Concussion Prevention

Part 1 of Concussion Series

The Question:
The million dollar question in protective athletic equipment these days involves determining the actual benefit of sports equipment in the prevention of concussions. On the list of politically correct hot topics not to discuss at cocktail parties, it ranks up there with religion, politics and gender issues. It doesn’t take the publication of more than a blog or two about mouthguards to realize that everyone in the world of sports dentistry, or sport in general, has an opinion about this. There is absolutely no doubt that a well designed, custom fit mouthguard reduces the incidence of dental injury due to trauma(1). What does the research tell us about concussion prevention? Appreciate that it is difficult ethically to evaluate in a well controlled laboratory study concussion injuries and their prevention. Not too many high-performance athletes want to sign up for a study examining the short and long term effects of getting smacked in the head with or without a mouthguard, and given the potential research outcomes, I wouldn’t want to either. Because of this, we are forced to look at theoretical models of concussions and prevention, bench top biomechanical studies and epidemiological studies to shed some light on the debate. In this blog (the first in a series looking at published research on concussions), we’ll look back at some historical population studies examining concussion injuries and mouthguard use. Epidemiology is a study of patterns of health and illness on a grand scale and is used to help inform evidence-based medical practitioners about risk factors and optimal treatment approaches for disease and to help prevent further illness.

The Science:
A comprehensive review of the literature evaluating protective equipment and concussion prevention was published in the British Journal of Sports Medicine in 2009(2). This article, written by, among others, a local Calgary researcher named Dr. Brian Benson (Sport Medicine Centre, Faculty of Kinesiology, and Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada) evaluated over 150 articles published in legitimate peer reviewed scientific journals. Here are some of the highlights related to mouthguard research. A study of 1033 professional ice hockey players published in 2005(3) revealed that the risk of concussion was not significantly different between players wearing mouthguards versus no mouthguards however, symptom severity was significantly greater for athletes not wearing mouthguards compared with those who did (players who wore mouthguards had significantly lower severity of injury than those that did not!). This was consistent with another study published in 2002(4) which provided evidence to suggest a protective effect of mouthguard use on concussion severity. In an earlier study done in the US, it was demonstrated that, when worn properly, mouth guards have been reported to decrease the risk of jaw fractures and reduce dental and concussion injury rates by 70% and 75% respectively(1). Modification of commercial (boil and bite/stock) mouth guards by making them smaller, however, has been shown to dramatically diminish this protective effect. Hockey is not the only sport which is garnering attention in the realm of concussion injury. A study evaluating 2470 football players from 21 Alabama high schools over 3 season illustrated that over half of all concussions sustained were by players not wearing mouthguards(5) (players that wore mouthguards had less concussions than those that did not!). Dr. Ray Padilla and some of his colleagues looked at this same issue and published some preliminary results of their study in the Journal of Dental Traumatology in October of 2009. They reported that a customized mouthguard may in-fact decrease the incidence of concussion/mild traumatic brain injuries in high school football athletes, but also noted that more comprehensive studies are required to confirm these initial findings(6).

The Take Home Point:
Research documenting exposure of athletes to concussive forces in game situations shows that protective athletic equipment can reduce both the severity and the incidence of concussion injuries in sports. Although more research is required to help us understand how these injuries occur and how to further reduce their incidence and severity, wearing a high-performance custom fit mouthguard as part of your protective gear is a great first step to reducing the impact that a heavy blow can have on your game, while increasing the impact that you can have on the outcome of your game! Stay tuned for our next blog on bio-mechanical studies and custom mouthguard use.

Reference Articles:

  1. Mastrangelo F. Eye and face injuries in high school hockey: cutting down the risks. In: Castaldi CR, Hoerner EF, eds. Safety in ice hockey. Philadelphia, PA: American Society for Testing and Materials, 1989:52–4.
  2. B W Benson, G M Hamilton,W H Meeuwisse, P McCrory, J Dvorak. Is protective equipment useful in preventing concussion? A systematic review of the literature. Br J Sports Med 2009;43(Suppl I):i56–i67. doi:10.1136/bjsm.2009.058271
  3. Benson B, Meeuwisse W. The risk of concussion associated with mouthguard use among professional ice hockey players [abstract]. Clin J Sport Med 2005;15:395.
  4. Benson B, Rose M, Meeuwisse W. The impact of face shield use on concussions in ice hockey: a multivariate analysis. Br J Sports Med 2002;36:27–32.
  5. McNutt T, Shannon S, Wright J, et al. Oral trauma in adolescent athletes: a study of mouth protectors. Pediatr Dent 1989;11:7–11.
  6. Dave Singh, Gerald J. Maher, Ray R. Padilla. Customized Mandibular Orthotics in the prevention of concussion/mild traumatic brain injury in football players: a preliminary study. Dental Traumatology. Volume 25, Issue 5, pages 515-521, October 2009
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