Brain-Pad

There are two issues that are at least partially missing in the 'Jaw-Impact and Base of Skull Consequences' debate:

First - there is no treatment except sitting down. Despite all the emphasis of what to do when there is an injury, except in cases of severe ones, the primary treatment is to sit out play. Along with that theme, there is mounting evidence that even a mild injury has permanent damage, and with each injury, large or small, there is some additional level of permanent neural damage.

Second - That the jaw has a role to play in transmitting forces into the base of the skull due to impact.

The discussion should be less about what to do about the injury and more about how to reduce the incidence of such injuries in sports.  When discussing the use of protective equipment, we must include protecting the jaw from impact in such a way as to reduce forces transmitted into the base of the skull.

An argument that I have heard from people on committees and in the position to make decisions is that there is no research linking blows to the jaw and head injury, therefore we do not need to include the jaw. It is true that there is limited Jaw-impaction research available today.

Here are the major published research studies.  Lower Jaw Impact Research.  Very promising results and conclusions.

Along the same lines, a short time ago the NFL was stating that there was no researched connection to base of skull injuries and long term damage.

I am calling responsible people and organizations to consider what makes sense intellectually and then let’s undertake prudent steps to protect athletes while we organize the research to further document the extent of the issue.

Let’s look at logic a little. Physics says that for every action there is a reaction. There are numerous blows to the jaw that can be observed in sports every day that result in head injuries. One does not need research to watch a player take a blow to the jaw and go down to say that it never happens.

Let’s look further at physics and anatomy. If there is a blow to the jaw then where does the force go? Physics says that the energy has to be dissipated. Of course, just watch a boxing match or a football game and you can see the head snap back or more often rotate violently on the spine when a blow is inflicted to the jaw. One commonly accepted mechanism of injury is the rapid acceleration and deceleration of the head causes stretching, tearing and collision with the skull to the very soft and delicate neural tissue. When the impact is to the jaw this force goes directly to the glenoid fossa, a very thin area of the skull and well off the center of rotation, causing violent angular and rotational forces that the muscles are not able to resist, as well as straight movement.

To consider all the effort and science that has been put in to helmet design it does not make sense not to put any effort into protecting the jaw from a blow that we know happens regularly. Most any dentist that you speak to would agree that putting the right material between the teeth to stabilize the jaw in a down and forward position would mitigate force transference to the skull. The only thing at this point that is lacking is extensive research.

However, there is enough anecdotal evidence to consider this mechanism and include the jaw in this injury discussion.

I recommend that dental experts be involved to consider protecting the jaw as new standards of testing and product development are considered during this process of attempting to reduce the incidence of injury in contact sports.

As conservative standards are enacted, further research will be stimulated and refinements and modifications will be possible when additional information is available.

Robert Mongrain DMD  |  8701 S. Garnett Rd.  |  Broken Arrow OK 74012
918.250.9528 office  |  918.760.3500 cell  |  This e-mail address is being protected from spambots, you need JavaScript enabled to view it