Why isn’t the mouth guard a mandatory piece of equipment in the NFL?

Dr. Gerald J. Maher, D.M.D., F.A.H.N.P.

If the NFLPA doesn’t know the answer to that question then they don’t need to be representing players.

Although there is a current study being conducted by the Center for the Study of Traumatic Encepholopathy, it could be decades before the research can provide any definitive results. The Center is looking at the brains of deceased NFL football players to study Chronic Traumatic Encephalopathy (CTE), a progressive degenerative disease of the brain, found in athletes (and others) with a history of repetitive concussions.

The study is a very important first step and it should be noted that boxing studies have already made the link between concussions and CTE, but the most important question we should be asking is: Why do concussions that cause CTE occur and how can we prevent them from happening? Moreover, why do most of the brain bank subjects have it manifest in the medial temporal lobe, or just behind the ear?  Some suggest it’s because the bone at the skull-base – where the end of the jawbone rests – is paper thin and just millimeters away from the medial temporal lobe and that when the jawbone gets hit and hammers at that paper thin area during collisions involving the head and jaw area, it produces concussions.

A key brain stem lives behind the jaw, and controls many functions of the body.  Normally a dime sized cartilage disk (meniscus) at the end of the jawbone protects the bone from traumatizing this paper thin area. Patients who have had multiple concussion have been found to have damaged or a slipped “meniscus”, thus opening the jawbone to a hammering effect, exacerbating the mild events of dizziness, the sensation of seeing stars, facial numbness and concussion.

This “hammering effect” can be reduced and therefore help in the prevention of concussions by one simple piece of equipment…….a corrective mouth guard!

In 2006, Baltimore Ravens players had over twenty concussions, a little better than the NFL average of 16. That same year the New England Patriots reported just (2) two. The difference between the two teams? Most of the Patriot players were evaluated prior to the season and fit with the Maher mouth guard.  The two Patriot players that had concussions were not wearing the Maher mouth gaurd, but once fitted, these players returned to play with no problem of recurrence. The New England Patriots medical records will show that by using this concussion protocol, they have the lowest concussion rate annually, as reported in a peer reviewed American Academy of Orofacial Pain paper. Congresssman John Conyers has specifically asked Roger Goodell to turn over these records. There is no word on whether this has happened.

The NFL is reluctant to discuss mouth guards because until now, researchers have had very little understanding of how they can be linked to concussions. Conventional mouth guards are made by taking an upper impression of the teeth, but they only protect the teeth and do not address any TMJ (Temporal Mandibular Joint) issues.

All prior mouth guard research has been devoid of a consistent TMJ element and that is why no previous mouth guard research has ever shown a reduction in concussions in humans, only arbitrary results. One very big problem with the NFL research is that they used crash test dummies and since crash test dummies are not equipped with jaw joints, their research method was questionable from the very beginning.

The NFL funded researcher, Elliott Pellman, looked at injuries that took place from 1996 to 2001, but chose to study only those concussion-causing hits that researchers could re-enact from watching video. As a result, the committee analyzed 25 concussions out of a total of 787 that team doctors and athletic trainers reported over that period, and didn’t find one case in which a player suffered a concussion while striking another player. Here is an article about Dr. Pellman: ESPN

Dr. Gerald J. Maher, the developer of the Maher mouth gaurd said that the NFL study threw out the majority of concussions that a helmet would be unable to protect against. He also said that the helmet can’t protect the jaw, in fact, the chin strap compounds the problem.

The NFL helmet research consisted of approximately fourteen studies at a cost of $7 Million dollars – funded equally by the Owners and the Players Union – and was specifically conducted to assist in the development of the Riddell “Revolution” Helmet. That’s a lot of money to help in the design and development of a product sold by a private company.

It is interesting to note that the NFL’s initial 2001 research on the majority of concussions showed a need for jaw stabilization. The following statement was from a Riddell official as reported in the Pittsburgh Tribune Review: “The helmet was designed to protect players from concussions but also provides the best jaw protection available on a football helmet.” The Revolution Helmet was made after a study came to the surprising conclusion that 70 percent of players’ concussions occurred from blows to the jaw or side of the head.

If Pellman’s research had focused on the origin of jaw concussion, or the majority of concussions, not just those focused on helmet improvements, then the direction of the research might have been very different.

Unfortunately, the NFL appears to have steered the research toward a lucrative series of redundant studies that minimized the effects of concussion and overstated the effectiveness of the new helmet design.

Chris Nowinski and Dr. Robert Cantu from the CSTE publicly criticized this as a “marketing” piece that stated the new Riddell Revolution helmet reduced concussions by 30%. Many feel it is a complete fabrication for the purpose of selling the helmets.

The NFL did not do its due diligence to protect its players from the most common type of concussion force, a blow to the jaw. Instead, Dr. Pellman steered the study toward a series of misleading, highly questionable studies that resulted in a boon for Riddell’s stock and has not reduced the concussion rate one bit. This whole debacle has been reckless and self destructive to the NFL’s research reputation.

At Fourth & Goal, we are not in the business of endorsing products used by active players, but we’ll make an exception in this case because the Maher mouth guard is the only one that has any data on human research, history of use in the NFL and an American Dental Association approved fitting evaluation and protocol.

This small piece of “mandatory” equipment could save the NFL from a long line of active and retired players applying for NFL Disability. It will cost the league nothing to provide this protective gear for their players, because most insurance will cover the cost and many current players are using it today. You would think that the liability issue alone would force the NFL and the NFL Players Association to make these specialized mouth guards mandatory equipment, but, then again, that might look like an admission of guilt for allowing this travesty to go on for as long as it has.

It’s a shame that “retired” NFL players have to plead with the NFL and the NFL Players Association to protect the active players. Maybe it’s because retired players have experienced the crippling effects of concussions and we don’t want to see history repeat itself and add to the body count. Something needs to be done today, not twenty years from now.

The Union must take action to reduce and prevent concussions. Active players cannot be co-conspirators in their own demise and the NFLPA cannot allow them the opportunity to do so. It’s the Union’s job to ensure the safety of its members and that is why a mouth guard mandate and preseason jaw evaluations should come from the NFL Players Association, not the League.

If you would like more information on the Maher mouth guard go this website: http://www.mahercorlabs.com/mouthguard.htm

Written by Jeff Nixon – posted Feb. 24, 2010