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Interview with Dr. Paul Belvedere on performance mouthpieces

April 1, 2010
Dr. Dalin: This month I am talking with Dr. Paul Belvedere about a new service for patients ...

For more on this topic, go to and search using the following key words: performance mouthpieces, physiology, Dr . Paul Belvedere, Dr. Jeff Dalin.

Dr. Dalin: This month I am talking with Dr. Paul Belvedere about a new service for patients: performance-enhancing mouthpieces by Under Armour. A science known as craniofacial neurometabolic physiology has arisen from the study of intraoral devices and their effects on human performance. Paul, would you explain this science and the implications it can have in dentistry?

Dr. Belvedere: Jeff, let me give you a condensed answer to a broad segment of human physiology.
Dr. Paul BelvedereCraniofacial neurometabolic physiology is a new branch of science. Nonetheless, there are related references to physiologic reactions in our bodies that involve the basic principles of CNP. CNP evaluates the roles of neuroreceptors, neurotransmission, activation, or suppression of neuropathways, and the mechanism of neuropathways while working toward a better understanding of the responses that occur during stressful situations. This happens not only in human performance but other situations, such as postural degradation. Additionally, CNP looks at the craniofacial musculoskeletal system, concussion causation, and how stress, cortisol, and lactate affect bodily performance in excess.

Dr. Dalin: A large part of this discovery stems from our bodies being overloaded by stress and the subsequent elevated levels of cortisol and lactic acid. Can you elaborate on this?

Dr. Belvedere: When presented with a stressful situation, the body responds by clenching the teeth. It is not only clenching the teeth, but doing so in the same anatomic configuration that creates a problem. Excessive physical or mental stress leads to a heightened response known as “fight or flight.” It is this response that ignites a chain of events that start in the hypothalamic-pituitary-adrenal axis.

During a stressful experience, the hypothalamus releases the corticotropin-releasing hormone (CRH) that activates the pituitary gland to release adrenocorticotropin into the bloodstream. This signals the release of three hormones —epinephrine (adrenaline), norepinephrine (nonadrenaline), and cortisol. These hormones affect various parts of the musculature system, and exacerbate the effect that stress puts on the body when released in excessive amounts. Any action of the oral system that decreases the flow of oxygen adds to the body’s stress level.

Dr. Dena Garner, assistant professor for the Department of Health, Exercise and Sport Science at The Citadel, tells us: “Research has consistently noted the correlation between exercise fatigue and higher lactate levels. As one increases exercise intensity, the glycolytic pathway is highly utilized to meet energy needs. The end product of this pathway is the production of lactic acid. Lactic acid is broken down into lactate and hydrogen ions, and it is this increase of hydrogen ions that is negatively associated with metabolic processes, leading to fatigue.”

Thus, any mechanism that elicits lowered hydrogen levels that result from lactic acid buildup speeds up the process of an athlete reaching fatigue. For example, if the pathways used during exercise rely more on oxygen, then lactate levels will be lowered.

By introducing an intraoral device that will reposition the mandible and the condyles, as well as change the anatomic configuration, thereby allowing for more air passage, it appears one major advantage is gained. Yet, understanding this link between lowered lactate levels and increased airway openings remains a complex issue that requires further investigation.

Dr. Dalin: This concept has been rediscovered recently and several companies have worked on the “power positioning” of the jaws. One of these companies — Bite Tech Laboratories — at which you have worked, talks about the “optimal safety power position” via the introduction of “reverse wedge” bite plates. How is this done?

Dr. Belvedere: More than 40 years ago, I experienced a left temporomandibular joint (TMJ) dysfunction. This was the experience that began my journey of validating performance-enhancing mouthwear. By studying and analyzing occlusal disciplines — coupled with my experience as a patient with this condition — reverse wedge technology proved to resolve the difficulty by establishing centric positions of the condyles without extensive techniques, such as electromyography. My work with Bite Tech has involved developing the reverse wedge oral appliance.

The effects that will occur by increasing the height of two contralateral molars are that the mandible pivots on these “high spots” and drops the condyles while shifting the mandible onto the sling of the masticatory muscles.

The masseter is the prime target. Some of the muscle fibers also are stretched to some degree, and the condyles are no longer in the normal static position. If made permanent, this would be destructive to the masticatory system.

By using an intraoral appliance (only during increased activity), all return to normal when the appliance is removed. Also, the percentage of angle used in the reverse wedge bite plates, approximately 2%, is the key to pivoting the mandible without an excessive increase in the vertical dimension of occlusion. A correctly made appliance worn only in the mouth uses this freeway space.This is a prime reason for Bite Tech’s involvement since all appliances are created the same but with custom-made fits.

Dr. Dalin: Until now, only anecdotal evidence has existed to support claims. What does recent research show about clinical studies conducted by companies in this field?

Dr. Belvedere: As previously quoted, Dr. Garner’s work with Bite Tech has produced double blind, scientific studies that validate intraoral appliances and their positive role in performance enhancement. Subsequent research is now being performed. Dr. Henry Cross III, clinical research chair with Bite Tech Research Institute, is spearheading additional scientific studies in conjunction with Dr. Garner. These studies utilize athletes and nonathletes as subjects with additional emphasis on other stress-creating human situations that don’t pertain solely to athletics. In short, Bite Tech is doing its homework. It is yet to be determined if others will follow the company’s lead.

Dr. Dalin: How does the Bite Tech Under Armour performance mouthwear compare to what other companies, such as Pure Power mouthguards, have developed?

Dr. Belvedere: Bite Tech’s mission statement is to create performance enhancement and protection without drugs, and with systems and techniques that do not require dentists to have specialized equipment and devices to accomplish their patients’ goals. Through the collaboration of Under Armour, Patterson Dental, and Bite Tech, I believe there is an efficiency that no other performance-enhancing appliance manufacturer has. Looking at user comparisons and testimonials, I can only report what I have been told: “The fitting process is more efficient while the actual fit is better than any mouthguard I’ve worn before. And they work!”

Unsolicited testimonials may be considered “anecdotal,” but in watching televised sports broadcasts, I am fascinated by the number of Under Armour logos in the mouths of professional athletes I see coming off the field.

Dr. Dalin: How can a dentist become an authorized provider of these types of mouthguards? Also, will dentists be able to tap into the marketing support of companies who create mouthguards?

Dr. Belvedere: Dentists can purchase a “launch kit” from a Patterson Dental representative. Upon purchase, they are added to the network of authorized providers on Under Armour’s online directory so patients and athletes seeking this technology in their respective areas can locate the nearest provider. The launch kit offers sample products to be used for patient education and knowledge.

Each kit also comes with dental team education literature and fitting instructions, prescription forms, brochures, and other valuable marketing support. The kit also has a free product coupon for dentists so they can experience the benefits of this technology. The fitting process is simple. Fabrication requirements include upper and lower PVS impressions, a centric occlusion bite registration, and a prescription form that are shipped to Bite Tech Laboratories in Florida to be custom made.

Dr. Dalin: Paul, thank you for taking the time to talk with me. Is there anything else that you would like to share with our readers?

Dr. Belvedere: Jeff, I sincerely want to thank Dental Economics® for its interest in performance-enhancing mouthwear. It naturally follows since DE is the leader in presenting new and practice-building information to our profession. If there is a desire for further information that I might offer readers, contact me at [email protected]. Thank you.

References available in Download Center at

Dr. Paul Belvedere graduated from Loyola Dental School, Chicago, in 1955, but began teaching as a student instructor in 1954. He has taught dental continuing education for more than 30 years. He maintains a general and cosmetic practice in Edina, Minn.

Jeffrey B. Dalin, DDS, FACD, FAGD, FICD, practices general dentistry in St. Louis. Contact Dr. Dalin at [email protected].

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