Concussions and the mouth guard myth

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.