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Sunday Morning Quarterback

Sunday Morning Quarterback

Sunday, October 23, 2005

SUNDAY MORNING QUARTERBACK
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While pondering a lunch of some cost, or of Skittles and potato chips...

Another great weekend for the couch potato, though limited to about a half-dozen watchable games, was able to catch two overtimes sandwiching a down-to-the-last-play thriller, all between good teams playing for various stakes.

SMQ WATCHED: Caught bits and pieces of Ohio State-Indiana, Texas-Texas Tech and Northwestern-Michigan State, but not nearly enough to make any sort of judgement...

MICHIGAN 23, IOWA 20: Entirely wrong was SMQ about Iowa's Second Annual Resurgence (see below). If it were going anywhere, UI would have pulled that game out in overtime, done the "Just Win, Baby" thing it did the last two months of last year. It's not last year's team. It's not last year's Michigan team, either, especially without Mike Hart. But the Wolverines have now won two straight, finally, both with guts and testicles on the final play, and this one on the road to prove him wrong, so SMQ will lay off.
- SMQ must report turning on the television with intentions of enjoying this game and finding instead, on every channel, something called the "Sci-Fi Channel," which he vaguely remembers having heard of before. This show, featuring serious ac-TORS in a kind of haunted house (SMQ guesses) was, again, on every channel. While. Football. Is. Being. Played. Solution: after the failure of usual jiggle methods, call and wait for locally-based and alliteratively-titled cable company, then try another TV on another cable hook-up (this took some unhooking and lifting, as SMQ's home is not TV-saturated). This was successful, and the reader will be spared the remaining details of this anticlimactic weekend drama. Suffice to say, all is cool.

Halloween frights begin early at SMQ's

- Iowa's second touchdown drive was a beautiful, beautiful thing, which should become a how-to video on the short, move-the-chains passing game, AKA the dreaded "West Coast Offense." Drew Tate: 8-8, 82 yards, touchdown.
- A Steve Breaston appearance! The much-hyped speedster burned confident-looking Iowa for a 52-yard, go-ahead touchdown on a screen pass (SMQ repeats: nobody in college football runs the screen pass better, year-in and out than Michigan) in the fourth that forced the Hawkeyes into frantic comeback mode. What is Michigan's win-loss ratio when Breaston scores, or makes a big play (40+ yards)? 7-0? 8-0? Better?
- Chad Greenway and Abdul Hodge: Too close for comfort?
- The Hawkeyes' defensive line deficiencies were clear in the overtime, when those two badass linebackers couldn't cut through to save them on the goal line. Also: big-time clutch catch on third down in overtime by spinning Jason Avant. Henne was way off, and his senior friend bailed him out to set up the winning score. Things are looking up for Ann Arbor-based mega schools; see below.

ALABAMA 6, TENNESSEE 3: Entirely right was SMQ about the prodigious punting featured in this slugfest, which is much more the type of game he'd rather see than a score-a-minute PAC Ten game. The drama of a play like Cory Anderson's "Coach Called the Right Play and I'm Going to Score - oh shit" fumble, and the joy it created in that stadium (Brodie Quinn beamed like a ten-year-old on the sideline without the prospect of a comeback drive on his shoulders) could only happen in a game in which points are at a premium. One of the most electric games SMQ ever attended was a random 3-0 battle with little on the line between Southern Miss and UAB in 2001; M.M. Roberts Stadium has never been louder than on USM's blocked field goal following a third quarter goalline stand. Ditto Bryant-Denny yesterday, whose atmosphere beamed right off the TV, and made SMQ consciously recognize all the reasons - band blaring fight song, pom poms, amateurs succeeding and garnering possibly the greatest fame in their lives with feats long remembered by tens of thousands - college football is much better than the pro game, in which low-scoring games are routine and deathly dull. Defense=drama.
- Tennessee's defensive linemen are MEN. Wow, Parys Haralson is really muscular and good. The third-and-long pass rush the Vols consistently inflicted on Brodie reminded SMQ of Miami's unstoppable third-and-long defensive line in 2001 and '02.
- Then, of course, Croyle beats them after the fumble on a third-and-nine toss for 44 yards against man-to-man. Alabama may miss Prothro, but D.J. Hall was clutch here and is at least as an adequate go-to guy as anyone Auburn had on its run last year. This is the play, in combo with Roman Harper's hit to cause the fumble a minute earlier, that had "special team going far" written all over it, which all non-Top 10 teams making a title run need at some point in the season.
- Isn't Alabama a carbon copy of that Auburn team? Discuss.

LSU 20, AUBURN 17: Another fantastic game decided, alas, by chokery of fairly high order, given that the kick he doinked off the upright in overtime was previously competent (7-9 on field goals entering last night) John Vaughn's fifth gaffe on six tries in the game. SMQ also counted five easy dropped passes by the Tigers, led by Devin Aromashodu, who's dropped his share before. For LSU's part, the Tigers dropped two WIDE O P E N touchdown passes, which would have avoided overtime altogether or made the final Auburn kick untenable, respectively, and followed the first of those drops with a shank of a field goal that itself would have prevented the game from going to OT. And SMQ thoroughly enjoyed this game.
- "The Upright Game!" "The Upright Game!" Does Ron Franklin receive royalties each time this phrase is uttered? Why was he pushing that title so hard, so immediately?
- Kenny Irons' third quarter bust up the middle may have been the best run anybody's made yet this season - Irons was hit at the line, punished, carried and ripped through four very serious LSU tacklers, popped out of the pile, kept his balance and outran everybody for a 74-yard touchdown - and it didn't even make the WWL's center of athletics program. Irons called his own shot before the game, telling cameras he was going for 200, and delivered. This young gentleman has a lot of burst and steam behind him; he makes decisive cuts and gets up the field fast. Had he not been limited to one carry (for six yards) against Georgia Tech, when the team netted 50 yards rushing behind Great White Hope Tre' Smith and plodder Carl Stewart and left its first-time starting quarterback out to dry, last night would have been a Top 10 struggle.
- While SMQ is on Cox, he is dramatically improved since that opener. He did hit fewer than 50 percent of his passes (16 of 40) but there are the aforementioned drops to factor into that statistic, as well as the fact that he just looked more comfortable with the system, was not flustered by blitz after blitz, didn't put the ball into trouble (zero picks, down from four vs. Tech) and threw very decisively most of the night; he has very good play-action fake mechanincs, which Auburn uses on most pass plays - SMQ particularly likes Al Borges' dropback, play-action draw action, followed by a deep, sideline-to-sideline crossing route behind the biting linebackers, and loved, loved, loved the go-ahead fourth-down touchdown toss to huge Anthony Mix, created by God for exactly that situation, off the play-action in the fourth quarter, when many coaches would have tried some kind of predicatable flood pass or tricky screen/pick/crossing action into a zoned-out end zone - and knows where he wants to go when he comes out of the fake. Given that Cox was competent and big mistake-free, and the running game came through in spades, Auburn's loss in a defensive game is hard to understa...oh right, the blown punt coverage and five missed field goals. Right.
- So, did Auburn prove a point, even in a loss? Yes and no: still a competitive team worthy of playing deep into the fourth quarter with any team in the SEC, but without the edge that put them over the top against the best teams last year. LSU, for its part, needed that win badly, if only because of the psychological damage and fan-turning a second overtime home loss in the span of a month could have on the team. Why is SMQ still so unsure of Les Miles? Holly Rowe gave a sideline report late in the game last night that described Miles' frantic call for a timeout - a la the inexplicable "T" he tried to call after a late interception against Tennessee, and another failed out-to-the-numbers effort as Vaughn missed the final kick to win in regulation - which was instead granted to Tommy Tuberville, after which Miles, Rowe said, sighed a huge breath of relief. Which seems to be happening anytime something goes well for LSU in a tough game: frantic Miles sighs for relief. For a coach with the deepest team this side of L.A., he doesn't seem entirely in control the way Don Nicky was here. Maybe players are having a tough time respecting his immaculate, out-of-the-box-square cap.

WHAT WE LEARNED
Arizona State: Not so good, after all...Michigan State: Still schizo, after all...Iowa: Not storming the fort, after all...Texas Tech: Just as we suspected, after all...Auburn: Can still run the ball, after all, even if it can't kick it.

SMQ WAS RIGHT ABOUT...
"...these are teams coming from very different directions, and Northwestern's momentum after stunning Wisconsin keeps rolling over what already looked like a seriously mentally disturbed team the last two years before the catastrophic field goal folly against the Buckeyes...

"...don't forget who first jumped on the Big Purple Bandwagon that rides around every five years."

SMQ's placement of the Wildcats in the Top 25 was "lunacy" last week; this week, combined with his correct "upset" projection over the fast fading Spartans (though he did not foresee 49-14), it will be hailed for its brilliance and followed by all with sense.

Michigan State, meanwhile, obviously lost focus after blowing that field goal try in ridiculous fashion and nearly sending its coach to the hospital for blood pressure (or prison for murder in blind rage), and the last description that could ever apply to the Spartans the past three seasons is "mentally tough." Things had to go well early for them this week, and they didn't. Season virtually shot. Mentally tough teams don't make those mistakes in the first place; mentally weak, schizophrenic teams don't recover from them for weeks.

SMQ WAS WRONG ABOUT...
"...Iowa's following last season's come-from-nowhere script to T, only with a better running game, and might rise up and roll like a train through the Big Ten/Eleven the rest of the season. The beast is awakened, and tied for the league lead..."

SMQ repeats: this is not last year's Iowa team. The same chutzpah isn't there; Roth and Co. would have pulled Saturday's game out. Drew Tate appears to have recovered from his concussion problems, and the prospect of missing a bowl is unlikely, but any league title hopes Iowa had deluded itself - and SMQ - into believing are out the window.

PLAYERS OF THE WEEK
Brady Quinn and Maurice Stovall: Quinn - 32-41, 467 yards, six touchdowns; Stovall - 14 catches, 207 yards, four touchdowns. New school record-holders. So BYU isn't USC - that's a lot of really good guys now listed behind these two in next year's media guide.

Brad Smith: Wow - 480 yards, four touchdowns. Nebraska's not exactly Bayl...well, not exactly that bad. So that's why this guy was a Heisman candidate for a couple weeks last year. Is Missouri the favorite in the Big XII North? Jesus...

Brett Basanez: 24-30, 331 yards, four total touchdowns. If only SMQ could coax a similar performance from NCAA Football 2006 Brett (2-4, 1-2 in the Big Ten, 7 INTs in loss to Wisconsin...that's on Heisman, by the way, following Georgia Tech's too-easy national title on All-American, a season that featured all five Yellow Jacket offensive linemen garnering first-team All-America honors, even after test-cheating LT #72 was suspended for the last four games).

BEST IN A LOSS
Kenny Irons: 27 carries, 218 yards, one touchdown. SMQ's already lauded the USC (that's South Carolina) transfer's third-quarter run and his overall 200-yard show. Most importantly for Auburn, found their workhorse for the year, and next year, too.

WHAT? WHAT?!
Upset of the Week

SMQ gives the rare non-DI-A shout out to Ohio Northern, which vanquished the Mount Union Purple Raiders' 110-game regular season win streak. The Polar Bears' 21-14 win was the first for any team over the Division III power in a non-playoff game since 1994.

Also, Western Michigan over Bowling Green...45-14? What happened to OMG Omar?

JUST WHEN YA THINK YA KNOW A FELLA...
Time to Re-think...

Rick Clausen as a better option to Erik Ainge. Against the blitzing fools of LSU, this was the right move, because Ainge's read-and-react weakness against that style led LSU to keep playing it, which played right into fifth-year senior Clausen's limited hands. But as a full-time starter, Clausen has thrown one touchdown in three games. He may cut down the mistakes, but he cuts down the big plays, too. At this juncture in the season, with three losses already and four obvious wins no matter who the QB is and Notre Dame remaining, why not give the future - Ainge is still the future, right? - a chance to gain a little confidence heading into next season?

A FINE WHINE
SMQ Complaint of the Week

What is the deal with putting a wide receiver at quarterback in the shotgun? I mean, really. Ooh, this guy played quarterback in high school! If a guy with gloves is back there, think it may be a draw? Defenses are rarely baffled by this inevitable play following a switcheroo. Michigan did the right thing at the right time against Iowa by letting Antonio Bass throw a pass, which must have been a shock to the Hawkeyes, who left Jason Avant wide open around the five yard-line. Of course, Bass's throw made it obvious why he was moved to wide receiver in the first place.

SMQ FUTURE PROGRAMMING NOTE
Now that we're well into the season and teams have developed an identifiable, uh, identity, SMQ will begin running "team reports" on those he's gotten to scout in person or on television - taking previous performances into heavy account, of course.
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Permalink

9:02 AM

Comments:
How about...
"SMQ WAS WRONG ABOUT..."
The fact that UCLA would even need to consider making a 4th-quarter comeback against an overmatched Oregon State squad.

Anybody who has followed the Pac-10 closely this year should know that the Bruins weren't in any real danger against the Beavers because OSU has no run game - even last week's 194 yards by Yvenson Bernard are put into perspective when it's revealed he ran the ball 41 times... a 4.7 YPC is solid, but not so hot that it's deserving of 40+ carries, unless the other parts of the offense are misfiring badly.

True, UCLA's run defense makes any and all comers look like Heisman candidates, but there's a big difference between giving Bernard 160+ yards on 30 carries, and the absolute destruction wreaked by Cal and WSU.

The Bruins, whose pass defense is unspectacular but solid, don't face another good ground game until December 3rd. Barring an offensive meltdown, they should be safe until they roll up to USC and have to deal with Bush/White.

---UB
 
I'm not sure about this yet, but I think the Avant catch in overtime may actually have been brilliantly thrown by Henne, since it looked to me like an accurate, in-stride pass was interception all the way.

And the obvious running play with the WR in the shotgun has actually baffled a fair number of defense this year for Michigan... they've run it 5 or 6 times, usually to good effect. Have no idea why it's worked, but it has.
 
quick point: Avant's amazing catch in overtime was on 2nd down, not 3rd down.
 
www.mahercor.com



Peer reviewed American Academy of Orofacial Pain study



Abstract: The Use of a Custom Mandibular Athletic Mouthguard in the Prevention of Concussions in NFL Football Players

Jeffry R Shaefer DDS MS MPH



Objective: Observe the benefit of a mandibular appliance for the control of concussions among football players. Concussions in contact sports are an ongoing problem. In relation to football, Pellman, funded by the NFL, showed that oblique blows to the head causing head acceleration are the most dangerous, while quarterbacks, wide-receivers and linebackers are the type of players most at risk for concussions (1-3). Blows to the chin are dangerous as there is no protection from such a blow to prevent direct transmission of the force to the brain, while forces from other directions can be controlled by the player’s helmet and facemask (4). Various studies have examined the benefit of mouth guards to prevent force transmission through the mandible from blows under the chin (5-13). The consensus from these studies is that mouth guards are successful in protecting oral structures but that their benefit in controlling concussions is unclear. Methods: A case series report. Results: Maher reports excellent compliance, satisfaction, and control of concussions in a case series of 22 New England Patriot football players who used a concussion prevention mouth appliance he constructed (14). Eleven of the Patriots had a prior history of concussions and controlled their potentially career-ending concussions with Maher’s appliance. The use of Dr Mayer’s patented appliance has allowed the New England Patriots football team players to have the lowest number of concussions in the league (14). Conclusion: a retrospective analysis of NFL football players use of athletic mouth guards and the corresponding rate of orofacial injuries and concussions and a prospective study to measure the affect of this appliance on concussion rates in players with and without a prior history of concussion is warranted.









1. Pellman EJ: Background on the National Football League’s research on concussion in professional football. Neurosurgery 53: 797–798, 2003.



2. Pellman EJ, Viano DC, Tucker AM, Casson IR: Concussion in professional football: Location and direction of helmet impacts–Part 2. Neurosurgery 53: 1328–1341, 2003.



3. Pellman EJ, Viano DC, Tucker AM, Casson IR, Waeckerle JF: Concussion in professional football: Reconstruction of game impacts and injuries. Neurosurgery 53: 799–814, 2003.



4. Williams ED. Jaw joint disorders in contact sports athletes: diagnosis and prevention head and neck injuries in sports. In: Hoerner EF, ed. Jaw Joint Disorders in Contact Sports Athletes; Diagnosis and Prevention: Head and Neck Injuries in Sports. Philadelphia, Pa: ASTM STP 1229, American Society for Testing and Materials; 1994.


5. Chapman PJ. The bimaxillary mouthguard: increased protection against orofacial and head injury in sport. Aust J Sci Med Sport. 1985;17:25-28.
.
6. Hodgson VR. Standard Method of Impact Testing and Performance Requirements for Football Faceguards and Mouthguards Impact Test, 7 Load Ring Triaxial Accelerator Model May 13, 1993.


7. Barth JT, Freeman JR, Winters JE. Management of sport related concussions. Dent Clin North Am. 2000;44:67-83.



8. Barth JT, Freeman JR, Winters JE. Management of sport related concussions. Dent Clin North Am. 2000;44:67-83.


9. Proctor MR, Cantu RC. Head and neck injuries in young athletes. Clinics in Sports Medicine. 2000;19:693-715.
.
10. Torg JS, Truex R Jr, Quedenfeld TC, et al. The national football head and neck injury registry: report and conclusions, 1978. J Am Med Assoc. 1979;241:1477-1479.


11. Woodmansey KF. Athletic mouthguards prevent orofacial injuries: a review. Gen Dent. 1999;Jan-Feb:64-69.


12. Francis KT, Brasher J. Physiologic effects of wearing mouthguards. Br J Sports Med. 1991;25:227-231.



13. Tomotaka Takeda, Keiichi Ishigami, Sanae Hoshina, Toru Ogawa, Jun Handa, Kazunori Nakajima, Atsushi Shimada, Tsuneya Nakajima, Connell Wayne Regner Can mouthguards prevent mandibular bone fractures and concussions? A laboratory study with an artificial skull model Dental Traumatolog 21( 3 )Pg 134, June 2005



14. Maher: personnal communication; publication pending


Purpose:

To present to the Academy a case series of subjects using a single arch mandibular appliance to prevent concussion.



Background and discussion:



The claim that athletic mouthpieces worn during contact sports are helpful in the prevention of concussions is controversial. Two trials that have been commonly used to support this claim; Stenger’s study on Notre Dame footballers and Hickey’s cadaver study have methodological problems. In fact McCrory (Br J Sports Med 2001) states that only anecdotal evidence points to a dental appliance effect against concussion. He summarizes:

Although the use of correctly fitting mouthguards can reduce the rate of dental, orofacial, and mandibular injuries, the evidence that they reduce cerebral injuries is largely theoretical, and no clinical evidence for a beneficial effect in reducing concussion rates has yet been demonstrated clinically.

A recent study of the incidence of concussions in college basketball players showed no statistical difference (.35 vs .55 per 1000 exposures) between wearers and non mouthguard wearers (Labelle 2002). Wisniewski (Dent Trauma 2004) found no positive affect for a custom-made mouthguard compared to a “boil and bite” type appliance for the prevention of orofacial injuries or concussions in a study of Division I football players. Barbic observed the effect of the dual arch Brain-Pad appliance worn for one season by Canadian college athletes playing contact sports. Although the Brain-Pad is recommended by the American Boxing Association to prevent concussion, Barbic found it to provide no greater protection when compared to a non-custom mouthpiece in a randomized trail. These studies can explain why many experts in Sports Medicine discount the potential affect of blows to the jaw in the etiology of concussion.

In comparison, Benson’s investigation of hockey players wearing full vs half face shields points to a role of forces directed against the mandible as contributing to the incidence of concussions (1.71 vs 4.71 missed practices). He also found the increased potential for concussion in those players wearing half face shields could be reduced significantly if they wore a mouth guard (5.57 vs 2.71 missed practices). In a laboratory study using lateral blows to the jaw on a skull model, Takeda (Clin J Sports Med 2005) found that wearing a mouth guard decreased (P < 0.01) the distortion to the mandibular bone and the acceleration of the head significantly compared with not wearing a mouth guard (54.7%: to the mandible, 18.5%: to the head).

Gusenbauer proposes three explanations for a positive benefit for the prevention of concussions from the use of a dental appliance:

Dissipation of forces directed to the jaw
Stabilization of neck muscles when clenching on a mouthpiece so as to resist head acceleration
Distraction of the condyle from the glenoid fossa decreasing force transfer via the temporal bone




Conclusion: Concussions in contact sports are a great concern, especially among adolescents. Athletes whom have had a concussion are 4-6 times at greater risk for a second concussion. Powell and Barber-Foss report that 3.9-7.7% of high school and college athletes sustain a MTBI (minor traumatic brain injury) each year. Many of these athletes will continue to play despite these increased risks and feel protected by appliances such as the Maher mouthpiece (see Boston Globe story). The effectiveness of this appliance might or might not be substantiated by a randomized clinical trial to measure it’s affect but such data will allow athletes and parents to make informed decisions about the continued participation in a contact spot. Possibly the positive effect from a dental appliance is limited to a subset of athletes such as those with TMJ disk displacement, forward head posture, children under the age of 14, females, or athletes with a prior history of MTBI. Clearly further study with a randomized clinical trial to answer these questions is indicated.

Purpose:

To present to the Academy a case series of subjects using a single arch mandibular appliance to prevent concussion.



Background and discussion:



The claim that athletic mouthpieces worn during contact sports are helpful in the prevention of concussions is controversial. Two trials that have been commonly used to support this claim; Stenger’s study on Notre Dame footballers and Hickey’s cadaver study have methodological problems. In fact McCrory (Br J Sports Med 2001) states that only anecdotal evidence points to a dental appliance effect against concussion. He summarizes:

Although the use of correctly fitting mouthguards can reduce the rate of dental, orofacial, and mandibular injuries, the evidence that they reduce cerebral injuries is largely theoretical, and no clinical evidence for a beneficial effect in reducing concussion rates has yet been demonstrated clinically.

A recent study of the incidence of concussions in college basketball players showed no statistical difference (.35 vs .55 per 1000 exposures) between wearers and non mouthguard wearers (Labelle 2002). Wisniewski (Dent Trauma 2004) found no positive affect for a custom-made mouthguard compared to a “boil and bite” type appliance for the prevention of orofacial injuries or concussions in a study of Division I football players. Barbic observed the effect of the dual arch Brain-Pad appliance worn for one season by Canadian college athletes playing contact sports. Although the Brain-Pad is recommended by the American Boxing Association to prevent concussion, Barbic found it to provide no greater protection when compared to a non-custom mouthpiece in a randomized trail. These studies can explain why many experts in Sports Medicine discount the potential affect of blows to the jaw in the etiology of concussion.

In comparison, Benson’s investigation of hockey players wearing full vs half face shields points to a role of forces directed against the mandible as contributing to the incidence of concussions (1.71 vs 4.71 missed practices). He also found the increased potential for concussion in those players wearing half face shields could be reduced significantly if they wore a mouth guard (5.57 vs 2.71 missed practices). In a laboratory study using lateral blows to the jaw on a skull model, Takeda (Clin J Sports Med 2005) found that wearing a mouth guard decreased (P < 0.01) the distortion to the mandibular bone and the acceleration of the head significantly compared with not wearing a mouth guard (54.7%: to the mandible, 18.5%: to the head).

Gusenbauer proposes three explanations for a positive benefit for the prevention of concussions from the use of a dental appliance:

Dissipation of forces directed to the jaw
Stabilization of neck muscles when clenching on a mouthpiece so as to resist head acceleration
Distraction of the condyle from the glenoid fossa decreasing force transfer via the temporal bone




Conclusion: Concussions in contact sports are a great concern, especially among adolescents. Athletes whom have had a concussion are 4-6 times at greater risk for a second concussion. Powell and Barber-Foss report that 3.9-7.7% of high school and college athletes sustain a MTBI (minor traumatic brain injury) each year. Many of these athletes will continue to play despite these increased risks and feel protected by appliances such as the Maher mouthpiece (see Boston Globe story). The effectiveness of this appliance might or might not be substantiated by a randomized clinical trial to measure it’s affect but such data will allow athletes and parents to make informed decisions about the continued participation in a contact spot. Possibly the positive effect from a dental appliance is limited to a subset of athletes such as those with TMJ disk displacement, forward head posture, children under the age of 14, females, or athletes with a prior history of MTBI. Clearly further study with a randomized clinical trial to answer these questions is indicated.

Purpose:

To present to the Academy a case series of subjects using a single arch mandibular appliance to prevent concussion.



Background and discussion:



The claim that athletic mouthpieces worn during contact sports are helpful in the prevention of concussions is controversial. Two trials that have been commonly used to support this claim; Stenger’s study on Notre Dame footballers and Hickey’s cadaver study have methodological problems. In fact McCrory (Br J Sports Med 2001) states that only anecdotal evidence points to a dental appliance effect against concussion. He summarizes:

Although the use of correctly fitting mouthguards can reduce the rate of dental, orofacial, and mandibular injuries, the evidence that they reduce cerebral injuries is largely theoretical, and no clinical evidence for a beneficial effect in reducing concussion rates has yet been demonstrated clinically.

A recent study of the incidence of concussions in college basketball players showed no statistical difference (.35 vs .55 per 1000 exposures) between wearers and non mouthguard wearers (Labelle 2002). Wisniewski (Dent Trauma 2004) found no positive affect for a custom-made mouthguard compared to a “boil and bite” type appliance for the prevention of orofacial injuries or concussions in a study of Division I football players. Barbic observed the effect of the dual arch Brain-Pad appliance worn for one season by Canadian college athletes playing contact sports. Although the Brain-Pad is recommended by the American Boxing Association to prevent concussion, Barbic found it to provide no greater protection when compared to a non-custom mouthpiece in a randomized trail. These studies can explain why many experts in Sports Medicine discount the potential affect of blows to the jaw in the etiology of concussion.

In comparison, Benson’s investigation of hockey players wearing full vs half face shields points to a role of forces directed against the mandible as contributing to the incidence of concussions (1.71 vs 4.71 missed practices). He also found the increased potential for concussion in those players wearing half face shields could be reduced significantly if they wore a mouth guard (5.57 vs 2.71 missed practices). In a laboratory study using lateral blows to the jaw on a skull model, Takeda (Clin J Sports Med 2005) found that wearing a mouth guard decreased (P < 0.01) the distortion to the mandibular bone and the acceleration of the head significantly compared with not wearing a mouth guard (54.7%: to the mandible, 18.5%: to the head).

Gusenbauer proposes three explanations for a positive benefit for the prevention of concussions from the use of a dental appliance:

Dissipation of forces directed to the jaw
Stabilization of neck muscles when clenching on a mouthpiece so as to resist head acceleration
Distraction of the condyle from the glenoid fossa decreasing force transfer via the temporal bone




Conclusion: Concussions in contact sports are a great concern, especially among adolescents. Athletes whom have had a concussion are 4-6 times at greater risk for a second concussion. Powell and Barber-Foss report that 3.9-7.7% of high school and college athletes sustain a MTBI (minor traumatic brain injury) each year. Many of these athletes will continue to play despite these increased risks and feel protected by appliances such as the Maher mouthpiece (see Boston Globe story). The effectiveness of this appliance might or might not be substantiated by a randomized clinical trial to measure it’s affect but such data will allow athletes and parents to make informed decisions about the continued participation in a contact spot. Possibly the positive effect from a dental appliance is limited to a subset of athletes such as those with TMJ disk displacement, forward head posture, children under the age of 14, females, or athletes with a prior history of MTBI. Clearly further study with a randomized clinical trial to answer these questions is indicated.

With mouthpiece, dentist tackles concussions

NFL says more evidence needed

By Keith Reed, Globe Staff | March 30, 2006

If New England Patriots wide receiver Deion Branch never has another
concussion, he can thank former boxing champ ''Marvelous" Marvin Hagler and Gerald Maher, his Weymouth dentist.
In 1980, the Brockton-bred pugilist called Maher, a specialist in jaw
structure and facial pain, to ask why his crushing punches floored some
opponents, while others walked away from them.
Maher's answer was that the alignment of the jaw made some people
susceptible to concussions -- catch somebody with his mouth in the wrong position, and it's lights out. He created a mouthpiece that kept Hagler's jaw in the right spot, preventing Hagler -- and many other professional athletes since then -- from suffering the injury, which results from a violent jarring of the head that renders the victim unconscious and in some cases induces vomiting or permanent
memory loss.

Now Maher, who has filed for a patent, is pushing the National Football
League, which doesn't require its players to wear mouthpieces, to study
whether his device or others like it could protect athletes from concussions that might end their careers -- or worse.

''For safety reasons, I think it would help every player, and I'm interested in the safety of every player in the NFL," Maher said.

He has fitted about two-thirds of the Patriots for the devices, and
hand-delivered a mouthpiece to former Patriots nose tackle Ted Washington in Houston on the day of the 2004 Super Bowl.
None of the players Maher has outfitted have suffered concussions using the equipment, he said. The Patriots reported no concussions last season.

That's not enough to convince league officials to change their policy,
though.

Elliot Pellman, football's medical liaison and chairman of its concussion committee, said a few athletes' success stories can't supplant the hard medical research the league requires before it endorses a piece of equipment. Maher is not the first dentist to claim that a mouthpiece prevents concussions, but none has offered scientific evidence to back it up, he said.

Morever, other devices have had unintended consequences for players who wore them for safety. Pellman recalled that in the 1990s, players began wearing ProCaps, an apparatus that slipped over their helmets and was supposed to prevent concussions. The league responded to the product's growing popularity among players and tested ProCaps. It found no evidence that ProCaps reduced concussions, but did find an increased risk of neck injury.The league recommended that players cease using them.

''The New England Patriots might be wearing this mouthpiece, but can anyone guarantee me that there may not be an incidental component that occurs that is not desirable?" Pellman said.
A Patriots spokesman declined to comment.

But scores of athletes, from high school footballers to professional
basketball stars, have pushed Maher's device between their teeth, convinced it will help protect them.
Maher said he has applied for a $125,000 grant from the NFL to fit a team other than the Patriots -- perhaps a college football squad -- with his mouthpieces so their effectiveness can be objectively studied. Pellman said he's unaware of the status of that application, but that the league, along with Wayne State University, is building a sophisticated model to study the effectiveness of several mouthpieces, including Maher's, in preventing concussions.


If the NFL wants more evidence, Duxbury High School's football coach might be worth calling. Eleven of the team's players had previously suffered concussions, some three or four times. After hearing about Maher's mouthpieces, the coach, Dave Maimaron, asked the dentist to fit the players who had suffered concussions. There were no concussions last season, and Duxbury went undefeated, taking a state championship.

''I almost feel like we had an advantage this season," Maimaron said.
''Everybody should be wearing this thing. I'd be very surprised if that
doesn't happen."

Concussions are common in volatile sports like boxing, whose very object is to hit your opponent harder than your opponent hits you, and football, where 200- to 300-pound men collide and send each other into the ground over and over.

Maher's mouthpieces are designed on the principle that keeping an athlete's jawbone and temporal mandibular joint properly aligned absorbs the force of blows that would otherwise literally rattle their skulls and cause a concussion. The most susceptible position, he argues, is when the mouth is tightly closed. Then, the force of a blow can travel unobstructed up the jawbone and into the skull. Helmets protect against concussions and other injuries caused by blows to the crown of the head, but their chin straps keep players' jaws in precisely the position that Maher argues puts them at risk.

His mouthpieces separate the jawbone from the joint slightly, helping to absorb the blows. They also fit tightly over the bottom row of teeth, letting football players talk to each other. Besides Branch, Patriots Asante Samuel, Vince Wolfolk and Daniel Graham wear the mouthpieces.

Maher said he doesn't think he can eradicate concussions, but he thinks many are preventable.

''You would never say to an athlete that they're not going to get a
concussion," he said. ''But I want to put them in the best position to try and prevent that."

Keith Reed can be reached at reed@globe.com.
© Copyright 2006 Globe Newspaper Company.
 
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