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Mouthguards and Injury Presented by : Clif Hancock

Mouthguards and Injury Presented by : Clif Hancock.                  <> . Mouthguard History. Mouthguards, originally referred to as gum shields were invented to prevent lip and gum injury in boxers. In the 60’s and 70’s they were introduced in many other sports, most noticeably football.

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Mouthguards and Injury Presented by : Clif Hancock

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  1. Mouthguards and InjuryPresented by : Clif Hancock                  <>

  2. Mouthguard History • Mouthguards, originally referred to as gum shields were invented to prevent lip and gum injury in boxers. • In the 60’s and 70’s they were introduced in many other sports, most noticeably football. • This occurred after two studies, one at Notre Dame, and another study by Hickey et al.

  3. Controversy • Despite their use for almost half a century, there is controversy over whether a mouthguard can prevent certain types of injury. • Concussion and mandibular fracture prevention are two debated aspects of mouthguard use.

  4. Suggested mechanisms of protection • Impact forces may be absorbed somewhat by the deformation of the mouthguard • The time over which the energy of an impact is applied can be lengthened. • Forces are spread out more evenly throughout the gums and teeth protecting the lip from cuts and individual teeth from chipping.

  5. Controversial suggested effects • Mouthguards may space the temporomandubular joint differently allowing for more impact absorption. • This may prevent fractures and concussions by increasing the time over which energy is transmitted to the head and may attenuate forces being transmitted through the skull and to the brain.

  6. Fracture • In vitro studies suggest that fractures could be prevented. • A study by Takeda et al. using an artificial skull model, measured strains in the mandible after an impact.

  7. In this experiment Takeda et al. cut mouthguards to cover progressively smaller areas. When struck with an impact device mandibular strain went up as occlusional area went down. Mandibular Strain With Different Protection

  8. Other Laboratory Studies • Another 2005 study by Takeda using a similar apparatus looked at differences between mouthguard use and unprotected impacts. • Waliko et al. had similar findings in a cadaver model.

  9. A graph showing strain deformation at various points on the artificial skull model mandible. Distortion of the mandible was compared with and without a mouthguard. Takeda T., Ishigami K., Hoshina S., Ogawa T., Handa J., Nakajima K. et al. (2005).

  10. Concussions • The previously mentioned studies also looked at the possibility of concussion avoidance with mouthguards. • Takeda’s 2005 study showed reduced cranial acceleration with a mouthguard, but measured mandibular, not cranial strain. • Walilko measured almost 1/10 the strain above the mandibular fossa with the use of a bimaxilary guard. 25um vs 250um.

  11. The Problem • No sufficient in vivo studies have supported these in vitro tests. • Labella et al. Found that in NCAA basketball players mouthguard use showed no statistically significant effect on jaw fractures. • Wisniewski et al. had similar findings with a study on NCAA football.

  12. Why?? • 1) Mouthguards vary tremendously. There are many basic types. • 2) The mandible is complex, it’s shape, muscle attachments, and composition give it anisotropic characteristics. • 3) Not all sports impacts happen directly from the front and land on the mental portion of the mandible.

  13. Why? • Several studies have shown mouthguard type to be important such as Takeda’s study on occlusional area, Warner’s study on mouthguard type, and Westerman’s study on mouthguard material thickness

  14. GuardTypes • Stock Guard • Boil and Bite • Custom Guard • Bimaxilary

  15. Sketch of the orientation of the buccal and lingual side of the mandible; the lines indicating the orientation of the osteonal axis. Figure from Nomura T., Gold E., Powers M., Shingaki S., and Latz J. (2003). Micromechanics/structure relationships in the human mandible. Dental Materials. 3:167-173.

  16. A sketch showing a mandible in the fracture apparatus used in the elucidation of its fracture properties.. This figure is from Unnewehr M., Homann C., Schmidt P.F., Sotony P., Fischer G., Brinkmann B. et al. (2003).

  17. A picture of the resulting fractures of the jaw in the Unnewehr experiment. A side impact takes about ¼ the force to produce a fracture.

  18. Conclusion/Recommendations • Mouthguards should be worn in many sports to prevent tooth avulsions and other dental trauma.

  19. Conclusion/Recommendations • If mouthguard use does have any effect on concussion or fracture the greatest protection will be gleaned from a bimaxilary guard with sufficient occlusional area.

  20. Conclusion/Recommendations • It seems likely that any added benefit beyond prevention of tooth fracture/avulsion would be small. As custom guards are expensive and provide only theoretically better protection than other guards, many athletes may not want to bother with them.

  21. Thoughts for a Test • 1)Why might mouthguards protect from concussion? • 2)Why might this effect not show up in many in vivo studies?

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