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
Indeed, there is little doubt that
today’s athletic mouthguards are
not like your granddaddy’s mouthguards,
but more like Shaq Daddy’s.
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
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
Since then, mouthguard materials,
fabrication techniques and subsequent
fit have been improved to
increase both protection and comfort.
Most recently, mouthguard design
has been studied in an attempt to
enhance athletic performance as
well as decrease the incidence of
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
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
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.
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
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
Under Armour Performance
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
studies to support their claims for
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.