says
Michael W. Collins, a neurologist at Henry Ford Health System in Detroit who
examined the effect of multiple mild concussions.
Most people still believe that a concussion means getting knocked out, Dr.
Collins says. But a concussion is any alteration in mental function after a blow to
the head. Symptoms may be subtle: headache; dizziness; difficulty with balance
or memory; confusion, even a personality change.
It has long been known that multiple mild concussions are more likely than a
single episode to lead to long-term problems, and Dr. Collins tried to measure the
difference.
His research involved 393 college football players and found that about one in
three had suffered a concussion at some time and one in five had two or more
concussions.
Those who had suffered two or more were significantly more likely to report
continuing problems with headaches, sleep and concentration, and they scored
significantly worse on paper-and-pencil tests of the ability to learn words, to think
quickly and to handle complex tasks. A complex task would be cooking a big
Thanksgiving dinner, for example.
Players who had learning disorders, 13.5% of the sample, fared even worse if
they had two or more concussions, suggesting that the disorders make the brain
especially vulnerable to jarring injuries.
“If they have a learning disability, if they have one concussion, you should be a lot
more cautious in returning them to games and practices after their first
concussion,” says an expert not involved in the studies, Jeffrey T. Barth, the chief
of medical psychology and neuropsychology at the University of Virginia.
In another report, researchers explore how often concussions occurred in football,
wrestling, soccer, basketball, softball, baseball, field hockey and volleyball at 235
high schools nationwide from 1995-98.
There were 1,219 concussions, and 90 students suffered two or more, say
researchers led by John W. Powell, a professor of kinesiology and an athletic
director at Michigan State University.
A third article in the journal reported that amateur soccer players scored lower on
tests of memory and planning than other amateur athletes did and that repeated
blows to the head might be the culprit.
Contents
Wearing mouthguards helps
Hockey players can improve
New mouthguards offer more
Wearing mouthguards helps
Dentists, in particular, have waged many battles to ensure that kids are wearing
mouthguards, not just to protect teeth, but in some cases, to prevent
concussions altogether, or lessen their severity when they do occur.
“If a blow is received to an athlete’s mandible, the mouthguard can absorb the
force and sometimes prevent the athlete from sustaining the concussion,” says
Dr. David Kumamoto, a general dentist in Chicago who teaches at the University
of Illinois School of Dentistry and serves as dentist for several UIC Flames teams.
“If you are hit on the side of the head, a mouthguard probably won’t help much.
Generally, a blow to the chin might prevent injuries but even that’s not
guaranteed.”
A mouthguard will, however, go a long way in preventing injuries to the oral
cavities. Numerous studies, he says have documented the decline in injuries –
especially on the football field – when athletes wear mouthguards.
“There is no doubt about it,” says Dr. Kumamoto. “With the increase in sports
participation, in all age groups and sexes, the mouthguard should be part of the
uniform.”
Two years ago, Dr. Kumamoto and his colleagues at UIC conducted a survey to
determine dentists’ attitudes about sports dental issues. One reason the study
was conducted was to determine exactly how dentists became familiar with
sports issues, because they get little if any training in this area in dental school.
UIC sent out 996 surveys to Illinois dentists selected randomly and received 442
back, a response rate of roughly 45%. “Even though many dentists don’t have
training in this area, they probably learn about mouthguards through their own
athletic experiences,” says Dr. Kumamoto. “About 87% of dentists said they
participated in sports activities as a child and 67% as adults. About 32%
participated in sports evens as children where they wore mouthguards. About
15% reported that they had experienced oral trauma as a result of childhood
sports activities.”
About 85% of the dentists said they had made custom mouthguards for patients,
and 33% made custom mouthguards for a sports team.
Other findings include:
81% of dentists believe that formal and enforceable regulations should be
enacted to ensure mouthguard use in all organized children’s sports;
96% believe mouthguard should always be worn in collision sports;
83% believe custom mouthguards made in a dental office are a
cost-effective method to protect an athlete’s mouth;
83% believe mouthguard use should be mandated in all secondary school
sports;
89% believe mouthguards should be required in men’s contact sports;
91% believe mouthguards should be required in women’s contact sports;
33% say they learn to make mouthguards in dental school; 14% from
continuing education classes;
64% recommend custom-made mouthguards as the most effective type of
protection of the oral cavity.
“This study gave us a great tool to measure where we are and where we need to
go,” says Dr. Kumamoto. “Even though most dentists know the importance of
mouthguards, I think we need to find ways to connect dentists with sports teams
so that young athletes know how to protect their teeth. It’s just a matter of
education.”
Slowly but surely, he says, the battle is being won. Through the years, dentists
have been able to educate their colleagues in medicine, and new generations are
growing up knowing the value of their teeth and how these small pieces of plastic
can help maintain their smiles. But some sports groups insist on hanging on to
macho routines and superstitions.
Back to top
Hockey players can improve
Superstitious rituals are one of the main reasons National Hockey League
players often skip the more logical habit of wearing protective mouth gear while
they play and practice. Professional hockey season already has begun, and sure
to follow are injuries to the oral cavity – injuries that often could be prevented.
Dr. Joseph Perno, team dentist for the Philadelphia Flyers and the farm club
Philadelphia Phantoms says that professional hockey players strive for
consistency and when there’s a change in a routine – including a visit to the
opposing team’s dentist for treatment of an injury – the athletes feel it affects the
way they play.
“Many players feel that starting to wear a mouthguard can break their consistent
game pattern,” says Dr. Perno. Although mouthguards decrease dental injuries
that occur from pucks, high-sticking, cross-checking and slashing, some
superstitious, anti-mouthguard players embrace them after being treated for a
traumatic dental injury, says Dr. Perno.
He notes that a six-ounce hockey puck can reach 120mph and hit teeth with an
impact force of 1,250lbs. He offers the following communication tips for dentists
who want to change the habits of young hockey players:
-
The total rehabilitation costs for a single avulsed tooth are more than 20
times the cost of a quality professional mouthguard – lifetime dental
rehabilitation costs can exceed $15,000 per avulsed tooth. -
Mouthguards prevent an estimated 200,000 injuries in high school and
college football. -
An athlete is 60 times more likely to sustain damage to teeth when not
wearing a mouthguard. -
Almost one-third of all dental injuries is due to sports-related accidents.
-
During a single athletic season, athletes have a one in 10 chance of
suffering a facial or dental injury. -
The most commonly injured tooth is the maxillary central incisor.
-
A mouthguard not only can help prevent concussions, but also cerebral
hemorrhages, incidents of unconsciousness, jaw fractures and neck
injuries.
Even though the oral cavity of a typical NHL player experiences more dental trauma than that of a non-hockey playing person, Dr. Perno says he’s seen a decrease in dental injuries among Flyers players compared to 20 years ago due to the use of mouthguards and mouthguard awareness programs. “We are finally beginning to influence some players to hang up their mouthguard superstitions,” he says.
New mouthguards offer more.
Some sports dentists now are hitting the dental meeting circuit to inform colleagues of a new type of mouthguard – a version that is pressure-laminated, meaning that it uses individual layers of plastic to create a device that better protects teeth. The traditional vacuum-formed mouthguards provide one layer of plastic as protection.
“The new pressure-laminated mouthguards are more effective because they can be altered depending on the needs of the athlete and the type of sport in which each athlete participates,” says Dr. Kumamoto. “For example, a mouthguard with more layers of plastic would be more suitable for collision sports such as rugby, hockey, football and maybe even basketball. Mouthguards with thinner layers are better suited for athletes in less physical sports such as soccer, baseball or softball.”
The thinnest type of mouthguards can be used for smaller kids who don’t yet need the full protection of an older athlete. “Young kids generally do not need to have all that plastic in their mouths,” says Dr. Kumamoto. “It’s uncomfortable and can impair speech and even breathing in some cases.”
Dr. Kumamoto says that the pressure-laminated mouthguards are molded around the tips of the teeth more accurately, accounting for a more form-fitting and tighter mouthguard that offers better protection.
Pressure-laminated mouthguards are made in the dental office using the Biostar, a machine specially designed to fuse several layers of plastic. They cost more than traditionally vacuum-formed mouthguards, but are considered to be vastly superior in their ability to protect.
The mouthguards can be created in different colors to match those of athletes’ schools. Colored mouthguards are preferred over clear mouthguards because they can be seen clearly by coaches, referees or umpires who monitor their use.
“They are rather new in the dental world and most coaches and athletes do not yet even know they exist,” says Dr. Kumamoto. “This is wonderful new stuff that will become the standard form of protection for athletes. Technology like this will lead to a decline in oral injuries in the future.”
That, say dentists, is the name of the game.
By Chris Smith
Link to Sports Dentistry Web Site Concussion Prevention
More on MouthGuards