Can gumshields help reduce concussion? We ask the experts *H&H Plus*

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  • Following recent discussions about the benefits of gumshields for riders, H&H canvassed opinions from governing bodies’ chief medical advisers, a dentist and mouthguard specialist, plus riders from across the disciplines...

    Debate over the use of gumshields in equestrian sport has resurfaced following a call from a high-profile jockey and discussion at the International Eventing Forum.

    The 20-time Grade One-winning jockey Paddy Brennan called for “every jump jockey to be wearing” a gumshield, adding that his “saved his head” in a fall at Leicester last month.

    While talking about the best way to fall at the International Eventing Forum at Hartpury (3 February), orthopaedic surgeon Michael Eames said wearing a gumshield can help dissipate the energy in your jaw and neck, reducing the risk of a head injury.

    Although there is no conclusive evidence gumshields reduce a person’s risk of concussion, some who wear them are convinced of the benefits, and they can certainly help prevent dental injuries, which are painful, inconvenient and expensive.

     Cheltenham Gold Cup-winning amateur Sam Waley-Cohen offers cost-price mouthguards to jockeys through his business, Portman Dental Care.“At the moment, we can’t categorically say to jockeys if they wear a gumshield and fall, they’ll have less chance of concussion,” said the British Horseracing Authority’s (BHA) chief medical adviser Dr Jerry Hill.

    “I encourage jockeys to wear gumshields, especially ones that are custom-made, and as long as they’re properly fitted, there isn’t any issue with them.

    “We’re in the process of commissioning a new medical records system, which will allow us to gather much more useful data and we’ll be able to do more analysis. That will give us sport-specific data for racing and then we can give sensible advice.”

    H&H has been contacted by dozens of riders across the disciplines — particularly racing, polo, team chasing and eventing — who opt to wear gumshields for a variety of reasons. All opted for a properly fitted type, over the “boil and bite” version, at a cost of roughly £50 to £100, depending on the level of protection. Some said they barely notice wearing them, while others found they took a bit of getting used to.

    Abigail Lewis told H&H she is a convert after cracking teeth in a pointing fall last season.

    “It was the most painful thing I’ve ever done,” she said, adding that she wears it for both tooth protection and concussion prevention. “I don’t even realise I’ve got it in — it was £120 compared to £800 for [the work I’ve had done].”

    Aurora Eastwood told H&H she wears a gumshield “every time” she plays polo, for both teeth protection and to mitigate against concussion, and believes they should be compulsory in all fast equine sports.

    Amateur eventer Alysen Miller, who has a background in racing, told H&H she looked into it extensively and said the research she found between mouthguards, concussion and even spinal damage prevention “didn’t seem entirely baseless”.

    “An absence of evidence doesn’t mean an evidence of absence,” she said, adding it is the piece of equipment she notices “the least”. “It does seem a very small tweak you can make to your kit, even if it is a very small chance [that it will help].”

    Former jockey Alice Mills told H&H wearing one for racing was a natural progression from hockey and rugby.

    “I didn’t see any reason not to carry on wearing it for team chasing,” she added.

    Billy Aprahamian, amateur jockey and assistant trainer to Nicky Henderson, told H&H: “It is becoming more and more common now compared to five years ago in point-to-pointing and is much more common in jump racing, where a lot of the jockeys are wearing them — anything to protect themselves.”

    Anthony Lovat, dentist and founder of pioneering mouthguard company OPRO, told H&H the company does not collect data on which sports its customers take part in, so could not say if it has had an increase in demand from racing or equestrian sports.

    “What I can say is on the whole, the use of mouthguards is certainly on the rise globally,” he said, adding that people are becoming more aware of dental injuries and how to prevent these.

    He added that impression-fitted mouthguards offer greater protection because they result in a better fit and the thickness is greater than that of the boil and bite. This is because the process and machines used to create them are stronger than a human hand or bite can achieve.

    “That’s not to say all boil and bite mouthguards are bad, but the ultimate is the custom fit,” he added.

    The company is also working with Sports & Wellbeing Analytics on their latest mouthguard, which features built-in technology that monitors head impact data.

    Mouthguards work by absorbing energy, meaning the force the wearer experiences is dissipated over a longer period of time, reducing or eliminating dental injuries.

    One rider told H&H she looked into them after suffering a nasty fall while not wearing one, but was advised against it by her treatment team owing to the forces riders can experience in a fall and the question as to whether that could result in greater damage.

    Dr Lovat added in the 20-plus years of Opro, he has never known a mouthguard to cause harm.

    The British Equestrian Federation’s chief medical officer Pippa Bennett told H&H that looking at the research available, there is no conclusive evidence a mouthguard protects the wearer from concussion.

    “Custom-made mouthguards will help protect your teeth — will it lower your risk of concussion? Possibly, but it’s not proven,” she said.

    She added that much research is ongoing into factors surrounding concussion, including neck strength, gender and the lasting impacts of head injuries.

    Dr Bennett encouraged people to be aware of concussion symptoms and that these can sometimes first become apparent hours later.

    She is also working on a system within the World Class programme, whereby riders would have an initial assessment after a fall, followed up by further assessments at various intervals, such as three, 24, 48 and 72 hours.

    “We want to be absolutely sure we are not putting anyone back on a horse when they really shouldn’t be riding,” she said.

    “We are also working on graduated return advice. At the moment, there is the initial 21-day stand-down time [from competition], but nobody really tells riders what to do at home.”

    There is growing evidence in how improved neck strength can help prevent concussion, as this can help control the rapid acceleration and deceleration in a fall. Concussion is not always caused by direct blows to the head, but the brain hitting the inside of the skull, with research showing a stronger neck can help reduce the amount of energy transferred to the brain during an impact.

    The Injured Jockeys Fund has shared videos of neck-strengthening exercises for riders, to help mitigate their risk.

    An ongoing project at Imperial College London, funded by the Racing Foundation, is also looking at an in-ear device, which monitors the wearer’s heart rate, electrical activity of the heart and brain, blood oxygen levels and respiratory rate, as well as containing an accelerometer.

    It is being trialled within the NHS at present and the BHA is looking at potentially testing it to measure the above statistics after a fall.

    The ultimate aim is for jockeys to wear these while racing, but it is not at that stage yet.

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