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Athletic development specialists dedicated to the art and science of excellence in movement

Mouthpieces and Performance...Do they Help?

 

Perhaps due to my music background as a trumpet player, the jaw has been a source of fascination to me in athletics.  In all forms of movement, the jaw plays an important role, though we mostly appreciate this role when things go wrong.  The cue “packing the neck” and demanding proper breathing patterns are two ways to access the jaw without addressing the jaw itself.  The neck and airway both have profound influence on jaw function and offer clues as to how the jaw is working. (See also, TPI Case Study: Golfer with Previously Broken Jaw; and Looking Beyond the Mouth: Orthodontics and Their Effect on Athletic Development)

It’s fairly well established that jaw problems can affect all aspects of life negatively.  When neck and shoulder dysfunction is present, the jaw often takes a beating, which can lead to localized jaw pain, headaches, dizziness, and breathing problems.  Even before the athletic implications of these problems, quality of life can suffer for athletic and sedentary folks alike.  Couple these developments with orthodontics, and the situation can get easily jumbled!

Unfortunately, there’s very little communication between clinicians that deal with the jaw and other professionals.  Most would agree that the jaw is connected to everything else, but few know what to do about it.  Dealing with jaw pain (often referred to as temporomandibular joint dysfunction) itself is wrought with much disagreement, even among professionals…many insurance carriers will even exclude jaw treatments from routine coverage.  Some professionals like to splint everything, while others take a less invasive approach.  Rarely is the rest of the body incorporated, though if you follow Rocabado’s work, it is clear an integrated approach is possible.    

Recently, several mouthpieces/mouthguards have hit the market purporting to improve athletic performance.  We have seen improvements in medical settings with orthodontics…can similar concepts apply to healthy populations?  I am somewhat intrigued by these products not only for the supposed benefits, but also for the learning effect.  Perhaps mouthpieces can teach more effective jaw and neck mechanics.  But first things first…before asking whether mouthpieces can IMPROVE performance, do we know if they impede performance? 

Literature is clear that properly fitted custom mouthpieces should not hurt performance.  Duddy (2012) found that custom mouthguards for contact sport athletes did not impede performance, whereas boil-and-bite mouthpieces (specifically, the Under Armour Max Flow in this study) resulted in worse performance and greater discomfort, though it would be interesting to note how comfort and performance may have been tied.  Rapisura (2010) found that mouthguards made specifically for women did not impair their performance either.  Kececi (2005) and Cetin (2009) studied taekwondo and found no impairment of aerobic or anaerobic performance.  Now for the main question…

***Is there any evidence to suggest mouthguards can improve performance? 

Endurance: Garner (2009) conducted thirty minute treadmill tests on fit college males and found that lactate levels at a given exertion were lower with mouthpieces than without.  Theoretically, the mouthguard assisted in airway opening which allowed for improved gas exchange.  Garner (2011) bolstered that theory showing that custom mouthpieces actually did improve gas exchange parameters in ten minute treadmill tests of a similar college student population.

Stress: Garner (2011) found that after intense resistance exercise, a group wearing mouthpieces had a faster decrease in cortisol in a ten minute window immediately after exercise than a group not wearing mouthpieces.  However ,the no-mouthpiece group did show reductions in cortisol after this ten minute window. 

Speed and power: Pae (2012) found that clubhead speed and driving distance increased in a sample of professional golfers wearing performance mouthpieces, although ball speed (how fast the ball leaves the clubface) did not increase.  Putting performance did not improve either.  One theory behind these results is that the mouthpiece improved stability, which coincides with contemporary thoughts on “packing the neck.”  Golfers will try anything to get better, so it will be interesting to see if mouthpiece use catches on, particularly with the recent success of mouthpiece endorser Hunter Mahan

Auditory and visual reaction time: both were found to improve with mouthpiece use in college aged males and females.  Theory behind the improvements was increased blood flow to the TMJ (Garner 2009) 

Conclusion

If mouthpieces are helping to improve breathing, stability, and stress, it begs the question whether we can improve our coaching to give athletes whatever they are purportedly gaining from the mouthpieces.  Stress reduction, stability, airflow, and reaction times are all traits that can be improved organically.  Surely we can learn something with further investigation into the mechanisms that produce favorable results with mouthpiece use.  Though more study is needed, the results do coincide with the theory behind the linkages between the head, neck, and rest of the body.  Maybe I'll have to conduct my own n=1 study...    

References

Duddy FA, Weissman J, Lee RA Sr, Paranjpe A, Johnson JD, Cohenca N.  Influence of different types of mouthguards on strength and performance of collegiate athletes: a controlled-randomized trial.  Dent Traumatol. 2012 Jan 25. doi: 10.1111/j.1600-9657.2011.01106.x. [Epub ahead of print]

Rapisura KP, Coburn JW, Brown LE, Kersey RD.  Physiological variables and mouthguard use in women during exercise.  J Strength Cond Res. 2010 May;24(5):1263-8.

Cetin C, Keçeci AD, Erdoğan A, Baydar ML.  Influence of custom-made mouth guards on strength, speed and anaerobic performance of taekwondo athletes.  Dent Traumatol. 2009 Jun;25(3):272-6.

Keçeci AD, Cetin C, Eroglu E, Baydar ML.  Do custom-made mouth guards have negative effects on aerobic performance capacity of athletes?  Dent Traumatol. 2005 Oct;21(5):276-80.

Garner DP, McDivitt E.  Effects of mouthpiece use on airway openings and lactate levels in healthy college males.  Compend Contin Educ Dent. 2009 Jul-Aug;30 Spec No 2:9-13.

Garner DP, Dudgeon WD, Scheett TP, McDivitt EJ.  The effects of mouthpiece use on gas exchange parameters during steady-state exercise in college-aged men and women.  J Am Dent Assoc. 2011 Sep;142(9):1041-7.

Garner DP, Dudgeon WD, McDivitt EJ.  The effects of mouthpiece use on cortisol levels during an intense bout of resistance exercise.  J Strength Cond Res. 2011 Oct;25(10):2866-71.

Pae A, Yoo RK, Noh K, Paek J, Kwon KR.  The effects of mouthguards on the athletic ability of professional golfers. Dent Traumatol. 2012 Mar 4. doi: 10.1111/j.1600-9657.2012.01123.x. [Epub ahead of print]

Garner DP, Miskimin J.  Effects of mouthpiece use on auditory and visual reaction time in college males and females.  Compend Contin Educ Dent. 2009 Jul-Aug;30 Spec No 2:14-7.

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