Mandibular orthotics in the prevention of brain injury in football players

I’m grateful to Dhru Shah for the link to this paper by Prof Dave Singh of the SMILE Foundation, California- full title of which is:

“Customized mandibular orthotics in the prevention of concussion/mild traumatic brain injury in football players: a preliminary study”

Prof Dave Singh

It’s an American paper, so it refers to American Football, not “soccer”, but it’s interesting nonetheless I think, especially as I make appliances very similar to this for a number of Premiership footballers (soccer players) and the main benefit for them seems to be a reduction in pelvic strain and hamstring injuries.

Here’s the abstract:

Abstract

Background/Aim: It is accepted that sports mouthguards decrease the incidence of dental injuries in athletes, but the value of oral orthotics in the prevention of concussion/mild traumatic brain injuries in footballers remains contentious. However, previous investigations have primarily studied non-customized mouthguards without dental/temporo-mandibular joint examinations of the subjects. Therefore, the aim of this study is to determine whether the use of a customized mandibular orthotic after temporo-mandibular joint assessment reduces the incidence of concussion/mild traumatic brain injuries in high-school football players.

Materials and methods: Using a longitudinal, retrospective design, data were collected from a cohort of football players (n = 28) over three seasons using a questionnaire. The mean age of the sample prior to the use of the customized mandibular orthotic was 17.3 years ± 1.9. Prior to deployment, dental records and temporo-mandibular joint evaluations were undertaken, as well as neurocognitive assessment, including history of concussion/mild traumatic brain injuries. After establishing optimal jaw position, a customized mandibular orthotic was fabricated to the new spatial relations.

Results: The mean age of the sample after three seasons was 19.7 years ± 2.0. Prior to the use of the customized mandibular orthotic, the mean self-reported incidence of concussion/mild traumatic brain injuries was 2.1 ± 1.4 concussive events. After the deployment of the customized mandibular orthotic the number of concussive events fell to 0.11 ± 0.3 with an odds ratio of 38.33 (95% CI 8.2–178.6), P < 0.05.

Conclusion: The preliminary results of this study suggest that a customized mandibular orthotic may decrease the incidence of concussion/mild traumatic brain injuries in high school football athletes, but a comprehensive study is required to confirm these initial findings. Furthermore, additional research is necessary to indicate the possible mode(s) of action of a customized mandibular orthotic in the prevention of concussion/mild traumatic brain injuries.

Link to full paper HERE - you might need to log in or register with Dentinal Tubules to read this.

2012 American Equilibration Society Meeting, Feb 22nd/23rd, Chicago

Nice to see so many big names back on the list of speakers for the 2012 AES meeting, looks like a great programme.

“Evidenced Based TMD: Paradigms for a New Decade”

http://goo.gl/x4aPm

Programme:
Wednesday February 22, 2012
7:00 – 8:00 AM: Registration and Continental Breakfast
8:00 – 8:20 AM: Opening Ceremony
8:20 – 8:30 AM: Introductions
Panel 1: Orofacial Pain: Mechanisms and Treatment Considerations
8:30 – 9:15 AM: Evidence: What is the Value? – Peter Baragona, DMD
9:15 – 10:00 AM: Orofacial Pain: Looking at the Big Picture – Jeffrey Okeson, DMD
10:00 – 10:30 AM: Break with Exhibitors
10:30 – 11:15 AM: Glia as the “Bad Guys” in Dysregulating Pain & Opioid Actions: Clinical Implications – Linda Watkins, PhD
11:15 AM – 12:00 PM: Psychological Considerations in the Management of TMD: Red Flags – Charles Carlson, PhD
12:00 – 12:15 PM: Morning Panel Discussion
12:15 – 1:30 PM: Lunch
Panel 2: Occlusion, TMJ Imaging, and Arthrocentesis
1:30 – 2:15 PM: Functional Occlusal Assessment: The 3 Ps –John Kois, DDS, MS
2:15 – 3:00 PM: Intracapsular Disorders: Imaging Considerations – Gerhard Undt, DMD, MD
3:00 – 3:30 PM: Break with Exhibitors
3:30 – 4:15 PM: Arthrocentesis: A Technique for the Treatment of Adhesive TMJ Disorders – Steven Shall, DDS and Matthew Lark, DDS
4:15 – 4:45 PM: Afternoon Panel Discussion
6:30 – 8:30 PM: President’s Reception
Thursday February 23, 2012
7:00 – 8:15 AM: Registration and Continental Breakfast
7:15 – 8:15 AM: New Member Breakfast
8:15 – 8:30 AM: Introductions
Panel 3: Sleep and Medical considerations of Orofacial Pain
8:30 – 9:15 AM: The Efficacy of Hard Splint in Treating TMD: Results of a Systematic Review – James Fricton, DDS
9:15 – 10:00 AM: Medical Conditions Posing as TMD – Donald R. Tannenbaum, DDS
10:00 – 10:30 AM: Break with Exhibitors
10:30 – 11:15 AM: Daytime Bruxism and the TMD/OFP Patient – Alan G. Glaros, PhD
11:15 AM – 12:00 PM: Sleep Medicine and The Dentist – Dennis R. Bailey, DDS
12:00 to 12:15 PM: Morning Panel Discussion
12:15 to 1:45 PM: Lunch and AES Membership Meeting
Panel 4: The Restoraive TMD Connection
1:45 – 2:30 PM:
TMD Related Topics – Frank Spear, DDS, MS
2:30 – 3:15 PM: Advanced Implant Reconstruction for the Parafunctional Patient – Ricardo Mitrani, DDS, MSD
3:15 – 3:45 PM: Break with
:45 – 4:30 PM: Is Occlusion Dead or Just Sleeping it Off? , Dr. Jeffrey Rouse
4:30 – 5:00 PM: Afternoon Panel Discussion
5:00 – 5:15 PM: Closing Remarks

Playing with Vertical Dimension? Know the Rules!

There’s a great position paper on the subject of when, how and by how much it is OK to change the Vertical Dimension of Occlusion (VDO) from M. Rebibo et al of the Université de la Méditerranée, Marseille HERE

There is a discussion of the myths around whether one can or cannot increase or decrease VDO and a very useful chart (Table 2) showing the effect that a change in height at the molars will have on position of the incisors and the incisal pin of the articulator. There are also several very interesting case presentations, including the use of occlusal equilibration alone to close down a significant anterior open bite. Please read the article and comment below if you have any questions of observations.

I might put a few similar cases of my own up if there’s sufficient interest, or if you have some photos and a case report you are prepared to share and have discussed please send them to me and I will publish them on here for you.

Andy

Migraine Awareness Week

Congratulations to Pav Khaira for managing to follow up his recent appearance on the radio with a great piece on the role of occlusal appliances in the management of migraine in his local newspaper:

Yorkshire Post article

Please let us know if you have anything planned in your practice for Migraine Awareness Week – seems like a great opportunity to get the message across to the general public.

PPD Magazine Editorial – Mark Cronshaw

I really enjoyed reading Mark Cronshaw’s editorial piece in PPD magazine so I asked him to send me the text so we could repeat it here. Well worth a read.

Fractured teeth and restorations, sensitivity and acute pain, loose teeth, abnormal wear, bone loss. Difficulty chewing, atypical facial pain, TMJ breakdown and the list goes on. There are those (including myself) who believe this condition is directly related to frequent headaches, neck and shoulder pain, tinnitus, vertigo and more. An impressive list of important disorders – and the likely cause of these many problems is…? Of course the answer is occlusion.

Abfraction lesion under gingival tissue – final proof?

 

 

 

 Loss of cervical tissue around teeth has been linked to the presence of excessive occlusal loading.

These are known as abfraction lesions, defined as “Loss of tooth structure, usually in a wedge-shaped pattern in the cervical area of the tooth, attributed to flexure and fatigue in an area away from the point of loading (usually cervical).” The true aetiology of these has been called into question, with some recent research purporting to show that a toothbrush and abrasive dentifrice are required for them to develop. 

A case I saw this week seems to contradict such an assertion – this aesthetic case need a little gingival recontouring around the anteriors:

…. so I started to work on the lateral first and look what has appeared! This photo was taken moments after removing the gingival tissue, and it hasn’t been touched by a bur: 

Now, this looks suspiciously like an abfraction lesion to me, and it has has been subjected to significant occlusal loading palatally from a deep overbite Class II div 2 situation for many years. Is this final proof that such things really do exist – it can’t possibly be toothbrush abrasion since this is the first time it’s ever seen the light of day. Any other ideas, or do you think I have found something significant?

Survey on oral and dental considerations with eating disorders

I think we’re all aware that bulimia in particular can be a major factor in the development of occlusal changes and wear, so I’d be very grateful if members of the dental team could complete this survey on oral and dental considerations with eating disorders for a project being organised by Alexandra Day (Sheffield) with support from Dr N Martin (Sheffield), Dr A Milosevic (Liverpool) and Prof A Eder (UCL Eastman).

https://www.surveymonkey.com/s/CXW9BBR

Should take no more than a few minutes and will help highlight possible need for better support and education in this increasingly important field.

Many thanks.
_________________
Andy Lane

More from Barry Glassman on Bruxism Awareness Week

Dr. Barry Glassman, internationally acknowledged as a leading authority on TMD, migraine and dental related sleep breathing dysfunction, will open the 2nd Bruxism Awareness Week with a lecture at the Royal College of Physicians in London on October 24th 2011.

It turns out that Dr Glassman’s interest in the field was first encouraged by attending a Niles Guichet course, just like the majority of lecturers for SDS Occlusion! Interviewed at his specialist clinic in Pennsylvania, Dr. Glassman described how his interest was first aroused in this specific aspect of dentistry.

Feedback from the POISE Course

We get great feedback from our courses, and it’s great to hear how we are changing lives, but here is one that I felt we had to share with you:

I’m amazed what a difference having extra knowledge of occlusion has made. I have treated many hundreds of patients since finishing the course but one in particular jumped out at me. The patient in question has had undiagnosed occlusal problems for years. The SDS questionnaire flagged up the problem. Past dental history revealed a bridge which had failed four times in ten years and numerous broken teeth. On examination he has very large bony exostosis, abfractions, Masseteric hypertorphy and classic violin strings through his Temporalis which were excrutiating to touch. Absolute barn door case, straight out of the notes. Amazingly he’s been a patient at the practice for 20 years and it had never been picked up. As you said on the course, you can only see what you know. After a stabilization splint and a decent bridge made in CR he’s got no pain and is pleased as punch with me as a dentist. He is a GMP for a living and values the holistic approach that we’ve taken to his treatment. He has since recommended other patients to the practice.

It frustrates me that there is such a big black whole in undergraduate occlusion teaching. I now don’t like looking at work that I’ve done before the course as I can see my own mistakes even though I considered myself a good dentist. I have older dentists who’ve been qualified for years telling me that occlusion is a waste of time. I truly believe it is not and am very grateful to you and Higgy for changing my career. CM

If you’d like to change your career in a similar way please book on our next POISE course, 12th/13th November 2012 at ACE in Wakefield, you won’t regret it! Call Jemma on 01457 821800 or email: jemma@sds-ipso.com

Bruxism Awareness Week Lecture Special Offer

 This year’s Bruxism Awareness Week lecture entitled “NTI-tss Therapeutic Protocol – Traumatic Occlusion and Bruxism” will be delivered by Dr Barry Glassman one of the world’s leading authorities in the management of TMD, Migraine and dental sleep medicine and very popular speaker in the USA.

This prestigious event will be held at the Royal College of Physicians in London on 24th October 2011.
S4S are sponsoring the event and have agreed to provide all our SDS Occlusion Blog subcribers with a special booking package which includes your place at the event and a Kit of 5 NTI splints (worth £105.00) all for a 20% discounted rate of £280.00 (normally £350).
 
To take advantage of this offer book online HERE, select the “special offer booking package”, use discount code “CWK” and mention which kit you would like in the “order notes”.  Alternatively you can call S4S on 0114 250 0176.