Wednesday, May 11, 2016

Mouth Guards and Concussions: A Literature Review

An HGP member recently submitted a question regarding mouth guard use.  It sparked a discussion the topic and there seemed to be controversy on the topic.  As a health care provider and a professor, I like to turn to science for answers.  I did a fairly exhaustive search of the more current literature available to me in the medical library at the University of Nebraska Medical Center.  I found  it to be inconclusive at best, and definitely leaning toward the assertion that mouth guards do little to reduce the incidence or severity of concussion.

To be clear, I am making NO RECOMMENDATION regarding your parental decision on whether your goalie should use a mouth guard.  This is simply a review of the information (2005-present) that I was able to find on the matter for your edification.

A 2005 study in the Clinical Journal of Sports medicine compared 610 players on 12 football and rugby teams revealed no difference in the incidence of concussion based on type of mouthguard used.(Barbic, Pater, & Brison, 2005)

A 2007 article published in Sports Medicine, Knapik, et al concluded “Studies comparing mouthguard users with nonusers have examined different sports, employed a variety of study designs and used widely-varying injury case definitions. Prior to the 1980s, most studies exhibited relatively low methodological quality. Despite these issues, meta-analyses indicated that the risk of an orofacial sports injury was 1.6–1.9 times higher when a mouthguard was not worn. However, the evidence that mouthguards protect against concussion was inconsistent, and no conclusion regarding the effectiveness of mouthguards in preventing concussion can be drawn at present. Mouthguards should continue to be used in sport activities where there is significant risk of orofacial injury.”  (Knapik et al., 2007)

In a 2011 review of the literature on concussion published in Clinics in Sports Medicine, Daneshvar, et al reviewed the role of helmets and mouth guards in preventing sports-related concussions.  They wrote, “During the 1960s and 1970s, the use of mouth guards was made mandatory in many sports, including football, ice hockey, lacrosse, field hockey, and boxing. The rationale for these rule changes was to provide additional protection against dental and orofacial injuries and to reduce a player’s risk of concussion.  However, at that time, as well as now, there is little evidence that mouth guards provide protection against concussion.”  In a hockey-specific discussion in the same article, the authors state, while post-concussive symptoms  (headache, dizziness, etc) may be reduced by using a mouth guard, the rate of incidence and severity of concussion was not statistically different between those who wore a mouth guard and those who did not. (Daneshvar et al., 2011)

 In a an an article from the American Journal of Sports Medicine (2014) reviewing 2081 high school football players, comprising 134,437 football events,  9% sustained sustained sport-related concussions.    The study found that rate of concussion was HIGHER in players with a custom mouth guard as compared to those with a generic mouth guard. (McGuine, Hetzel, McCrea, & Brooks, 2014)

The National Athletic Trainers Association published a position statement on the management of sport concussion in 2014 based on an extensive review of the medical literature.  In it, they state: “Consistent evidence to support the use of mouthguards for concussion mitigation is not available. However, substantial evidence demonstrates that a properly fitted mouthguard reduces dental injuries.”  (Broglio et al., 2014)


Barbic, D., Pater, J., & Brison, R. J. (2005). Comparison of mouth guard designs and concussion prevention in contact sports: a multicenter randomized controlled trial. Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine, 15(5), 294–298.

Broglio, S. P., Cantu, R. C., Gioia, G. A., Guskiewicz, K. M., Kutcher, J., Palm, M., & McLeod, T. C. V. (2014). National Athletic Trainers’ Association Position Statement: Management of Sport Concussion. Journal of Athletic Training, 49(2), 245–265.

Daneshvar, D. H., Baugh, C. M., Nowinski, C. J., McKee, A. C., Stern, R. A., & Cantu, R. C. (2011). Helmets and Mouth Guards: The Role of Personal Equipment in Preventing Sport-Related Concussions. Clinics in Sports Medicine, 30(1), 145–163.

Knapik, J. J., Marshall, S. W., Lee, R. B., Darakjy, S. S., Jones, S. B., Mitchener, T. A., … Jones, B. H. (2007). Mouthguards in sport activities : history, physical properties and injury prevention effectiveness. Sports Medicine (Auckland, N.Z.), 37(2), 117–144.

McGuine, T. A., Hetzel, S., McCrea, M., & Brooks, M. A. (2014). Protective Equipment and Player Characteristics Associated With the Incidence of Sport-Related Concussion in High School Football Players: A Multifactorial Prospective Study. The American Journal of Sports Medicine, 42(10), 2470–2478.

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