Wednesday, September 28, 2016

Bite and Balance

By Chris Berdik

Could wearing a mouth guard lessen pain and improve athletic performance?

hockey player skating

The mouth guards may mean less work for the postural muscles—and more stability for athletes such as ice hockey players. Photo: iStock

Like most Canadians, Serge Bourgeois, the men’s hockey coach at New Brunswick’s Université de Moncton, takes the sport seriously. Naturally he was skeptical when a local dentist, Patrick Girouard, DG11, suggested that mouth guards might help his team skate better, shoot straighter and suffer fewer muscle aches and strains.

Mouth guards aren’t mandated for college hockey players in Canada. But there is some evidence that they may protect athletes from concussions by absorbing the shock of blows to the head and stabilizing the head and neck muscles, and Bourgeois encouraged his players to wear them. So when Girouard asked if the team would help him investigate the relationship between bite, balance and performance, Bourgeois put his skepticism aside. “I was all for it,” he says.

Girouard is conducting the research for his master’s degree, with a focus on craniofacial pain, via the School of Dental Medicine’s distance education program. His adviser is Noshir Mehta, director of Tufts’ Craniofacial Pain Center.

Girouard also recruited Moncton’s women’s hockey team and the men’s and women’s soccer teams to determine if wearing a mouth guard can improve posture and balance, thereby improving athletic performance and reducing injuries. The preliminary results are positive, says Girouard, although he has yet to fully analyze his data.

The research is based on the fact that humans never really stand still. Networks of muscles from head to toe are constantly making tiny adjustments to keep us in balance. In short, we sway slightly to keep from falling over.

The muscles that align the jaw are critical for correct posture because they also help control head position. By helping to stabilize these muscles, mouth guards may improve posture and balance by reducing body sway. Better balance, Girouard theorizes, could translate into more fluid skating, crisper dribbling in soccer, a more controlled golf swing and reduced muscle strain in just about any sport.

He is particularly interested in what are called neuromuscular mouth guards. As opposed to standard mouth guards that are flat-bottomed and mold to the upper teeth, neuromuscular guards contain both upper and lower tooth indentations and slightly reposition the bite so that the jaw muscles and joints are stabilized.

Potential links between mouth guards and better athletic performance first made headlines in the late 1970s and early 1980s, when dentists working with Notre Dame’s football team and the Philadelphia Eagles of the National Football League noted improved strength and reduced muscle pain in players who were fitted with mouth guards after sustaining concussions.

Similar findings were later reported among long-distance runners, bobsledders and weightlifters, inspiring a number of companies to market “performance-enhancing” mouth guards.

Checking the Pain

The evidence supporting performance benefits has largely come from “anecdotal reports rather than scientific studies,” Girouard says. And, like the Moncton hockey coach, he was initially skeptical of such claims.

Girouard first learned of the link between mouth guards and improved posture and balance in 2003 while attending a lecture by a dentist who had invented a device for diagnosing improper bite alignment. Girouard told the dentist about his love of long-distance running and the knee pain he’d experienced since he ran his first marathon in 2002. Pain relievers, acupuncture and physical therapy had done little good, says Girouard, “and I told him that I didn’t think any change in my bite would relieve the pain.”

The dentist challenged him to wear a dental appliance that corrected his bite and jaw position on his next long run. Girouard complied, even tacking on a couple extra miles “just to push it a little.” His knee pain was gone. That same year he popped in a mouth guard and ran the Quebec City marathon, all 26.2 miles pain-free. He completed the 2010 Boston Marathon, again with no knee pain.

While Girouard is a general practice dentist, more than half of his patients suffer from craniofacial pain. His graduate degree work at the Tufts Craniofacial Pain Center and the surprising benefits of wearing a mouth guard while running inspired his current research, for which he tested 80 athletes in late 2009 and early 2010.

Each athlete was fitted for a standard “flat-plane” mouth guard and a neuromuscular guard. Then the athletes were instructed to stand in a fixed position, close their eyes and bite down for 15 seconds in three scenarios—wearing no mouth guard, wearing a standard mouth guard and wearing the neuromuscular one. Girouard monitored the athletes’ body sway via a special mat embedded with pressure sensors, and he measured activation of their postural muscles on the temple, neck, lower back and lower leg via surface electrodes.

Less sway means less work for the postural muscles—and more stability for the athlete. And balance is critical in sport, says Girouard, whether it’s a tennis player getting set for a forehand, a soccer player trying to dribble past a defender or a hockey player trying to get the most bang out of his slap shot.

After he completes his statistical analysis of the data, Girouard says he will submit the study for publication. His preliminary results show that the majority of the Moncton athletes reported some benefits when wearing a neuromuscular mouth guard. “Many athletes demonstrated a reduction in sway, and hence a more stable posture,” he says, but only a full statistical analysis will indicate whether that finding is significant.

Girouard says he plans to continue his research by investigating if wearing a mouth guard can improve an athlete’s running gait, for which balance is critical for energy efficiency. “What we have so far measures static posture, and the next obvious question is whether this translates to the gait,” he says. “If the gait is more efficient, then the athlete expends less energy per step, which may improve overall performance.”

He adds that other tests could be developed for specific sports, measuring, for example, the accuracy and power of a golfer’s drive or a hockey player’s slap shot.

Beyond athletics, Girouard says his research might lend support to the use of neuromuscular dentures to improve balance and mobility in the elderly.

Although the Moncton collegiate athletes were necessarily kept in the dark about the hypothesis behind Girouard’s study, many of them since have become mouth-guard converts. Bourgeois says that only a few of his icemen still refuse to wear one. The neuromuscular variety in particular has won over players who once braved the rink with bare teeth. Performance aside, says Bourgeois, “they just say this one is more comfortable.”

Chris Berdik is a Boston-based freelance writer.

Posted October 17, 2010