Concussions and the mouth guard myth

Last Updated: Thursday, January 22, 2009 | 2:57 PM ET

by Ron Kuipers, CBC Sports

Contrary to popular belief, mouth guards do not prevent concussions from happening on the ice, according to Dr. Robert Cantu. (Eliot J. Schechter/Getty Images)

On Saturday, January 17, inside the Grand Ballroom of the Hilton Hotel in London, Ontario, some of North America's leading authorities on concussions gathered for a full day of hockey concussion discussion.

Former NHL stars Eric Lindros and Jeff Beukeboom were on the lead panel of the London Hockey Concussion Summit along with Team Canada's Jennifer Botterill. They were there to share their first-hand experience with concussions sustained during on-ice action.

They were joined by renowned neurosurgeons, neuropsychologists, sports physicians and team trainers from Canada and the United States. It was a distinguished group of specialists on stage together to discuss the latest information on concussions which continue to plague the hockey world.

While some portions of the conversation were very technical and medical, others were simple and easy to understand, including Dr. Robert Cantu's surprising assertion that mouth guards do not prevent concussions in hockey.

Yes, contrary to popular belief, mouth guards do not prevent concussions from happening on the ice, according to a man who has devoted a great deal of his professional medical career on sport-related concussions.

The Myth

Dr. Cantu is known throughout the world for his work on catastrophic head and neck injury, concussion and post concussive syndrome. He's had an 'athletic concussion grading system' named after him and he's considered a pioneer when it comes to the diagnosis and treatment of concussions.

During his power point presentation on Saturday, Dr. Cantu included the following slide:

INJURY PREVENTION

Mouth guards have a role in preventing dental and oro-facial injury but have not been shown to decrease concussion occurrence.

Even though a large portion of the hockey community has been under the impression for years that wearing a mouth guard helps prevent a concussion, Dr. Cantu offered up a simple explanation as to why that's not true.

"No study that mouth guards prevent concussions has been done," said Dr. Cantu. "But they do prevent injuries to the teeth so I would recommend all collision-sports players wear mouth guards."

Dr. Charles Tator is currently professor in the department of surgery at the University of Toronto. His previous positions included neurosurgeon-in-chief at Sunnybrook Health Sciences Centre and Toronto's Western Hospital.

He, too, sat on the London Hockey Concussion Summit head table and he backs up Dr. Cantu's suggestion that there's no scientific proof mouth guards prevent concussions.

"If you're talking about a study that has looked at one thousand kids with mouth guards and one thousand kids without mouth guards, well, that study hasn't been done."

Make mouth guards mandatory

So until 'that study' is published, can kids start playing minor hockey in Canada without a mouth guard again?

Dr. Tator says there's more than enough medical evidence to continue making mouth guards a mandatory piece of hockey equipment. "They help prevent dental injuries and there are fewer fractures. Most of us are reasonably sure they're worthwhile."

Dr. Cantu concurs. "Mouth guards protect the teeth and give you something to bite down on before a violent collision so yes, you should wear a mouth guard."

What about the theory that the more expensive custom-fit mouth guard provides more protection that the less expensive 'boil and bite' mouth guard? It's yet another myth according to both doctors.

"There is no evidence that custom-fit do a better job than 'boil and bite' mouth guards" said Dr. Tator.

"There are no statistics to suggest that custom-fit mouth guards are better than boil and bite mouth guards" Dr. Cantu said. "There is a higher level of comfort with custom-fit but not more protection."

NHL endorsement

Saturday's revelation that no medical research exists yet proving any type of mouth guard helps prevent a concussion must come as a surprise to hockey parents, trainers, family doctors and dentists who've been recommending mouth guards for years based on concussion prevention alone.

Even Ron Wilson, the head coach of the Toronto Maple Leafs, was quoted this week as saying, "We're trying to get all our players to wear mouth guards. If you get hit and you're wearing a proper mouth guard, it lessens the chance of a concussion."

Wilson's concussion comment might not be based on the latest medical, scientific research, but it still acts as an important endorsement for wearing mouth guards in hockey no matter what the reason. Just like the London Hockey Concussion Summit doctors ordered.

Should mouth guards be mandatory across Canada? Join our hockey community discussion.

Internal Links

HOCKEY FORUM: Should mouth guards be mandatory across Canada?

The Equipment Guy »

'Concussions' new enemy' approved for use in Canada: A reader asks Our Game's equipment guy whether those Cascade helmets Mark Messier's been marketing really work, and if they can be worn in Canada.
Clearing the throat protector: Neck guards are a necessary part of hockey equipment, but it's hard to know when they needs to be replaced
Honing in on the skate stone: I just headed home, put the kit in the bag and forgot about it for a month.
Wearing the pants in the hockey family: Former Team Canada defenceman Geraldine Heaney knows what it's like to win Olympic gold and take home seven straight world championships. She also knows what it's like to fall on her backside on the ice while wearing hockey pants that offer little protection.
The bottom of the bag: After digging through my online equipment bag, I've discovered a few odds 'n ends at the 'bottom of the bag' thanks to some email replies and a personal equipment revelation that helped my daughter's cause between the pipes.

Dollars & Cents »

How do I run a profitable fundraising event?: Your first step is choosing what the event will be. It should be tailored to your particular community.
How do I approach potential sponsors?: Most teams and leagues write a draft letter for potential sponsors. Make sure it introduces your league or team to the prospective sponsor, and outlines the benefits the organization will have in return.
How do I organize a profitable raffle?: Raffles are often held as fundraisers for teams and leagues.
How do I run a profitable "minor night" fundraiser?: With this type of fundraiser, the league comes to an agreement with a local junior team to buy tickets at a reduced rate.
How do I run a profitable drive-home program?: If you've decided to start a drive-home program, one way to let people know about it is to ask local businesses for free advertising as a donation to the league.

Fitness & Fuel »

'How do I get that extra burst of skating speed?': Acceleration is key. Skating during a game isn't about how fast you are, but how quick you can be.
'What summer exercises can my son do to stay in shape?': All you need is a pair of wheels to stay in top shape when the snow's gone.
'What are the best post-game foods and drinks?': Not eating and drinking properly after a game or practice can make you more susceptible to injury and illness.
Sports drinks: not necessary for kids, but not necessarily evil: Studies have shown that kids will drink more if they're given fluid they like. Water is boring, and Gatorade, Powerade and AllSport come in all different colours and flavours.
Staying fit for credit: Kate Andrews High School in Coaldale, Alta., introduced a new hockey program this year, and the results have been better than expected.