Page 143 - JSOM Summer 2020

lacrosse. Dentists and dental societies have advocated for MG
use in a much wider variety of sports and exercise activities
than is currently required.

Boxing
Boxing was the first recorded sport activity in which MGs FIGURE 1 Football
were used. Boxers fabricated MG-like devices from cotton, players at Notre
tape, sponge, or small pieces of wood. They clenched these Dame College,
materials in their teeth in hope of providing some protection 1952. 48
and shock absorption from the blows to the face. However,
the concentration it took to keep these materials on their teeth
could draw their attention away from the fight. In many in-
stances, these materials were considered illegal, and there were
reported cases where the materials were dislodged from the
teeth and entered the larynx. 17,34–36
In the 1890s, a London dentist named Woolf Krause was per-
haps the first dentist to develop MGs. He put strips of gutta began MG pilot programs, and anecdotal reports in the dental
percha (a natural, rubber-like resin) over the maxillary incisors literature suggested these programs were successful in reduc-
of boxers just before they entered the ring. In 1919 or 1920, ing the incidence of dental trauma. 45,49
37
a fighter named Dinne O’Keefe wore an MG designed by a
dentist, Thomas Carlos, when he fought then–world-welter- In 1960, the American Dental Association (ADA) House of Del-
weight-champion Jack Britton in Kenosha, Wisconsin. Philip egates endorsed the use of latex mouthpieces for football and
38
Krause (Woolf Krause’s son) fabricated perhaps the first reus- other contact sports. The National Alliance Football Rules
50
able mouthpiece, which was used by Ted “Kid” Lewis during Committee (composed of the National Federation of State High
championship fights in the 1910s and 1920s. In a fight be- School Athletic Associations, the National Association of Inter-
37
tween Ted Lewis and Jack Britton, Britton complained about collegiate Athletics, and the National Junior College Athletic
Lewis’s use of the mouthpiece and boxing officials ruled the Association) mandated MGs for high school and junior college
mouthpiece could not be used because it was not permitted football beginning in the 1962 season. 50–55 The National Col-
according to the rules at the time. legiate Athletic Association (NCAA) required the use of MGs
in college football beginning in the 1973 season. 51,56–58 The cur-
In 1927, Jack Sharkey fought Mike McTigue in an elimination rent NCAA football regulation requires all players to use an
tournament for a chance to face the heavyweight champion intraoral mouthpiece of any readily available color (not white
at the time, Gene Tunney. By the 10th round, McTigue was or transparent) that covers all the upper teeth and is made with
far ahead in the fight, but Sharkey, who was barely able to a US Food and Drug Administration–approved base material.
stand, managed to strike a blow to McTigue’s mouth. Mc- Proper fitting of the MG is recommended. 59
Tigue’s ragged teeth cut his lip so severely that the fight had to
be stopped. The contest was awarded to a dazed Sharkey. 34,37 Other Sports
Shortly after this fight, boxing officials of the New York State Table 2 shows state efforts to introduce MGs into US high
Athletic Commission allowed boxers to use MGs. 17 school sports. In 1993, Minnesota required MGs for high
60
school soccer, baseball, softball, basketball, volleyball, and
In 1930, the first descriptions of MGs appeared in the dental wrestling, but rescinded the requirement about a year later, due
literature. In response to an inquiry by another dentist, three to community resistance and a presumed lack of data on oral
dentists provided information on how to fabricate custom injuries in the selected sports. 8,60 Efforts in Massachusetts to
MGs for boxing, using dental impressions, wax, and rub- mandate MGs for boys’ and girls’ basketball and soccer were
ber. 35,39,40 Dr Clarence Mayer, who, in 1926, served as the box- initiated in 2003, coincident with the Massachusetts Dental So-
ing inspector for the New York State Athletic Commission, ciety’s public MG awareness program. Despite these efforts and
also described how to customize a mouthpiece of similar ma- support, the basketball mandate was rescinded in 2007 and the
terial. A subsequent publication recommended the addition soccer mandate rescinded in 2009, because of presumed MG
17
of steel springs to reinforce the soft mouthpieces. 41 sanitation concerns. More successful were mandatory require-
ments for MG use in soccer and basketball in New Hampshire
Football and for soccer in Maine, which are still in force. 60
The next sport to adopt MGs was football in the United States.
In the 1940s and 1950s, dental injuries accounted for 23% On a broader national level, both the NCAA and National
to 54% of all football injuries. 42–47 A 1950 survey involving Federation of State High School Associations (NFSH) cur-
65 major football colleges reported a total of 733 chipped or rently require MGs for football, field hockey, ice hockey, and
fractured teeth among approximately 4,000 football players. lacrosse, 60–62 with the NFSH additionally requiring MGs for
42
Articles began to appear in the dental literature promoting the wrestlers with dental appliances. The NCAA and the Amateur
use of MGs in football, and many of these articles provided Hockey Association have required MGs for ice hockey since
fabrication techniques. 18,44–46 In 1952, Life magazine published 1975. 63,64 Specific penalties are prescribed for MG nonusers,
65
an article that included large pictures of several star Notre but enforcement and use of MGs in ice hockey have not been
Dame football players who were lacking incisors (Figure 1). consistent. The NCAA rules for men’s lacrosse requires use
48
64
This may have focused popular attention on the high likeli- of “intra-oral mouthpieces of yellow or any other highly visi-
hood of dental injury in football. High schools and colleges ble color” during play (but not practice). 66
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