Merits of Custom Mouthguards

I recently attended the Hockey Canada symposium on concussion in Montreal. The main focus of this presentation was to promote safer play in hockey. This symposium was attended by experts in their field from across Canada drawing from sports injury, Canadian standards on equipment and neuroscience and medicine. The event was co-sponsored by Think First Canada which is a charitable organization founded in 1992 by renowned neurosurgeon Dr. Charles Tator to develop and deliver educational programs to reduce brain and spinal cord injury. Think First Canada has produced a booklet and DVD entitled Smart Hockey and it is recommended that every player watch the DVD before they begin their hockey season.

Modern research has taught us two things:

  1. The young brain is more vulnerable to injury
  2. The developing brain is prone to further concussions. Smart Hockey has been implemented and practiced in Quebec for four years now and as a result body checking is not allowed in Quebec until the Bantam level.

A study completed by Dr. Carol Emery of the University of Calgary on Pee Wee hockey players from Alberta and Quebec compared injury and concussion rates among 11-12 year-old ice hockey players, playing in a league in which body checking is permitted compared with a league in which body checking is not permitted was associated with a 3-fold increased risk of all game-related injuries, concussion, severe injury, and severe concussion. The general consensus of the panel was education is needed regarding safer play and head and spinal injuries.

At the Third International Symposium on concussion in Zurich the consensus on return to play was reached based on a graduated table of rehabilitation and symptoms or lack of with the average time of return to play being seven to ten days. Who as coaches and parents follow this guideline? One of the problems is pressure from coaches, parents and team mates to return to play these attitudes need to change! A player is at a much higher risk for “Second impact syndrome” if he or she is not fully recovered. A second concussive episode may exacerbate the efforts of an initial concussion disproportionate in its severity and cause serious and long term neurological and behavioural consequences . The effects of concussion have also been shown to be cumulative and repeated exposure to head injury may therefore result in progressively deteriorating cognitive function.

To assess whether a player is ready to return is the SCAT assessment tool which has been changed and improved to the SCAT2. This tool represents a standardized method of evaluating injured athletes for concussion and can be used in athletes aged from 10 years and older . This tool enables the calculation of the Standardized Assessment of Concussion. (SAC) score and Maddocks questions for sideline assessment

As much as all the improvements in equipment has helped prevent injuries it has also given players a sense of being armoured and invincible which in itself can contribute to rougher play. One important key point is the athlete does not have to lose consciousness to suffer a concussion. Second impact syndrome or post-concussion syndrome can have long term and sometimes fatal outcomes.

Equipment was discussed at length, the focus being helmets, face masks and mouthguards. The main purpose of a mouthguard is to prevent orofacial injuries but,there are theories on how they may actually prevent concussion or at least reduce the degree of minor traumatic brain injury. (mTBI)

A study was recently completed by Dr. B. Benson of the University of Calgary on 500 NHL ice hockey players on mouthguard use and concussion. The results of the study is in the hands of the NHL and will be made public soon. I would like to think that if the study show that a properly fitted mouthguard is of some merit in concussion prevention than hockey associations and committee’s will embrace and endorse the use of custom-fit mouthguards.

Another recommendation was for all players, parent and coaches to have mandatory concussion education as they do in the State of Washington.

So why is concussion prevention so important? The damage from concussion is being studied more than ever and the damage or “tangles” found in brains of deceased athlete’s are found to be similar to those of people with Alzheimer disease. But, the list of symptoms of traumatic brain injury are varied and can be life long.

The International Ice Hockey Federation reported in 2001 that sports organizations have to make mandatory the use of an internal mouthguard, which may not only prevent dental and orofacial injuries but, also play a role in the reduction of incidence and severity if TBI.

In conclusion, education is the key to safer play in all sports and anyone who is involved with sports at one level or another has an obligation to see this goal is achieved.

Bernadette MacKay RDH
Educator and Change Agent
Bernadette is the president of Allsportsguards and has been a registered dental hygienist for the past 13 years having spent the past five as a dental hygiene educator.

References;

  1. Jama 2010; 303 (22): 2265-2272
  2. British Journal of Sports Medicine 2009;43:i76-i84doi:10.1136/bjsm.2009058248
  3. McCrory P R.Berkovic SF. Second impact syndrome. Neurology 1998;50:677-83
  4. Cantu RC. Second Impact Syndrome Clin Sports Med 1998;17:37-44
  5. Gronwall D. Wrightson P. Cummulative effect of concussion. Lancet 1975:ii:995-7
  6. McCrory P et al Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004. British Journal of Sports Medicine. 2005;39:196-204
  7. Maddocks, DL; Dicker, GD; Saling, MM. The assessment of orientation following concussion in athletes. Clin J Sports Med. 1995;5 (1):32-3
  8. British Journal of Sports Medicine 2002;36:410-427doi:10.1136/bjsm.36.6.410
  9. Piccininni P. Mouthguards and concussion prevention: International Symposium on Concussion in Sport (Abstract) Br. J Sports med 2001;35:375



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