I know of both players and coaches, who advise others to wear gumshields during contact drills for the reason that it stops concussion. But is this true?
In this article, I’m going to take a look at what the current research says on the matter, and whether this is something we should be claiming when advising our players.
A gumshield, or mouthguard, is a small appliance that covers the top teeth and surrounding soft tissue (a.k.a oral mucosa). The aim of this device is to prevent and reduce trauma to the teeth, lips, jaw and surrounding soft tissue by absorbing shock and stabilising the jaw. Indeed, mouthguards were originally developed in 1890 by Woolf Krause, a London dentist, to prevent lip lacerations in boxers.
There are different devices available to players, each made of different materials.
Stock gumshields are made ready to use; ‘boil and bite’ gumshields are to be heated in hot water and placed in the mouth and moulded to the teeth, and custom-made gumshields are made with a model of the individual’s teeth and surrounding tissue. This final type of gumshield is thought to provide the greatest protection.
The British Dental Association recommend individuals playing in ‘high-risk groups’ to wear mouthguards as a preventative tool.
A study, albeit dated, of 754 junior high school American football players advocated the use of mouthguards. However, a 2013 critical review of the literature to determine the effectiveness of protective equipment in reducing sports related concussion, reported there was no evidence to suggest that the use of gum shields in American Football significantly reduced the risk of concussion.
However, a recent 2020 case-control design study which looked at the association between concussion and mouthguard use in youth hockey reported use of a mouthguard was associated with decreased odds of sustaining a concussion. Interestingly, those with ‘off-the-shelf’ mouthguards were associated with decreased odds of 69% vs 49% lower odds when wearing dental custom-fit mouthguards, a non-significant statistical result.
Yet, mouthguards as previously mentioned, are not simply worn to reduce the risk of sports related concussions. Literature supports the use of the devices for reducing orofacial trauma, such as injuries to teeth and lips, and jaw fractures.
A 2019 meta-analysis of the effectiveness of mouthguards for the prevention of sports-related orofacial injuries and concussions found mouthguards to significantly reduce the overall risk of facial injuries. Indeed, they reported those athletes wearing mouthguards had less than half the risk of orofacial injuries compared to those who did not wear mouthguards. Interestingly, this study reported that the risk of concussion due to use of a mouthgaurd was not reduced. Yet, there are flaws in the methodological quality of some of the studies included within this review – something which could be addressed in future work. However the authors of this study have advised that mouthguards are used in all sports where there is a significant risk of orofacial injury i.e. American football.
Therefore, it seems that until more conclusive research is conducted in a wider sporting context, or indeed within our sport, we cannot fully ascertain whether the incidence of concussion is reduced with the wearing of a mouthguard.
So why should you wear a gumshield?
- Gumshields should be worn to prevent injury to the teeth, jaw and surrounding soft tissue.
- At present, the research does not support the use of gumshields for prevention of sports related concussions.
Benson, B.W., McIntosh, A.S., Maddocks, D., Herring, S.A., Raftery, M. and Dvořák, J., 2013. What are the most effective risk-reduction strategies in sport concussion?. Br J Sports Med, 47(5), pp.321-326.
Cave V., Burns, B., O’Donnell, E., McGrath, N.. (2019). Sports injuries and dental trauma: a project to save knocked out teeth. Available: https://www.bda.org/news-centre/blog/Pages/Sports-injuries-and-dental-trauma-a-project-to-save-knocked-out-teeth.aspx. Last accessed 13/05/2020.
Chisholm, D.A., Black, A.M., Palacios-Derflingher, L., Eliason, P.H., Schneider, K.J., Emery, C.A. and Hagel, B.E., 2020. Mouthguard use in youth ice hockey and the risk of concussion: nested case–control study of 315 cases. British Journal of Sports Medicine.
Knapik, J.J., Hoedebecke, B.L., Rogers, G.G., Sharp, M.A. and Marshall, S.W., 2019. Effectiveness of Mouthguards for the prevention of orofacial injuries and concussions in sports: systematic review and meta-analysis. Sports medicine, pp.1-16.
Green, J.I., 2017. The role of mouthguards in preventing and reducing sports-related trauma. Primary dental journal, 6(2), pp.27-34.
McCrory, P., 2001. Do mouthguards prevent concussion?. British journal of sports medicine, 35(2), pp.81-82.
Yasui, T., Gonda, T., Maeda, Y., Ishigami, K., Ueno, T., Matsumoto, M., Takamata, T., Koide, K., Kawara, M. and Kobayashi, K., 2017. Do Mouthguards Prevent or Reduce Oral Injuries and Concussion during Sports Events. International Journal of Sports Dentistry, 10, pp.7-11.