The Role of Mouthguards in Sports-Related Head Injuries

Role of Mouthguards in Reducing Mild Traumatic Brain Injury/Concussion Incidence in High School Football Athletes

Winters J, DeMont R
Gen Dent. 2014;62:34-38

Study Summary

Awareness and understanding of head trauma in sports have increased substantially in the past several years.^[1] From professional sports organizations to youth athletic leagues, recognition of the importance of education and prevention and management of traumatic head injuries in sports, which often have short- and long-term complications, has become paramount.^[2] Protective equipment used during sports has been acknowledged as a means to potentially minimize the risk for traumatic brain injury (TBI) and concussion during these activities.^[3]

Winters and DeMont investigated the role of custom-made, properly fitted mouthguards (MGs) compared with over-the-counter (OTC) MGs and their effects on mild TBI/concussion incidence in high school football athletes. This randomized, prospective study included 412 male high school athletes from 6 football teams in Western Pennsylvania. Three teams were randomly assigned to wear a custom-fitted, pressure-laminated (LM) MG (total of 220 players), and 3 teams wore a standard OTC MG of their choosing (total of 192 players). All of the players wore the same football helmet while in the study, and instructions were given by an investigator to the players, coaches, and the certified athletic trainers on the proper use of the LM and OTC MGs. The posterior thickness of the occlusal areas for both the LM and OTC MGs were measured and recorded prior to player use.

When a mild TBI/concussion occurred in any practices or games during the 2005 season, pertinent information about the injury was documented, and the MG worn at the time of the injury was collected and submitted to 2 independent measurers for measurement of the thickness of the MGs in the posterior occlusal area. Differences between the LM and OTC MG groups with respect to mild TBI/concussion were analyzed statistically.

The results of the study were:

The average thickness of the posterior occlusal area of the LM MGs was 3.5 mm at the beginning of the football season.
The average thickness of the posterior occlusal area of the OTC MGs was 1.65 mm at the beginning of the football season.
There were 24 occurrences of mild TBI/concussion during the football season.
Eight injured players were wearing an LM MG that had more than 3 mm thickness in the posterior occlusal area at the time of injury.
Sixteen injured players were wearing an OTC MG with an average thickness of 1.34 mm in the posterior occlusal area at the time of injury.
The incidence rate of mild TBI/concussion was 8/220 (3.6%) in the LM group and 16/192 (8.3%) in the OTC group, which was statistically significant (P = .0423).

Viewpoint

The risks for orofacial and dental injuries during sports-related activities are minimized with use of an MG.^[3] Evidence supporting the use of MGs in sports to reduce the risk for mild TBI/concussion is scant. A previous report by Singh and colleagues^[4] observed that a customized mandibular orthotic used during sports reduced the incidence of mild TBI/concussion in their population of high school football athletes.

The results of the current study appear to support previous findings that wearing a custom-fitted MG may reduce the incidence of mild TBI/concussion in high school football athletes. The current study also suggests that custom MGs should have at least a 3 mm thickness in the posterior occlusal area to statistically reduce the incidence of mild TBI/concussion in high school football athletes.

Perceived limitations of the current study may include use of only 1 type (LM) of custom-fitted MG and use of 3 types (stock, boil and bite, "cut-off" [no posterior coverage]) of OTC MGs. Overall, this study provides additional evidence supporting the role of MGs in reducing the risk for mild TBI/concussion in this specific athletic population.

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