Jan. 24, 2020

Mouthguards do more than just protecting teeth in youth ice hockey

New study finds risk of concussion reduced by wearing a mouthguard
Hockey players wearing mouthguards
Hockey players wearing mouthguards Adrian Shellard

Mouthguards were first developed in the 1890s by a British dentist to keep boxers from getting dental and facial injuries during matches. But there is another compelling reason to use this protection.

Researchers discovered that mouthguards reduce the risk of concussion in ice hockey, according to a new study by the University of Calgary published in the British Journal of Sports Medicine.  

“This study is the strongest evidence to date that supports mandatory mouthguard use for youth between the ages of 11 and 17 when playing ice hockey,” says Dr. Carolyn Emery, PhD, chair of the Sport Injury Prevention Research Centre at the Faculty of Kinesiology.

Though policy around the use of mouthguards is in place in some areas of Canada, researchers say it should be more effectively enforced.

“It can be challenging for referees to enforce the use of mouthguards, so we would like to see parents and coaches get involved to ensure they are being used as we saw a significant reduction in concussion with mouthguard use,” says Dr. Brent Hagel, PhD, senior author on the study and a professor in the departments of Paediatrics and Community Health Sciences at the Cumming School of Medicine

Carolyn Emery

Carolyn Emery says the study provides strong evidence for mandatory mouthguards in youth hockey.

Adrian Shellard, for the University of Calgary

Two styles of mouthguards tested

Researchers looked at players who sustained a concussion during play, and those who sustained an injury but did not have a concussion. They also looked at two types of mouthguards, those that were a dental custom fit, and those that were off-the-shelf. 

Both protected against concussion, reporting a 64-per-cent reduction in the odds of concussion when mouthguards were worn. However, this protection was statistically significant for off-the-shelf mouthguards and not the custom dental. Hagel noted it could be related to a smaller sample size once considering mouthguard type and that more work is needed in this area.

Mouthguards may protect against concussion because they reduce the forces transmitted to the brain, but further research is necessary to understand the protective mechanism.

“An off-the-shelf mouthguard is an inexpensive and effective way to protect against concussion, but we are in the early days of investigating the biomechanics of the specific types of the mouthguards that are best,” says Hagel.  “The main point is, we are on the right track for this piece of protective equipment, and this is something we want to investigate across multiple contact sports such as football.”

Brent Hagel

Brent Hagel says the study has implications for multiple contact sports such as football.

Adrian Shellard, for the University of Calgary

Importance of funded research by students

The study began as an undergraduate research project by University of Calgary Kinesiology student Dirk Chisholm, funded by Alberta Innovates – Health Solutions and the Markin Undergraduate Student Research Program for Health and Wellness. 

“It was thanks to Dirk Chisholm that this project came to be, as he was tenacious about getting it to the finish line,” says Hagel.

Dirk Chisholm graduated with an undergraduate degree in Kinesiology from the University of Calgary and is now attending medical school at the University of Alberta.

“This exciting discovery is the final product of an undergraduate research project which demonstrates the value a strong undergraduate research program can have for our communities,” says Emery.

The Integrated Concussion Research Program (ICRP) is a university-wide initiative to study concussion, which has brought together experts from the Cumming School of Medicine, Faculty of Kinesiology, and Faculty of Arts, with support from the Alberta Children’s Hospital Research Institute (ACHRI) and the Hotchkiss Brain Institute (HBI). The Alberta Children’s Hospital Foundation was instrumental in the creation of the ICRP and provides continuing support.

The research was funded by the Canadian Institutes of Health Research (Safe2Play), Alberta Innovates (Alberta Program in Youth Sport and Recreational Injury Prevention), and the Hotchkiss Brain Institute.


Led by the Hotchkiss Brain Institute, Brain and Mental Health is one of six strategic research themes guiding the university towards its Eyes High goals.

Dr. Brent Hagel, PhD, is a professor in the departments of Paediatrics and Community Health Sciences at the Cumming School of Medicine and a member of the Faculty of Kinesiology’s Sport Injury Prevention Research Centre, the Alberta Children's Hospital Research Institute and the O'Brien Institute for Public Health.

Dr. Carolyn Emery, PhD, is the chair of the Sport Injury Prevention Research Centre, Faculty of Kinesiology  and holds a joint appointment in the Cumming School of Medicine in the departments of Paediatrics and Community Health Sciences, and is a member of the Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, O'Brien Institute of Public Health and McCaig Institute for Bone and Joint Health.

Other study authors include Dr. Amanda Black, CAT(C) PhD, Dr. Luz Palacios-Derflingher, PhD, Paul Eliason, MSc, PhD candidate and Dr. Kathryn Schneider, PT, PhD.