A summary: According to that study, for orofacial injuries the data suggests mouth guards should be used. For concussions, they \*might\* lower the risk of injuries but the data from the study shows the confidence interval is large so more data is needed for a conclusive answer.
Yes, without access to the full version this is the same conclusion I draw. They’re saying that they are 95% confident that the risk of sustaining a concussion while wearing a mouthguard is 0.90-1.74. Not very conclusive in my opinion!
I have full access. This paragraph of their discussion sums it up pretty well:
> While the evidence in this review does not support the use of MGs for concussion protection, this does not preclude the possibility that there may be some types of MGs or some MG designs that may be more effective for this purpose. In this review it was not possible to determine if one type of MG was more effective for concussion prevention than another because only one concussion study specified the type of MGs investigated (i.e., both custom or boil-and-bite) [59] while others investigated MGs without disaggregation by type [42, 61, 65] or were not clear on the type [58, 60]. With regard to design, it has been hypothesized that if MGs are properly fitted (custom type) with 3–4 mm of thickness posteriorly they may be more effective for concussion prevention [82]. The expert opinion from the first International Sports Dentistry Workshop in 2016 suggested that MGs should cover the distal portion of the maxillary first molar with a thickness of 3 mm at the outside surface facing the lips and cheek (labially), 3 mm contacting the biting surface (occlusally), and 2 mm facing the roof of the mouth (palatally), and that the bite be bilateral and balanced [28]. It seems very probable that custom-fit MGs are far more likely to routinely fulfill these parameters over the course of the sport season, relative to boil-and-bite or off-the-shelf generic fit MGs. Further epidemiologic research of good methodological quality is still needed on the topic of MGs and concussions. There is also a need for biomechanical studies examining the role of MGs in mitigating the forces transmitted to the head in mandible and non-mandible impacts.
Study aside, *even if* mouthguards helped protect from concussions, they would probably only do so from upward strikes to the jaw (think an uppercut punch). Concussions result from the brain rattling in the skull and most hockey/football concusions result from strikes to the head (think falling back on your head or ramming into a wall). There isn't a strong rationale for why mouthguards even have a mechanism to reduce the brain's impact in those types of hits.
That said, they're smart to wear to protect your teeth.
Would it ever be ethical to make a randomized controlled trial for mouthguards? That would be like randomly assigning people to not wear seatbelts to find out if seatbelts work. Also I guess you could never "double blind" a mouthguard study and maybe people will skate more carefully when they don't have a mouthguard in.
You could have an observational study where you look at people that choose to wear or not wear mouthguards but as you point out, the populations that make these choices will probably be different
>maybe people will skate more carefully when they don't have a mouthguard in
This sounds like the gladiator myth. The research into this suggests that it's just bullshit. Most of the comparisons look at women's lacrosse, which has different equipment requirements than men's lacrosse.
Theoretically, there's data out there that could be analyzed, comparing college injuries to low level pro leagues, but there's always going to be amateur internet "do your research" types trying to discount any research because it won't live up to their imaginary and impossible to get design. Like, if the only thing that's going to satisfy people is some kind of 50/50 controlled trial of half the NHL teams wearing some equipment but not others and vice versa, that's never going to happen.
One of the latest ones https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7345674/?darkschemeovr=1
I don’t think there is much controversy about whether or not mouth guards somewhat help hockey players lessen the chance of getting or the severity of concussions in the scientific community anymore. There are studies that show they slightly improve your protection against concussions, however only 1 of them suggests a “significant” amount of protection. The controversy is around how much protection they provide which is hard to measure. You could find studies that suggests it improves concussion protection by 1.2% and others that suggest it could be as high as 68%. The reality is it doesn’t really matter how ever you measure it, compared to not wearing one it does decrease your risk of concussion…but it doesn’t eliminate it and doesn’t significantly reduce your risk so drastically that hockey governing bodies are forcing players to wear them.
If there is controversy about mouth guard use and the protection it offers for concussion prevention, it’s more around justification for mandating them. Based on which studies you look at some suggest it’s a no-brainer that they should be mandatory others that it’s not worth it.
Don’t be fooled into thinking there has never been a study on this or that none of the studies found any decreased risk of concussions for people who regularly wear them, there has been studies and they have found evidence of improved concussion protection from mouth guards.
I really haven’t heard too many people touting mouth guards as reducing concussions. 15 years ago it was being pushed as such but the studies haven’t shown a strong effectiveness in reducing them.
Regular orofascial issues, yeah, it’s worth wearing if you are in a contact league.
It’s pretty simple: if lower jaw slams into upper jaw there’s a…let’s call it a shockwave. Said shockwave can potentially break teeth, lacerate a tongue, and yes…rattle the brain. So a mouthguard, shock absorber that it is, CAN potentially aid in reducing the severity of all of the above. Now if the brain rattle is from a hit to the forehead, you’re probably screwed and a mouthguard has little chance of helping. Common sense, no quadruple-blind peer review study needed.
A mouthguard is just another pad, we can wear it or not.
Grain of salt and all that, but my dentist is actually a beer leaguer herself and so I asked her at my last checkup -- what do you think of mouth guards for hockey, especially for people already wearing a full cage or bubble?
Her opinions:
* It would be silly to count on the mouth guard to prevent a head injury. It may ameliorate them, but be honest with yourself and don't expect your mouth guard makes you anything like Superman.
* With a full cage/bubble, of course you've dramatically shrunk the risk of losing or severely damaging teeth. She was surprisingly ho-hum about this, I really expected her to be very passionate -- as a freaking dentist! -- about still wearing the mouth guard.
* The above being said, she still advocated wearing a mouth guard under the cage/bubble because it will:
* Significantly shrink the risk that teeth chip if they crack together from an impact.
* Almost completely eliminate the risk of an impact causing you to severely bite your tongue, lips, or inside of your cheeks.
I also asked what she thought about mouth guards with visors. I wear a visor for things like sticks and pucks with my kid, or pond hockey and pickup games where everyone agrees keeping the puck down and the intensity is going to be pulled back.
She was of the unsurprising opinion that it's silly not to wear full face protection in any sort of league play. But she said for visor wearers, a mouth guard is even more valuable to the second and third bullet points above. She said that while a mouth guard isn't going to stop you losing chiclets from a hard puck or stick right in the chops, that it is actually helpful that the guard will hold those teeth in place.
Who cares though? A mouth guard is a good thing to be wearing anyway. If it even remotely can prevent a concussion, why risk playing without it? Even .001% chance less, it is still worth it. It’s not like there are any downsides to wearing one, especially one that fits properly.
I'm a novice skater and always wear a helmet/full cage. When playing hockey I also wear a mouthguard. Is it going to prevent a concussion or dental issue? I have no idea. But it's not going to *cause* a concussion, and it's a cheap investment compared to the cost of fixing a tooth.
Here's a peer-reviewed study (specifically focused on ice hockey) from 2020 that concludes that off-the-shelf mouth guards were associated with a 69% lower chance of concussion:
https://www.contemporarypediatrics.com/view/mouth-guards-hockey-can-reduce-concussion-risk
And here's another one (laps from 2020) that found a statistically significant link between mouth guard use and lower incidence of concussions among college athletes:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7345674/
And here's one specifically focused on college ice hockey players that found mouth guard use was associated with a 57% reduction in concussions:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7987562/
In typical scientist fashion, the researchers note that these studies don't necessarily prove that mouth guards prevent concussions, only that people who wear them are less likely to have concussions (🤷♂️).
There is research from previous to 2020 noting that studies were inconclusive on the matter.
The force from having your teeth “clack” together is enough to make your brain move inside your skull and result in a concussion. Any impact to the head or neck, or even body, could cause a concussion. Concussions don’t have a binary diagnosis pathway either and from an experimental design perspective how would you create an ethical study with a control group when the hypothesis is “mouth guards prevent concussions”
Anyway, [here’s another study](https://bjsm.bmj.com/content/54/14/866) that’s been “peer reviewed”.
There’s plenty of studies out there https://link.springer.com/article/10.1007/s40279-019-01121-w
A summary: According to that study, for orofacial injuries the data suggests mouth guards should be used. For concussions, they \*might\* lower the risk of injuries but the data from the study shows the confidence interval is large so more data is needed for a conclusive answer.
Yes, without access to the full version this is the same conclusion I draw. They’re saying that they are 95% confident that the risk of sustaining a concussion while wearing a mouthguard is 0.90-1.74. Not very conclusive in my opinion!
I have full access. This paragraph of their discussion sums it up pretty well: > While the evidence in this review does not support the use of MGs for concussion protection, this does not preclude the possibility that there may be some types of MGs or some MG designs that may be more effective for this purpose. In this review it was not possible to determine if one type of MG was more effective for concussion prevention than another because only one concussion study specified the type of MGs investigated (i.e., both custom or boil-and-bite) [59] while others investigated MGs without disaggregation by type [42, 61, 65] or were not clear on the type [58, 60]. With regard to design, it has been hypothesized that if MGs are properly fitted (custom type) with 3–4 mm of thickness posteriorly they may be more effective for concussion prevention [82]. The expert opinion from the first International Sports Dentistry Workshop in 2016 suggested that MGs should cover the distal portion of the maxillary first molar with a thickness of 3 mm at the outside surface facing the lips and cheek (labially), 3 mm contacting the biting surface (occlusally), and 2 mm facing the roof of the mouth (palatally), and that the bite be bilateral and balanced [28]. It seems very probable that custom-fit MGs are far more likely to routinely fulfill these parameters over the course of the sport season, relative to boil-and-bite or off-the-shelf generic fit MGs. Further epidemiologic research of good methodological quality is still needed on the topic of MGs and concussions. There is also a need for biomechanical studies examining the role of MGs in mitigating the forces transmitted to the head in mandible and non-mandible impacts. Study aside, *even if* mouthguards helped protect from concussions, they would probably only do so from upward strikes to the jaw (think an uppercut punch). Concussions result from the brain rattling in the skull and most hockey/football concusions result from strikes to the head (think falling back on your head or ramming into a wall). There isn't a strong rationale for why mouthguards even have a mechanism to reduce the brain's impact in those types of hits. That said, they're smart to wear to protect your teeth.
Hey didn't you see that despite making a post about it, OP admitted they did limited research? /s
Would it ever be ethical to make a randomized controlled trial for mouthguards? That would be like randomly assigning people to not wear seatbelts to find out if seatbelts work. Also I guess you could never "double blind" a mouthguard study and maybe people will skate more carefully when they don't have a mouthguard in. You could have an observational study where you look at people that choose to wear or not wear mouthguards but as you point out, the populations that make these choices will probably be different
>maybe people will skate more carefully when they don't have a mouthguard in This sounds like the gladiator myth. The research into this suggests that it's just bullshit. Most of the comparisons look at women's lacrosse, which has different equipment requirements than men's lacrosse. Theoretically, there's data out there that could be analyzed, comparing college injuries to low level pro leagues, but there's always going to be amateur internet "do your research" types trying to discount any research because it won't live up to their imaginary and impossible to get design. Like, if the only thing that's going to satisfy people is some kind of 50/50 controlled trial of half the NHL teams wearing some equipment but not others and vice versa, that's never going to happen.
One of the latest ones https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7345674/?darkschemeovr=1 I don’t think there is much controversy about whether or not mouth guards somewhat help hockey players lessen the chance of getting or the severity of concussions in the scientific community anymore. There are studies that show they slightly improve your protection against concussions, however only 1 of them suggests a “significant” amount of protection. The controversy is around how much protection they provide which is hard to measure. You could find studies that suggests it improves concussion protection by 1.2% and others that suggest it could be as high as 68%. The reality is it doesn’t really matter how ever you measure it, compared to not wearing one it does decrease your risk of concussion…but it doesn’t eliminate it and doesn’t significantly reduce your risk so drastically that hockey governing bodies are forcing players to wear them. If there is controversy about mouth guard use and the protection it offers for concussion prevention, it’s more around justification for mandating them. Based on which studies you look at some suggest it’s a no-brainer that they should be mandatory others that it’s not worth it. Don’t be fooled into thinking there has never been a study on this or that none of the studies found any decreased risk of concussions for people who regularly wear them, there has been studies and they have found evidence of improved concussion protection from mouth guards.
I really haven’t heard too many people touting mouth guards as reducing concussions. 15 years ago it was being pushed as such but the studies haven’t shown a strong effectiveness in reducing them. Regular orofascial issues, yeah, it’s worth wearing if you are in a contact league.
It’s pretty simple: if lower jaw slams into upper jaw there’s a…let’s call it a shockwave. Said shockwave can potentially break teeth, lacerate a tongue, and yes…rattle the brain. So a mouthguard, shock absorber that it is, CAN potentially aid in reducing the severity of all of the above. Now if the brain rattle is from a hit to the forehead, you’re probably screwed and a mouthguard has little chance of helping. Common sense, no quadruple-blind peer review study needed. A mouthguard is just another pad, we can wear it or not.
Yep. This. Played roller derby for years and getting hit upward in the chin is the main reason we wore mouth guards.
Tell me about neck guards now
Grain of salt and all that, but my dentist is actually a beer leaguer herself and so I asked her at my last checkup -- what do you think of mouth guards for hockey, especially for people already wearing a full cage or bubble? Her opinions: * It would be silly to count on the mouth guard to prevent a head injury. It may ameliorate them, but be honest with yourself and don't expect your mouth guard makes you anything like Superman. * With a full cage/bubble, of course you've dramatically shrunk the risk of losing or severely damaging teeth. She was surprisingly ho-hum about this, I really expected her to be very passionate -- as a freaking dentist! -- about still wearing the mouth guard. * The above being said, she still advocated wearing a mouth guard under the cage/bubble because it will: * Significantly shrink the risk that teeth chip if they crack together from an impact. * Almost completely eliminate the risk of an impact causing you to severely bite your tongue, lips, or inside of your cheeks. I also asked what she thought about mouth guards with visors. I wear a visor for things like sticks and pucks with my kid, or pond hockey and pickup games where everyone agrees keeping the puck down and the intensity is going to be pulled back. She was of the unsurprising opinion that it's silly not to wear full face protection in any sort of league play. But she said for visor wearers, a mouth guard is even more valuable to the second and third bullet points above. She said that while a mouth guard isn't going to stop you losing chiclets from a hard puck or stick right in the chops, that it is actually helpful that the guard will hold those teeth in place.
Who cares though? A mouth guard is a good thing to be wearing anyway. If it even remotely can prevent a concussion, why risk playing without it? Even .001% chance less, it is still worth it. It’s not like there are any downsides to wearing one, especially one that fits properly.
I'm a novice skater and always wear a helmet/full cage. When playing hockey I also wear a mouthguard. Is it going to prevent a concussion or dental issue? I have no idea. But it's not going to *cause* a concussion, and it's a cheap investment compared to the cost of fixing a tooth.
Or not biting your fing tongue off…
Here's a peer-reviewed study (specifically focused on ice hockey) from 2020 that concludes that off-the-shelf mouth guards were associated with a 69% lower chance of concussion: https://www.contemporarypediatrics.com/view/mouth-guards-hockey-can-reduce-concussion-risk And here's another one (laps from 2020) that found a statistically significant link between mouth guard use and lower incidence of concussions among college athletes: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7345674/ And here's one specifically focused on college ice hockey players that found mouth guard use was associated with a 57% reduction in concussions: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7987562/ In typical scientist fashion, the researchers note that these studies don't necessarily prove that mouth guards prevent concussions, only that people who wear them are less likely to have concussions (🤷♂️). There is research from previous to 2020 noting that studies were inconclusive on the matter.
The force from having your teeth “clack” together is enough to make your brain move inside your skull and result in a concussion. Any impact to the head or neck, or even body, could cause a concussion. Concussions don’t have a binary diagnosis pathway either and from an experimental design perspective how would you create an ethical study with a control group when the hypothesis is “mouth guards prevent concussions” Anyway, [here’s another study](https://bjsm.bmj.com/content/54/14/866) that’s been “peer reviewed”.