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Wednesday, April 19, 2006

Browns NFL Draft Preview: Defense - Part 1

Last week, we began my Browns’ 2006 Draft Preview by examining the current roster of players at each position on offense and determining what positions might be targeted in the draft. This week, we’re getting into a more important area of need for the Browns: DEFENSE. The Browns didn’t do as bad as their talent would have indicated last year thanks to good coaching on the defensive side of the ball and solid play by some key veterans. While the Browns’ defenders couldn’t come close to sniffing the QB and they could barely stop the run last year, they managed to rank 16th in overall defense in the league, and they ranked near the top in Red Zone defense. That’s pretty good when you consider the holes they are trying to fill on that side of the ball.

We’ll start breaking down the defense this week by spending one day a piece at each of the 3 major levels of the defense. Today, we’ll cover S and CB:

S
Bryan Russell – Criticized in Minnesota for so-so coverage skills, Russell is still a tough player and uses his head out there to make up for any disadvantages he may have against his opposition. Russell had a pretty decent first season with the Browns filling in nicely for departed flunkies like Earl Little who I remember most for being posterized after being flattened by Duce Staley and then complaining about playing time even though he wasn’t deserving of it. The converted QB is still a bit of an overachiever though, and the Browns may want one of the young guys to steal the job at some point from him. He’s a solid team guy though and that’s alright in my book.
Brodney Pool – The talented second year player out of Oklahoma had a bit of a rough go in his rookie season as he had his preseason derailed right after the first kickoff of the first game. Pool suffered a concussion and it seemed like an uphill battle for the rest of the season as he tried to catch up. He gained some valuable playing time late in the season and it is because of his talent that the Browns gave up average DB Chris Crocker to the Falcons for an extra 4th rounder in this year’s draft. He’ll have an open shot at the other S position now.
Sean Jones – Another young talented Safety derailed by injuries over his first few years, Jones came into 2005 healthy, but struggled a bit since he didn’t play at all during his rookie season in 2004. He spent a lot of time on Special Teams, and saw some time here and there at Safety during the season. The Browns are still very high on him and he’ll be in the mix for a starting position and much more playing time in 2006.
Sean Mayer – Former Patriot project player found his way onto the Browns in 2006. Mayer is currently relied upon as a backup who hasn’t really played much since 2004. He has some talent at the Safety position, but it remains to be seen what he can offer to this team right now.

CB
Gary Baxter – Baxter possesses good size and the ability to jam the WR at the line of scrimmage, but he was knocked a bit in Baltimore for his coverage skills and was thought to benefit greatly from the superior talent around him on the Ravens’ defense. Regardless of that, GM Phil Savage believed in Baxter’s ability and wanted to upgrade his secondary for 2005. He paid Baxter big money to come in here and mix it up with the top WRs in the division. Baxter got off to a tough start with the Browns as he suffered a concussion early much like Brodney Pool did, but rebounded to play well before he suffered another injury to shelve his season. Baxter is healthy and ready to go now and is hungry to make a great impact in 2006. It’s hard to think he’ll suffer the same misfortunes in 2006 as he did in 2005 with injuries so a full season from him will add to the depth of the CB position.
Leigh Bodden – Browns’ secondary coach, Mel Tucker (from Ohio State), is credited for helping Leigh Bodden develop into a middle-tier starting quality CB in 2005. Bodden had shown flashes of brilliance during the season, holding WRs like Chad Johnson to minimal production. With Bodden’s development, the Browns are blessed with 3 solid starters at the position now so they may have a good situation in the Nickel defense if they can keep all their guys healthy. Bodden was signed to an extension at the end of the season which will keep him here for some time.
Daylon McCutcheon – Daylon has been a rock on this team since they returned in 1999. He’s done a good job as the main CB for the Browns for years, although many feel that he’s best suited as a Nickel corner because of his size. Regardless, McCutcheon completes the trifecta of 3 quality starters on this team, and will help the Browns greatly during passing downs if he bounces in on the slot receivers. It’s remarkable to actually see a guy like this stick around during all these years of madness since 1999 so he’s a personal favorite of mine.
Pete Hunter – The former spot-starter for the Cowboys (that’s not saying much with the Cowboys corner woes over the last several years), Hunter has some size at the position that is noteworthy. Hunter was acquired in December as the Browns were looking to get some fill-ins at the CB position. Hunter may function well as a backup on this team since he’s got some experience as a starter, but he’s no stud.
Antonio Perkins – Drafted as a potential Nickel corner and a Punt/Kick returner in 2005, Perkins was an intriguing addition to the team. Unfortunately, Perkins barely saw any time returning kicks or playing in the secondary. Perkins was electrifying as the return man for Oklahoma during his college career, but it’s tough to see him supplant someone like Dennis Northcutt on punt returns. I’ll also be interested to see what kind of progress he makes as a CB during the off-season to find out whether he’ll really stick on this team.
James Thornton – A late add to the practice squad in 2005, Thornton remains a question mark as to whether he’ll even stick with the team in 2006. Thornton has bounced around over three seasons and hasn’t even had any game action.

Now that we have an idea of where the Browns’ secondary stands, we’ll spend some time with the LB corps tomorrow and find out what kind of holes are there. At first glance, that will be a major need going into the draft. Stay tuned…

posted by Chris @ 3:37 PM  

2 Comments:

  • At 8:13 PM, Anonymous Anonymous said…

    www.mahercor.com



    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.

     

  • At 8:13 PM, Anonymous Anonymous said…

    www.mahercor.com



    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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