title: Customized mandibular orthotics in the prevention of concussion/mild traumatic brain injury in football players: a preliminary study.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Director of Continuing Education, SMILE Foundation, Chatsworth, CA 91311, USA. drsingh@smilefoundation.org
authors.forename: G Dave
authors.initials: GD
authors.lastname: Singh
authors.forename: Gerald J
authors.initials: GJ
authors.lastname: Maher
authors.forename: Ray R
authors.initials: RR
authors.lastname: Padilla
mesh_terms: D000293:Adolescent; D001924:Brain Concussion / Q000517:prevention & control*; D004867:Equipment Design; D005538:Football / Q000293:injuries*; D006801:Humans; D007574:Jaw Relation Record; D008297:Male; D008310:Malocclusion / Q000175:diagnosis; D008334:Mandible; D009064:Mouth Protectors; D016017:Odds Ratio; D010173:Palpation; D010865:Pilot Projects; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013705:Temporomandibular Joint Disorders / Q000175:diagnosis; D055815:Young Adult