Mouth Guard Confusion, What's the Best Deal

Today’s mouthguards enhance performance, offer more protection and are more marketable

Time to play a little “Dental Jeopardy!”

Answer: gutta percha.

Question: What were the first athletic

mouthguards made of? (OK,

even Alex Trebek would’ve had a

tough time with this one.)

Double Jeopardy! Answer: Has his

own line of custom mouthguards.

Question: Who is Shaquille

O’Neal?

Indeed, there is little doubt that

today’s athletic mouthguards are

not like your granddaddy’s mouthguards,

but more like Shaq Daddy’s.

Mouthguard history

Athletic mouthguards, or mouthpieces,

have been around for nearly 120

years since a London dentist named

Woolf Krause developed them in

1890 to protect boxers from lip lacerations.

Known as “gum shields,” they

were made from gutta-percha.

Krause’s son Philip, also a dentist

and an amateur boxer, refined the

design and began making the shields

from vella rubber.

Mouthguards were first introduced

in the United States by Chicago

dentist Thomas Carlos in 1916.

For decades, mouthguards remained

largely unchanged.

It was not until the early 1960s

that a Canadian pediatric dentist

named Arthur Wood, appalled by the

number of dental injuries he saw in

hockey players, developed a “mug

guard” or “teeth guard” for which he

became known as the father of the

modern mouthguard.

Since then, mouthguard materials,

fabrication techniques and subsequent

fit have been improved to

increase both protection and comfort.

Mouthguards today

Most recently, mouthguard design

has been studied in an attempt to

enhance athletic performance as

well as decrease the incidence of

concussions.

The central focus has been on

the role of the mouthguard to guide

occlusion and, in turn, condylar position

within the fossa.

There are three major players in

the performance-enhancing mouthpiece

arena: Mahercor Laboratories,

Pure Power Mouthguards, and

Under Armour Performance Mouthwear

™ by Bite Tech. Each attempts

to enhance athletic performance by

improving strength, endurance, balance,

flexibility and reaction time

while decreasing injury risk from

concussions and jaw injuries.

Maher guards and splints

Dr. Gerald Maher, a Massachusetts

dentist who specializes in TMJ and

facial pain, was one of the first to

explore how an athletic mouthpiece

can affect performance and protection.

As the team dentist for the New

England Patriots, his primary goal

was to reduce the number of concussions

the players suffered.

He concluded that 64 percent of

adults have misaligned mandibles

where the condyles do not sit on

the cartilage discs; and, if someone

suffers a blow to the jaw in this position,

the condyles are more likely to

be driven into the base of the skull,

causing a concussion.

The Maher guards and splints

(www.mahercorlabs.com) are

designed so that the opposing teeth

are seated in a centric relation position

so that the condyles are in alignment

with the discs. These discs

will then act as shock absorbers to

cushion the impact of the condyles

on the skull.

In addition, because of the thickness

of the appliance, the condyles

are moved from a position where

they are resting directly against the

articular disc — or even against the

fossa in the case of patients with

internal derangements where the

disc is displaced, usually anteriorly

— to a position farther away from

the fossa on the articular eminence.

This would mean that it would

take a greater force to drive the condyles

into the skull.

Earlier this year, Maher, along

with Drs. G. Dave Singh and Ray

Padilla, published a preliminary

study that suggests a customized

mandibular orthotic may decrease

the incidence of concussions. The

study, however, did not attempt to

explain the mechanism of protection.

While Mahercor Laboratories

does not market their line of mouthpieces

and mouthguards for their

performance-enhancing effects and

doesn’t claim to have specific studies

to substantiate these benefits, some

of the athletes that have been outfitted

with their mouthpieces claim to

have noticed a significant increase

in strength, balance and speed.

They attribute this effect to the

full-body benefits of a properly, CRpositioned

mandible and point to a

1995 paper by Dr. Harold Gelb that

favors the premise that jaw repositioning

can enhance appendage

muscular strength and athletic performance.

The Maher splint design is a Gelb

splint or MORA (mandibular orthopedic

repositioning appliance). It

is not designed to offer soft tissue

protection, but Maher’s line also

includes upper full coverage mouthguards.

The Maher appliances may be

fabricated by dentists who are skilled

in capturing a CR bite by ordering it

through Mahercor Laboratories or,

more recently, Space Maintainers

Laboratory.

The laboratory fees range from

$75 for a custom mouthguard to

$175 for their protective splint, with

a recommend a retail price range of

$175 to $250 for the mouthguard and

$300 to $450 for the splint.

Pure Power Mouthguard

The biggest player in the performance-

enhancing mouthguard market

is currently Pure Power Mouthguard

or Makkar PPM™ (www.

makkaradvantage.com).

These mouthguards, developed

by Nova Scotia dentist Anil Makkar,

rely on the principles of neuromuscular

dentistry. Simply put, this philosophy

and treatment paradigm

is based on the principle that the

mandible is in its optimal position

when the muscles of the head and

neck are at rest. This “physiologic

rest” position is achieved by using

a TENS (transcutaneous electrical

nerve stimulator) unit.

Makkar and his company claim to

have a soon-to-be-released research

study that confirms the performance-

enhancing effects of their

mouthguard versus traditionally fitted

custom mouthguards.

They say that this study will show

a significant increase in vertical

jump as well as peak and average

power, which should be appreciated

by their marquee client Shaquille

O’Neal. They also claim their mouthguard

can improve balance, flexibility,

endurance, agility and recovery.

The PPM’s come as an upper

mouthguard for contact sports or

a lower splint-type mouthpiece for

other sports such as golf or running.

These guards may only be made

by a certified PPM dentist who is

trained in neuromuscular dentistry

and generally retail in the $1,500 to

$2,000 range.

Under Armour Performance

Mouthwear

The most recent mouthpiece to

enter the marketplace is the Under

Armour Performance Mouthwear™

by Bite Tech (www.pattersondental.

com/UnderArmour). Their design is

neither innovative nor proprietary,

however, Bite Tech is the only manufacturer

of the three that can claim

peer-reviewed, placebo-controlled

studies to support their claims for

performance enhancement.

Their mouthpieces do not rely

on a CR or neuromuscularly determined

bite, but simply the lack of

pressure in the fossa area created

By Eric Yabu, DDS

This image illustrates how a mouthguard

moves the condyle of the TM joint away

from the base of the skull. A Pure Power Mouthguard.