Effect of clenching with a mouthguard on head acceleration during heading of a soccer ball.

Concussions are acceleration-deceleration injuries that occur when biomechanical forces are transmitted to the cerebral tissues. By limiting acceleration of the head, enhanced cervical muscle activity derived from clenching with a mouthguard (MG) may reduce the incidence or severity of concussions following impact. The purpose of this study was to investigate the effect of voluntary clenching with a proper MG on acceleration of the head during "heading" of a soccer ball. Eleven male high school soccer players (mean age, 16.8 years) participated in the study. Each player was given a customized MG. An automated soccer machine was used to project the ball at the participants at a constant speed. The participants headed the ball under 3 different oral conditions: drill 1, heading freely performed without instruction and without the MG; drill 2, heading performed as the subject was instructed to clench the masseter muscles tightly while not wearing the MG; drill 3, heading performed as the subject was instructed to clench tightly while wearing the MG. Each participant repeated each drill 5 times. Linear acceleration of the head was measured with a 3-axis accelerometer. Activity of the masseter and sternocleidomastoid muscles was measured by wireless electromyography. Weak masseter and sternocleidomastoid muscle activity was observed during drill 1. After the soccer players had been instructed to clench their masseter muscles (drills 2 and 3), statistically significant decreases in head acceleration and increases in masseter and sternocleidomastoid muscle activity were observed (P < 0.05; paired t test). The effect was stronger when the players wore the MG. Dentists should encourage soccer players to habitually clench while wearing a proper mouthguard to strengthen cervical muscle resistance as a way to mitigate the damage caused by heading.