The claims of the manufacturers of the Pure Power Mouthguard and Pure Power Edge (PPM/PPE) are extraordinary. They claim that the orthotic increases strength, balance, and performance among athletes. They claim their sports guard can help athletes in all sports, including those that do not normally utilize a sports guard. Sports where they believe the PPM/PPE may help include:

· Baseball

· Basketball

· Bicycling

· Running, including cross country, track, and marathons

· Football

· Golf

· Skiing

· Skateboarding and snowboarding

· Weight training

· Water polo

In other words, they claim that athletes in all sports. They have also promised that their claims would be backed up by a major university study, possibly sponsored by Tufts University with the participation of Harvard University.

The Theory

The theory behind PPM/PPE is that malocclusion, or an improperly aligned bite, can have secondary effects on muscles and nerves of the face and neck, which in turn can affect vertebral position, leading to back pain and functional problems with the back. To some extent, this has been verified in clinical studies, with studies showing that treatment for temporomandibular joint disorder (TMD), a neuromuscular condition of the jaw, increases the length of chiropractic adjustments of the atlas vertebra, which in turn has been shown to lead to significant reductions in high blood pressure.

The theory is that any effect on the position of the spine and the muscles of the neck and upper torso could lead to reductions in performance, especially in any task that depends on upper body strength or functions on areas directly impacted by the position of the jaw, such as the inner ear, where the majority of our balance functions are regulated. In addition, poor bite position can lead to obstruction of the airways, reducing oxygen supply during periods of high demand. So, according to theory, athletes who have a bad bite position can experience improved better strength, balance, and stamina. Since some estimates say that as many as 90 % of Americans suffer from malocclusion, this means that virtually every athlete will experience improved performance from some form of dental orthotic.

The History

Dentists first proposed that malocclusion could affect athletic performance during the 1970s. Following revelations like the advent of Gatorade during the late 1960s, sports medicine was making a real impact on giving teams a competitive edge over their opponents, and everyone was on the lookout for the next big thing. In response to this, a number of innovations were tried, including the mandibular orthopedic repositioning appliance (MORA). The MORA jumped to prominence when it was used by the U.S. bobsled and luge teams during the Olympic Winter Games at Lake Placid, New York in 1980. Following this high-profile use, the American Dental Association (ADA) commissioned a scientific study of the mouthguard involving Louisville university football players and found no evidence that the mouthguard improved strength. Following this study, all hype surrounding the MORA vanished.

The Difference?

In the 1990s, neuromuscular dentists, who specialize in treatment of disorders of the hard and soft tissue of the jaw related to malocclusion, began to notice that their treatment seemed to have an unexpected side effect. Patients undergoing neuromuscular dental treatment seemed to be experiencing positive effects on their golf games. One dentist, Dr. Anil Makkar, pursued the lead and produced the PPM/PPE, designed to give athletes optimal bite position during sporting activities. Following demonstrations with a number of amateur and semi-pro athletes, Dr. Makkar and several disciples targeted professional athletes. As a result, the quarterback of the CFL team the Toronto Argonauts, the kicker for the St. Louis Rams, and, most notably, Boston Red Sox outfielder Manny Ramirez uses one. All these athletes swear by the results.

Is there a difference between the PPM/PPE and the MORA? According to proponents, the MORA was a manually-positioned appliance that involved a great deal of guesswork in its application. In contrast, the PPM/PPE is supposedly a scientifically-formulated device. Using instruments designed to give a quantifiable measurement of occlusion, PPM/PPE advocates say they can actually give real benefits to athletes who use the device during competition.

The Science?

So have the claims of PPM/PPE advocates been borne out through scientific studies? Despite Dr. Makkar's promotion of a double-blind placebo-controlled clinical study to be published in May of this year, no such study has been published. On other fronts, the news for the possible benefits of occlusion mouthpieces is mixed.

Researchers at the Gelb Craniomandibular Pain Center at Tufts University called the studies that through doubt on the effectiveness of the MORA "flawed," and claimed that new studies should be designed differently to be more effective at accurately evaluating the results of jaw posture appliances like the MORA and the PPM/PPE. On the other hand, a recent study of the golf swing six professional golfers with and without a MORA showed no difference when the golfers were or were not using the appliances.

The Question

So, the question remains: does the PPM/PPE improve performance of athletes? One hopes the recent study might be able to provide a definitive answer, but it is unlikely to completely close the issue. If the study is favorable to the PPM/PPE, there is likely to be charges that the design of the study allowed researchers connected with PPM/PPE to cherry-pick their data. If the study is unfavorable, it is likely that dentists who have invested significant amounts of money into the device will seek another study to better measure the results they claim. But no matter what, the issue cannot be pushed until the study is published.