The effects of mouthpiece use on cortisol levels during an intense bout of resistance exercise

The effects of jaw clenching and mouthpiece use on bat swing velocity in Division II athletes

Research assessing the effects of mouthpieces on an individual's aerobic, anaerobic, or muscular performance have attributed cited improvements to the participant's ability to jaw clench. Jaw clenching research finds positive outcomes with the task of jaw clenching with targeted muscle groups in a controlled laboratory setting. Thus, the study's goal was to determine if the addition of a mouthpiece would positively affect performance outcomes in a field-based whole-body muscle movement. Fourteen participants (8=F and 6=M) NCAA softball and baseball athletes completed 5 maximal bat swings with and without a mouthpiece in 4 conditions: no jaw clenching (NC), mouthpiece and jaw clenching (MP+C), mouthpiece only (MP), and jaw clenching only (C). Significant differences occurred in conditions, with the highest velocity noted in the combined condition of MP+C (71.9 mph) as compared to NC (67.9 mph), MP (68.6 mph), and C (70.9 mph). A repeated measures ANOVA demonstrated significant differences with bat swing velocity (F = 13.19, df 3, p < 0.0001). Pairwise comparisons revealed significant differences in MP+C with MP (p = 0.007); MP+C with NC (p = 0.001), and C with NC (p = 0.009). The results of this study provide evidence of jaw clenching's positive effects on the dynamic, whole-body explosive activity of a bat swing.

Sports mouthguard overview: Materials, fabrication techniques, existing standards, and future research needs

Sports mouthguards are proven devices that reduce both the probability of and damage to orofacial tissues. While commonly used, clinicians may be unaware of the different sports mouthguard materials, proposed fabrication techniques, design recommendations, and newer digital fabrication methods. An overview of existing sports mouthguard standards is presented. It identifies that identify that the present requirements, while historically chosen in good faith, appear to be arbitrarily selected and not from clinical evidence-based derived data. In addition, identified sports mouthguard heterogeneous testing and data acquisition methods distinguishes that little possibility is afforded for the correlation of results. Furthermore, updated evidence with concussion prevention and/or alleviation is presented with evidence provided by sports mouthguard imbedded technology. The need for continued research is stressed to provide evidence-based data for concussion alleviation/prevention, digital fabrication methods and materials, and clinically based information for the revision of existing standards.

A randomized crossover study on the effects of a custom-made mouthguard on cardiopulmonary parameters and cortisol differences in a validated handball specific course

BACKGROUND

The importance of mouthguards for handball players has been proven however, most players are reluctant to use it. The impact on physical capacity is assessed heterogeneously in the literature. This study aimed to investigate the influence of custom-made mouthguards (CMGs) under handball specific stress.

METHODS

This randomized crossover study used data from 15 youth professional handball players (age 17.0 ±0.5 years, weight 85.1±8.0 kg and height 191.2±6.9 cm) who performed a validated handball specific course and a lung function test. Pulmonary (spirometry), metabolic (blood lactate), and cortisol parameters were observed using a normal custom-made mouthguard without (nCMG) and with respiratory channels (CMGvent) in comparison to no mouthguard (Co).

RESULTS

In resting spirometry, no differences in the parameter peak flow were observed using the CMGvent (9.57±1.59 l·s-1) and nCMG (9.17±1.03 l·s-1) in comparison to the Co (9.38±1.26 l·s-1). Under maximum stress, there were no differences in ventilation using CMGvent (151.2±15.64 L ·min-1), nCMG (148.6±12.51 l·min-1), and without mouthguard (145.8±14.32 l·min-1). Similar oxygen uptake was observed when using a CMGvent (45.51±4.14 L ·min-1·kg-1), nCMG (45.50±5.06 ml·min-1 ·kg-1), and without CMG (Co 43.90±4.02 mL ·min-1). The parameters of HR (CMGvent 185.2±11.63 bpm vs. Co 179.4±13.24 bpm p=0.46, nCMG 178.2±11.54 bpm vs. Co p=0.97; CMGvent vs. nCMG p=0.08) and in the blood lactate values (CMGvent: 9.66±2.3 mmol·l-1 vs. Co 9.07±2.1 mmol·l-1 p=0.63; nCMG 9.39±2.8 mmol·l-1 vs. Co p=0.87; CMGvent vs. nCMG p=0.91) displayed no differences. The cortisol production under stress showed no differences in the performance with the CMGvent (1.78±3.58 ng/ml), nCMG (0.74±4.52 ng/mL), and in the procedure without mouthguard (0.25. ±5.01 ng/ml).

CONCLUSION

The results showed that under stress, there were no differences in the cortisol, ventilation, cardiac, and metabolic responses for all three conditions. Finally, the study shows that the use of a custom-made mouthguard does not negatively affect handball specific performance. Due to the preventive aspect of the mouthguard, the use of a custom-made mouthguard in handball is strongly recommended.

Effects of Wearing a Jaw-repositioning Intra-oral Device in Synchronized Swimming Athletes

The effects of wearing an intra-oral device on several ventilatory and fatigue markers have been reported for a variety of sports. The quality of the figures performed in synchronized swimming is directly affected by fatigue, and can be monitored during training sessions (TS). The aim of the study was to investigate the acute effects of wearing customized intra-oral devices on heart rate variability, rating of perceived exertion, blood lactate accumulation, and salivary cortisol production during a competitive training session. Twelve highly trained elite female athletes (age: 21.0±3.6 years) participated in the study. Fatigue markers were assessed at the beginning and at the end of the 3^rd and 5^th afternoon TS for that week, once with and once without an intra-oral device, in random order. Salivary cortisol levels were higher in relation to the baseline in the intra-oral device condition (P<0.05) but not in athletes without an intra-oral device. No differences between conditions were found in rating of perceived exertion (P=0.465) and blood lactate (P=0.711). No time or condition interactions or main effects were shown for heart rate variability. Thus, there is no evidence that wearing a low-arch intra-oral device is a good recommendation for high-standard athletes performing long and stressful routines.

Respiratory outcomes with the use of a lower custom fit genioglossal-effecting oral appliance

OBJECTIVE

Sleep apnea research cites that an oral appliance, which places the mandible in a more forward position and the genioglossus (tongue muscle) on the floor of the mouth, improves aspects of the pharyngeal opening. Exercise science research has cited improvements in airway dynamics and physiological variables with oral appliance use during exercise. Thus, the purpose of this study was to design an oral appliance that would act on the genioglossus and determine if there were effects on respiratory parameters while exercising.

MATERIALS AND METHODS

Seventeen healthy subjects ages 18-43 participated in this study. Prior to the exercise protocol, the order of the oral applicance (OA) or no oral appliance (no OA) condition was randomly assigned to subjects, with subjects completing both conditions. Respiratory parameters (respiratory rate, ventilation, oxygen, and carbon dioxide) were measured between conditions while subjects ran for 10 min at steady state.

RESULTS

The results demonstrated that both respiratory rate (25.97 BPM, OA and 28.35 BPM, no OA) and ventilation (47.66 l/min, OA and 50.34 l/min, No OA) were significantly lowered (p < .01) in the OA condition. There were no differences in carbon dioxide (1.89 l/min, no OA and 1.88 l/min, OA) or oxygen outcomes (2.17 l/min, no OA and 2.17 l/min OA).

DISCUSSION

The outcomes from this study suggest that the design of the oral appliance elicits an effect on the genioglossus, thereby resulting in lowered respiratory rate and ventilation with no negative effects on oxygen uptake during exercise.

Development and Implementation of an Intraoral Device for Occlusal Stability during Sports Performance: A Case Report

INTRODUCTION

Sports dentistry assumes a clinical relevance, not only in the prevention of orofacial trauma by the use of mouthguards, but also with the development of intraoral devices that aim to provide greater occlusal stability, as well as a greater balance in the level of certain structures of the cranio-cervical-mandibular complex. In this way, the dentistry can have an intervention action on sports performance.

OBJECTIVES

The objective of this research was to verify the existence of a correlation between occlusal stability and an eventual balance of some facial structures during sports performance using a specially developed Occlusal Stability Sports Performance Device.

METHODOLOGY

An individualized mandibular intraoral device was manufactured and evaluated on an athlete canoeing. Infrared thermography was the complementary diagnostic method used for this purpose.

RESULTS

Greater symmetry of certain regions of interest of the cranio-cervico-mandibular complex was observed with the implementation of the Occlusal Stability Sports Performance Device. These areas were the anterior temporal muscle, the masseter muscle and the temporomandibular joint. No asymmetry decrease was found in the anterior triangle region of the neck.

CONCLUSION

The use of this type of intraoral devices may allow greater occlusal stability and consequent balance of anatomical structures constituting the cranio-cervical-mandibular complex. Infrared thermography is an effective diagnostic tool for studying the results of the intraoral device on the cranio-cervico-mandibular complex use during canoeing.

Effect of mouthguard design on retention and potential issues arising with usability in sport

BACKGROUND/AIMS

Mouthguard retention could potentially increase an athlete's motivation to wear the device, due to potential improvements in physical comfort. The aim of this study was to examine the retentive properties of selected customised mouthguard designs, during normal conditions (dry) and within the presence of artificial saliva (wet). Additionally, the correlation between thickness and retention was investigated.

MATERIAL AND METHODS

Six different custom mouthguard designs (MG1-MG6) reported in previous studies, were pressure-formed with 2 and 4 mm blanks accordingly. Thickness was measured 10 times at seven anatomical points and the mean (±SD) was recorded. A novel rig was fabricated to connect the mouthguards to a Hounsfield H10KS Tensometer, which was used to fully displace each device from the model at a constant rate of 50 mm/min. The test was repeated under both dry and wet conditions.

RESULTS

Retention forces recorded at the anterior region demonstrated higher measurements under wet conditions than dry (P < 0.001). The total retention of the mouthguards was influenced by alterations in their design. Trend analysis indicated that 64% of MG retention could be explained by their thickness under dry conditions and 55% when wet.

CONCLUSIONS

Design and thickness of mouthguards are key factors in retention. Mouthguard fabrication techniques should be considered in order to minimize dislodgment of the devices as well as potentially increasing the wearability of mouthguards during sport.

Do Neuromuscular Dentistry-Designed Mouthguards Enhance Dynamic Movement Ability in Competitive Athletes?

The purpose of this study was to examine the effect of a neuromuscular dentistry-designed mouthguard (NMDD) on dynamic movement ability. Forty-two competitive athletes (8 women, 21.9 ± 2.9 years, 66.8 ± 18.8 kg, 1.68 ± 0.11 m; 34 men, 22.8 ± 4.8 years, 77.4 ± 12.7 kg, 1.78 ± 0.08 m) with greater than 2 years' experience in their designated sport were enrolled in the study. Participants completed the Functional Movement Screen (FMS), modified Star Excursion Balance Test (mSEBT), and a single-leg landing (SLL) task. Each subject was tested with 3 separate mouthguard conditions in random order: (a) no mouthguard (NO), (b) over-the-counter boil-and-bite mouthguard (BB; Shockdoctor Gravity, (c) and an NMDD (Pure Power Elite). Data were analyzed using a repeated-measures analysis of variance for each variable. There were no differences between mouthguard conditions in each of the 7 individual components or composite FMS score (p > 0.05). No differences were seen in the anterior, posteromedial, or posterolateral movements of the mSEBT; overall composite score; or time-to-contact measurements (p > 0.05). The BB condition (2.16 Nm·kg) exhibited higher peak knee valgus moments (pKVM) on the right leg only when compared with the NMDD condition (1.95 Nm·kg; p = 0.003) but not the NO condition (2.09 Nm·kg; p = 0.7262) during the SLL task. No differences in pKVM were seen on the left leg (p = 0.324). In conclusion, an NMDD was not effective at enhancing or diminishing measures of dynamic movement ability compared with BB or NO conditions.

Effects of a Custom Bite-Aligning Mouthguard on Performance in College Football Players

Besides injury prevention, mouthguards can also be employed to improve physical performance. The effects of personalization of mouthguards have rarely been investigated. This 3-armed, randomized, controlled crossover trial investigated the difference of wearing (a) personalized or custom-made (CM, e.g., bite-aligned), (b) standard (BB, boil and bite), and (c) no (CON) mouthguards on general fitness parameters in experienced collegiate football players. A group of 10 upperclassmen (age, 19-22 years; mean ± SD: age = 20.7 ± 0.8 years; body mass = 83 ± 7.4 kg; height = 179.1 ± 5.2 cm; body mass index = 25.9 ± 2.2 kg·cm), National Collegiate Athletic Association Division II football players with at least 2 years of playing experience, were randomly assigned to the 3 mouthguard conditions: a randomized, within-subjects repeated-measures design was applied. All participants were randomly tested on strength and endurance performance V[Combining Dot Above]O2max testing, with Bruce treadmill protocol including (a) time to fatigue, (b) blood lactate concentration in millimoles per liter at stage 2 and (c) at peak fatigue, (d) flexibility, (e) reaction time, (f) squat vertical jump, (g) countermovement vertical jump, and (h) 1 repetition maximum bench press. Repeated-measures analysis of variance showed no significant differences between the 3 conditions for each outcome variable (0.23 < p < 0.94; 0.007 < (Equation is included in full-text article.)< 0.15). These data indicate that CM mouthguards did not superiorly affect general fitness parameters compared with BB and CON. In turn, protective BB or CM mouthpieces did not appear to impair general fitness performance vs. CON. The recommendation of a custom bite-aligning mouthguards for performance enhancement in young Division II football players is questioned. Further studies with larger sample sizes, gender comparison, and (sport) discipline-specific performance testing are needed.

National Athletic Trainers' Association Position Statement: Preventing and Managing Sport-Related Dental and Oral Injuries

OBJECTIVE

To provide athletic trainers, health care professionals, and all those responsible for the care of athletes with clinical recommendations for preventing and managing sport-related dental and oral injuries.

BACKGROUND

Participation in competitive sports continues to grow at both the interscholastic and intercollegiate levels. Therefore, exposure to, and the incidence of athletic-related injury, including orofacial injury, will also likely increase. At the time of this writing, the leading governing agencies for interscholastic (National Federation of State High School Associations) and intercollegiate (National Collegiate Athletic Association) sports require only protective orofacial equipment (eg, mouthguards) for 5 and 4, respectively, of their sanctioned sports. Although orofacial injuries represent a small percentage of all sport-related injuries, the financial burden associated with these injuries (eg, tooth avulsion) can exceed $15 000 over an adult life. Therefore, effective management of sport-related dental injuries is critical to the long-term financial, physical, and emotional health of people who have experienced dental trauma.

RECOMMENDATIONS

Based upon the current evidence regarding sport-related orofacial injury, we provide recommendations related to planning considerations, education, and mouthguard efficacy, material, fabrication, and care considerations. Additionally, suggested best practices for managing sport-related dental injury are also given for athletic trainers and other health care professionals.

Acute effects of jaw clenching using a customized mouthguard on anaerobic ability and ventilatory flows

The latest findings on the ergogenic effects of a dentistry-design, bite-aligning mouthpiece require additional research to assess its impact on anaerobic ability and ventilatory parameters. This paper was aimed at determining the ergogenic acute effects of wearing a custom-made mouthpiece on oral airflow dynamics, 30-s Wingate Anaerobic Test performance parameters. Twenty-eight healthy and physically-active male subjects (age: 24.50 ± 3.32, height: 181.34 ± 7.4, weight: 78.14 ± 8.21), were voluntarily studied. The subjects were first briefed on the test protocols, and then performed the 30s Wingate test and Spirometer test. The experimental trials were performed in a random counterbalanced order. We evaluate maximum expiratory volume (VEmax L min(-1)), mean power (W kg(-1)), peak power (W kg(-1)), time to peak (s), rate to fatigue (Ws(-1)) and lactate production (mMol L(-1)), rate of perceived exertion (RPE). There were significant differences between mouthguard and no-mouthguard conditions in mean power (W kg(-1)), peak power (W kg(-1)), time to peak (s), and rate to fatigue (Ws(-1)) for the 30-s Wingate Anaerobic Test. Significantly lower lactate production (mMol L(-1)) was observed, in mouthguard condition but no significant differences were found in RPE. In airflow dynamics, the VEmax L min(-1) was significantly higher when comparing the mouthguard and the no mouthguard conditions in both forced and unforced conditions. In conclusion, wearing a customized mouthguard improves anaerobic ability and increases forced expiratory volume. This study will help practitioners improve athlete's performance in anaerobic activities where high intensity action might provoke jaw-clenching, contributing in reductions of lactate and fatigue, and improving ventilatory parameters.

The acute effect of a commercial bite-aligning mouthpiece on strength and power in recreationally trained men

Because of the relative newness of mouthpieces, there are few investigations into using performance mouthpieces during sport and physical activity to substantiate claims of performance enhancement. The purpose of this study was to investigate the acute effect of a commercially available, noninjury preventive, performance mouthpiece on practical acute performance measures of power and strength. A within-subjects design was used to evaluate 21 (N = 21) recreationally trained college aged males on the performance of a maximum countermovement vertical jump (CMVJ) from a force platform and 1 repetition maximum (1RM) bench press exercise for the following conditions: with mouthpiece (MP) and without mouthpiece (noMP). Rate of force development (RFD) and peak vertical force (PF) were derived from force platform data. Statistical analysis revealed no significant differences between conditions for CMVJ height (p = 0.13), RFD at 200 ms (p = 0.09), PF (p = 0.08), and 1RM bench press (p = 0.45). These data indicate that the use of this particular jaw aligning mouthpiece specifically in an attempt to produce an ergogenic effect on performance is unwarranted.

The effects of a customized over-the-counter mouth guard on neuromuscular force and power production in trained men and women

Although mouth guards were originally designed for injury prevention, even elite athletes are now using performance mouth guards to improve athletic success. Both expensive custom models and over-the-counter models are available, but the efficacy is not well known. Some athletes remain wary of the perceived potential for detriments using a mouth guard to their performance. Thus, the purpose of this study was to examine various physical performance tests when using a mouth guard including a customized over-the-counter mouth guard. Twenty-six trained men (25 ± 4 years; 1.78 ± 0.07 m; 83.3 ± 11.4 kg) and 24 trained women (23 ± 3 years; 1.65 ± 0.08 m; 62.6 ± 7.8 kg) volunteered for the investigation. The subjects completed a familiarization period and then balanced and randomized treatment conditions that included: (a) a customized Power Balance performance mouth guard (PB MG); (b) a regular over the counter boil-and-bite mouth guard (Reg MG); and (c) a no mouth guard (No MG) treatment condition. At each visit, the subjects completed a testing protocol that was sequenced in the following order: sit-and-reach flexibility, medial-lateral balance, visual reaction time, vertical jump, 10-m sprint, bench throw, and plyo press power quotient (3PQ). Heart rate and rating of perceived exertion (RPE) were recorded around the 3PQ. Significance was set at p ≤ 0.05. Expected significant sex differences existed for all power, strength, and speed variables. Bench throw power (watts) and force (newtons) were significantly higher under PB MG than either Reg MG or No MG or in both men and women. The 3PQ power and force production were higher than that for the other 2 treatments for the PB MG for men only. There were no significant differences for treatment conditions in the heart rate or RPE after the 3PQ test. Men were better able to maintain significantly higher 3PQ power production under PB MG treatment condition compared with the other 2 treatment conditions. Rate of power development was significantly higher in men for the vertical jump when using the PB MG compared with that for other treatment conditions in men only. No differences were observed in flexibility, balance, visual reaction time, or sprint time. The PB MG performance mouth guard improves performance of upper-body loaded power exercises in both men and women and lower body power exercise in men without compromising performance on any other performance parameters.

The effects of mouthpiece use on gas exchange parameters during steady-state exercise in college-aged men and women

BACKGROUND

The authors conducted a study to assess the effects of custom-fitted mouthpieces on gas exchange parameters, including volume of oxygen consumption over time [corrected] (VO(2)), volume of oxygen consumption over time per kilogram of body weight [corrected] (VO(2) /kg) and volume of carbon dioxide production over time [corrected] (VO(2)).

METHODS

Sixteen physically fit college students aged 18 through 21 years performed two 10-minute treadmill runs (6.5 miles per hour, 0 percent grade) for each of three treatment conditions (mouthpiece, no mouthpiece and nose breathing). The authors assigned the conditions randomly for each participant and for each session. They assessed gas exchange parameters by using a metabolic measurement system.

RESULTS

The authors used analysis of variance to compare all variables. They set the significance level at α = .05 and used a Tukey post hoc analysis of treatment means to identify differences between groups. The results showed significant improvements (P < .05) in VO(2,) VO(2) /kg and VCO(2) in the mouthpiece condition.

CONCLUSIONS

The study findings show that use of a custom-fitted mouthpiece resulted in improved specific gas exchange parameters. The authors are pursuing further studies to explain the mechanisms involved in the improved endurance performance exhibited with mouthpiece use.

CLINICAL IMPLICATIONS

Dental care professionals have an obligation to understand the increasing research evidence in support of mouthpiece use during exercise and athletic activity and to educate their patients.