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When I was in dental school, one of my instructors — Harold Gelb — tried to explain complex occlusal and TMJ concepts to students who had just learned the definition of mesial. It opened our eyes to appliance therapy and a variety of benefits of this treatment.
Around the same time in Minnesota, Dr. Paul Belvedere was looking at some of these devices, due to a problem with his dentition. One of his designs was a “reverse wedge,” which increased the interocclusal distance in the molar area and decreased it in the premolar area. This brings the head of the condyle slightly out of the fossa. His observations went beyond pain relief and led him to speculate and research the information that will be discussed in this column.
There has been much press lately on the use of dental appliances to increase physical performance, notably from some high-profile athletes who tout their benefits. There are a few schools of thought in our profession that debate not only which system is best, but if they work at all.
The most visible “system” is the Performance Mouthwear (formerly The Edge) appliance from BiteTech, a dental firm that is under the umbrella of the sports company, Under Armour. Patterson Dental is involved in the marketing of this product. The other product is from Dr. Anil Makkar. From his research, he has created the Pure Power Mouthguard, which is based on more complex neuromuscular measurements.
The Performance Mouthwear design puts a patented wedge between the teeth, and positions the jaw so it inhibits teeth from clenching. This decreases the effect that triggers the body’s stress mechanism and increases cortisol production. Dr. Bill Balanoff states that the cortisol initially induces increased epinephrine, reaction time, heart rates and blood flow to the muscles. Continued production, though, can be detrimental. There is also a release of glucose. These are well-known reactions to stress in the “fight-or-flight” response.
Dr. Balanoff also states: “A link between cortisol and lactic acid has been described. Because the appliance had some effect on cortisol levels, researchers studied the relationship of the Power Mouthguard and lactic acid levels during exercise. Significant reductions in lactic acid were found in those wearing the appliance, thus increasing duration of muscle activity.”
The shape of this wedge not only decreases the pressure on the TMJ, but it seems to increase the opening to the airways. This increases oxygen flow.
According to Dr. Heidi Aaronson, who works with Boston-area professional sports teams as the Dental Director for Professional Athlete Relations for Bite Tech, athletes have experienced increased endurance, more strength, and post-whiplash relief by using the appliance.
Dr. Makkar’s research is based on the neuromuscular precepts of occlusion, such as those taught at the Las Vegas Institute. Using myomonitors and other measurements, the jaws are placed in an ideal position. This may have a “trickle down” effect on the body’s entire postural position. This, according to Makkar, has resulted in improved athletic performance. Once “certified,” a dentist has a few options on the type and complexity of mouthguard being fabricated at a variety of prices for patients.
There is also a parallel body of research supporting mouthguards in the prevention of concussions while protecting the dentition. This is documented in the use of products such as those designed by Dr. Gerald Maher (mahercorlabs.com) and BrainPad (brainpads.com).
In addition to dental office-designed guards, pure economics has popularized basic inexpensive protection from Shock Doctor (shockdoctor.com). One common denominator pointed out by Dr. Ray Padilla, an authority on mouth protection, is the necessity for the appliance to fit well. All are in agreement that a loose-fitting appliance can be worse than not wearing one at all.
This has certainly opened up many debates in the dental occlusion community, as well as with “sports dentists” and mouthguard experts. There was an animated forum on this at the 2010 Yankee Dental Congress. Many of the initial claims have been looked at as anecdotal. Companies are continuing to submit clinical studies to the profession and add to this body of work. These studies are being reported at www.bitetech.com and www.makkaradvantage.com. I intend to research this topic more and hope to report on my findings later this year. I hope to get fitted with both appliances and see if my typing speed increases!
Dr. Paul Feuerstein installed one of dentistry’s first computers in 1978. For more than 20 years, he has taught technology courses. He was named “Clinician of the Year” at the 2010 Yankee Dental Congress. A general practitioner in North Billerica, Mass., since 1973, Dr. Feuerstein maintains a Web site (www.computersindentistry.com) and can be reached by e-mail at [email protected].