It's old news for the NFL. And now, the Tufts Dental School is exploring answers to the growing epidemic of head injuries among former players.
In January, neuropathologist Dr. Bennet Omalu linked former Philadelphia Eagles safety Andre Waters' suicide with brain damage he endured during his professional career. Less than a month later, former linebacker Ted Johnson told The New York Times that New England Patriots coach Bill Belichick forced him to ignore the advice of the team's trainer and play with concussions, causing him irreparable cognitive damage.
NFL commissioner Roger Goodell has been suffering from headaches of his own ever since.
For a game in which hard hits to the head are the norm, enduring a concussion is certainly nothing new. Yet the old "play through it" adage is hardly holding the clout it used to in the NFL or in any other contact sport, professional or amateur.
Instead, the latest approach to concussion management emphasizes prevention. The Tufts Dental School hopes to pave the way in the treatment.
For the last several months, Patriots dentist and Tufts Dental School alumnus Dr. Gerald Maher has been collaborating with Dr. Noshir Mehta, Professor and Chairman of General Dentistry at Tufts, with the hope of establishing a definitive connection between mouthpiece use and concussion rate.
"At this present moment, we're just in the talking stages," said Mehta, who is also the Director of the Cranial Facial Pain Center and Assistant Dean of International Relations. "There is evidence that concussions can be helped by mouthpieces. If you go to CVS and those places, you can look up mouth guards like the Shock Doctor, which says it's designed to prevent concussions. But no studies done have shown exactly how these can affect people with concussions. Dr. Maher says when you use these guards that there are fewer incidences of concussions."
Concussion treatment and the Maher Mouth Guard
Having worked with the Patriots since 1979, Maher has spent the majority of his career promoting a mouthpiece that he believes can reduce the rate of concussions in athletes. The Maher Mouth Guard is different from standard mouth guards in that it fits in the lower, rather than the upper jaw because, as Maher said, the upper jaw doesn't move.
Maher's research centers on the temporomandibular joint (TMJ), where the lower jaw meets the skull. Stabilizing the lower jaw, Maher pointed out, gives the Maher Mouth Guard an advantage.
"You can talk easily [and] breathe easily with it," Maher said. "It's hard, so you don't chew on it - that destroys the mouthpiece."
At $395, the guard fits on the back molars and is comprised of an acrylic mold held together by three stainless steel bands, which rest behind the teeth.
"The biggest thing is it is extremely doctor-patient sensitive," Maher said. "You have to diagnose correctly and put the jaw in the right position."
During his 20-plus years promoting the mouthpiece, Maher said he has worked with 200-300 Patriots players and nearly 1,000 people overall, with positive results. Still, both he and Mehta are quick to stress that the mouth guard could only lessen concussions endured from blows to the jaw - not for hits directly to the helmet or neck.
"We're trying to prevent the lower jaw from moving," Mehta said. "The mouthpiece needs to maintain jaw joints in the proper position. That doesn't mean that if you wear it and you hit your head against a brick wall you won't get a concussion, but it could reduce a blow."
Maher's research and the NFL
With Johnson's and Waters' cases coming to light, the NFL has had no choice but to recognize the long-term effects of concussions and reevaluate its general approach to concussion management.
But so far, the league is doing this without Maher's input.
The NFL denied two grant applications Maher submitted - for $30,000 in 2004 and $89,000 in 2006. Maher also was not in attendance when the league held a summit in Chicago during June to discuss concussions and the aftermath affect.
Without irrefutable studies supporting Maher's tactics, the NFL has been less than hot on the idea of promoting the mouth guard.
"The evidence has to be irrefutable and done by multiple groups rather than just one person," Mehta said. "The NFL has its own agenda. They want their people in the field and they have been resistant.
"Athletes respond to what coaches tell them," he continued. "If we can get coaches to believe in [the mouth guards], then the process will be accelerated. If we have to wait for the NFL or a professional group to come up with a position, then it will take a little longer."
As it stands, the NFL's current approach employs a computerized neurocognitive testing system called ImPACT to recognize potential brain injuries after a hit. Maher is critical of the league's inattentiveness to concussion prevention.
Despite this, Maher has been in contact with Goodell and has been asked to submit his research to a group out of Ottawa, Canada called Biokinetics. Still, he feels his efforts have been stymied.
"They are working on dummies, and I am 100 percent opposed to working on dummies with this device," he said. "You need to individualize this, and you can't do that with a dummy. I think working with them will be a waste of time."
But for medical professionals who have devoted their entire careers to treating these types of injuries, any increase in concussion awareness is welcomed.
"We're getting there," said Dr. Joseph Rempson, co-medical director and co-founder of the Atlantic Health Care Sports Concussion Center at Overlook Hospital in Summit, New Jersey. "We're getting more attention now than four to five years ago, and a large reason is athletes are getting bigger and stronger. Recognition is growing rapidly. We're starting to gain steam."
Although the NFL has yet to accept Maher's findings, there is no doubt it is concerned with the impact of concussions on its athletes.
The league prepared an informational pamphlet describing the symptoms of concussions for players and their families and agreed to expand neuropsychological testing. Additionally the NFL instituted a new hotline that will make it easier to report when a player is being forced to play through a head injury. Maher appreciates any new progress.
"Any information and recognition of concussions is good, so [the NFL is] moving in the right direction," Maher said. "At least they're admitting that there is a problem and they seem to be interested...but this is a small bandage for a gushing problem."
