ezgif.com-resize-50.jpg

Thinking about using a performance mouthpiece? Read this first


We’re all looking for an edge when we train. Whether you want to get stronger, fitter, or faster, a shortcut sounds good! So what if you could wear a “performance mouthpiece” when you train – like a mouthguard – and improve your performance immediately?

It sounds odd, doesn’t it? After all, how could wearing a mouthguard effect any other part of your body?

But these are the claims of several products, and they cite plenty of research to support these claims.

Some of these claims are quite extravagant, so it’s worth taking a closer look. After all, these devices could be game changers. To find out we’re going to look at the claims of one performance mouthpiece provider, New Age Performance.

an example of a performance mouthpiece

An example of a performance mouthpiece. Do they work advertised? Note: we are using images from the New Age Performance website under fair use (for the purposes of review and criticism), so permission was not sought.

Why wear a performance mouthpiece in the gym?

The claims around these mouthpieces differ depending on who is selling the product. Some make vague claims about improved performance that are hard to assess. But others make hard to believe claims about delaying lactic acid build up and enhancing reaction time!

strongman Brian Shaw endorses New Age Performance products

He’s one of the world’s strongest men, and he uses this product. Brian Shaw must know something we don’t, right? Image credit: Toronto Tribune.

New Age Performance make impressive claims around their mouthpieces, but aren’t very specific. They claim to be able to improve strength and power, mobility, and fitness. They claim, in fact, the benefits to be “endless”.

But before we look at the claims closely, let’s look at the people behind them. This doesn’t tell us anything about the product, but provides context. If they’re on the cutting edge of research in this area, we may be willing to trust some of their claims more. If they lack qualifications or experience, we need to be more cautious.

an example of the claims made about performance mouthpieces

New Age Performance make some big claims about their mouthpieces. Let’s see if the claims have enough evidence backing them up.

Who is behind these performance mouthpieces?

The CEO of the company is Canadian man Rob Charlton. According to interviews, the mouthpieces are modified versions of a device Charlton was already using in his workouts. While Mr Charlton appears to have several patents to his name, I couldn’t find any information about his qualifications. So, I must assume that his expertise is limited to his personal experience, and his business skills.

As we’ve discussed before, this personal experience doesn’t help anyone else decide on the best approach for them. One person’s experience will differ from another’s. So we need to look at what large numbers of people experience, under controlled conditions, before we can form a conclusion. This is what research is for, and why we’ll look at the research evidence in detail later.

the owners of New Age Performance

the owners of New Age Performance during an appearance on the CBS show Dragon’s Den in 2017. Image credit: CBS.

The co-owner is Canadian competitive eater and YouTube sensation “Furious” Pete Czerwinksi. Mr Czerwinksi is clearly an exercise enthusiast, but his degree is in engineering. While he’s obviously a smart man, again he relies on personal experience.

Some expertise in this case is provided by Dr Anil Makker, who practices cosmetic dentistry at a practice in Nova Scotia, Canada. Like Mr Charleton, he also holds a number of patents for mouthpieces (and the methods used to prepare them) that are claimed to improve athletic performance.

How are performance mouthpieces claimed to work?

We reached out to an expert to help us assess these claims, Dr Charles Allen. Dr. Allen is an Assistant Professor in exercise science at Florida Southern College, and has published research looking at a number of training aids.

Dr Allen says that “these mouthpieces supposedly work by creating a proper alignment of the temporomandibular (jaw) joint.” A misalignment in this joint can cause a condition known as temporomandibular disorder (TMD), “which is characterised by frequent and severe headaches, dizziness, and reduced force production in muscles.” Dentists can fit mouthpieces that modify the alignment of this joint and minimise these symptoms. Dr Allen explains further:

There is considerable evidence that when orthopaedic mouthpieces have been appropriately fitted, they improve the patient’s jaw alignment, associated symptoms are reduced, and muscular force production improves. This suggests there is an optimal jaw alignment position that can be achieved via oral appliance, and even if someone is not diagnosed with TMD, perhaps a more optimal jaw position can be achieved, along with the subsequent improvement in force production.

So far the concept is plausible, at least. If we have an ideal jaw position, we could produce more force when we train, and get stronger.

the temporomandibular joint

The temporomandibular joint. Image by Jmarchn, CC BY-SA 3.0.

A performance mouthpiece works? Great, where can I get one?

Not so fast. According to Dr Allen most of the evidence for this improvement has been shown in those diagnosed with TMD. Those without symptoms may not get the same improvement.

New Age Performance doesn’t draw this distinction. Their website states that a misaligned bite results in flow-on issues, such as worse balance and posture, that will limit athletic ability. Using their mouthpiece is supposed to correct this, and lead to improved training performance, though the website is very vague on how this happens.

postural changes from using a performance mouthpiece

I’m not sure if New Age Performance are serious about this or not. Their product would be revolutionary, if it led to the sort of change shown in this image!

New Age Performance make some extraordinary claims

So far we’ve established there could be a benefit from these mouthpieces. But it’s not clear that everyone gets these benefits. And if we did, New Age Performance make some claims that are hard to believe with any product. They’ve also made other claims in the media that are hard to confirm, and I find them less trustworthy as a result.

New Age Performance claims their product is banned in golf by the PGA, as it speeds up hip rotation. This increases the amount of force a golfer can impart on the ball. But I couldn’t find a source for this claim. I found many articles reporting this claim, but nothing quoting the PGA, or reporting the ban directly.

Some research shows that other mouthpieces can improve golf performance. But this research did not assess a New Age Performance mouthpiece. And as we’ll discuss later, there are other reasons to be cautious about applying these findings to the product we’re looking at here.

Also, the PGA doesn’t make the rules of golf – these are jointly written by the USGA, and the Royal and Ancient. I couldn’t find any reference to mouthpieces not being permitted in the current equipment rules of golf.

How does New Age Performance back up these claims?

New Age Performance use testimonials from well known athletes, which feature heavily in their advertising. Even if these endorsements were not paid for, they are a weak form of evidence. And paid endorsements are less trustworthy again. So we really need to know what the research says.

Also unconvincing is a video that is supposed to show an improvement in mobility after manipulating the position of your jaw. It uses a technique commonly used by alternative medicine practices, and those selling dubious products like Power Balance bracelets, known as “applied kinesiology”. If you want to read a more detailed critique of this approach I recommend this article from Pain Science.

It’s nonsense, because the body is warmed up and the nervous system stimulated before the repeated movement (in this case bending over). You would perform better no matter what you did in between – whether it was moving your jaw or aligning your chakras.

a test purported to show the benefit of performance mouthpieces

The old applied kinesiology trick has been around a long time, but it doesn’t prove anything. If you randomize the order you complete the test in, there would likely be no difference in these two conditions

Thankfully, they don’t just rely opinion and unreliable demonstrations. The New Age Performance website makes prominent mention of one study conducted by Shawn Arent and colleagues from Rutgers University. So we’ll spend some time looking at that.

Does the Rutgers study prove the New Age Performance mouthpiece improves performance?

Not really. There are some issues with how this research is reported on the website. They state that the research was conducted on a “performance enhancing mouthpiece”. But they don’t state which mouthpiece.

In fact, this research examined an earlier product Dr Makker was involved with, which were custom-fitted by a dentist. And these were very expensive (around $2000 at the time). These are not a New Age Performance mouthpiece, which is much cheaper, and are fitted by the consumer in a boil-and-bite fashion.

If you read the paper, you’ll note the comparison group for this study was a boil-and-bite mouthguard. And there was a small benefit with the custom-fitted mouthpiece in the fitness test, and vertical jump test. If anything, this suggests the product sold by New Age Performance is less effective than the dentist-fitted product.

any performance benefits from these products are small

Like many of these products, there is a difference between the claim and the reality. Most performance benefits from these types of training aids tend to be quite small.

If we’re looking for clear evidence that this device is effective, this study isn’t it. But we need to be careful not to place too much trust in just one study. We need to look at the whole body of evidence.

Thankfully, New Age Performance has a tab on their website labelled “Science”, and it includes descriptions of more research. So let’s have a look at the other research they cite.

What does the other research say about using a performance mouthpiece?

Unfortunately for me, they don’t link to the actual articles, or report all the relevant information of each study. I had to go looking for each paper. But I’m annoyingly persistent, so found a lot of them.

And there is a performance benefit from using a mouthpiece shown by this research. But these studies examined devices that were custom-fitted by dentists, not the boil-and-bit approach used by New Age Performance.

Some of the research they cite is very specific to dentistry, and not really relevant to exercise. The other research relates mostly to posture and strength, which is where we’ll devote our attention.

Posture

The research New Age Performance cites shows there could be an effect from jaw position on postural stability. But this doesn’t really back up their claims for several reasons.

Firstly, the image we showed you earlier clearly suggested that posture itself would be corrected. But this isn’t shown in this research – it just shows that participants swayed less when standing. This isn’t the same as correcting posture.

And one study only showed an association between postural stability and jaw position. So yes, adjusting jaw position changed someone’s postural stability. But adjusting their posture also changed their jaw position. There was no clear cause and effect relationship.

It also isn’t clear how this relates to exercise. While it’s plausible to me that there could be a benefit, these studies are a long way from proving it. When we exercise we rarely hold a static posture. And when we do, it’s often under load, and in different positions, not just standing upright and still.

And lastly, these two studies don’t use mouthpieces at all. Instead, they manipulate jaw position through other means (like standardized verbal instructions, or carefully placed cotton wool in the mouth). So not only is there no clear benefit to exercise, these studies don’t even show a mouthpiece improves stability. Let alone a boil-and-bite product like this one.

Strength

They cite studies looking at changes in strength in women with symptoms of TMD, and men and women without.

At least in this research actual mouthpieces were used. But both were using devices custom-fitted by dentists, comparing them to placebo devices using a mock fitting procedure. Strength was improved by these devices, consistent with the Rutgers study that features prominently in the New Age Performance promotion. But again, these aren’t the devices they are selling.

are there any strength training benefits from using a performance mouthpiece?

Like many of their claims about their mouthpieces, New Age Performance take research findings of improved strength from other devices as evidence that their device also works. But that’s good not enough information for us to know for sure.

What do we think so far?

None of the research cited, that I could find, is relevant to the claims made. Some show a benefit from dentist-fitted mouthpieces, but not boil-and-bite alternatives. And none assess the New Age Performance product.

And this is the research that is cited in support of their product! Why is that? It’s possible that the people citing this research do not know how to interpret academic literature.

But it’s also possible they find this evidence far more convincing than I do, because of their preconceived opinions. Most of us tend to be far more accepting of evidence supporting our position than evidence opposing it. So if we like the look of a piece of research after a quick look at the abstract, we may accept its findings without looking closely enough to understand the research fully.

the interpretation of research is hard. It's takes knowledge, practice, and an awareness of bias

It’s hard to interpret research evidence correctly. And that’s before we consider the effect of our biases

There is a lot of research into mouthpieces they do not cite

So if that’s the research that is cited, what research are they ignoring?

It turns out there is a lot more research to discuss. In fact, there have been at least two doctoral theses, which involve years of investigation and multiple research studies, into similar products.

The first was by Dr Devon Golem, part of the team involved in the Rutgers study featured on the New Age Performance website. It included this comprehensive study which compared a placebo mouthguard to two devices that were claimed to reposition the jaw. One was a boil-and-bite device, and one was custom-fitted.

There were no differences in balance, vertical jump, agility, strength. There were some minor differences in flexibility, but given the sheer number of analysis conducted, you’re always going to come up with something eventually through random chance. The authors didn’t correct for this as they probably should have.

The overall summary of Dr Golem’s work was that custom-fitted mouthpieces can improve performance, but are very expensive. Cheaper options, such as the boil-and-bite approach proposed by New Age Performance, have no impact on performance.

What about the other thesis?

The second thesis was by Dr Allen, who found that no benefit in strength or power from using these products, other than the ability to clench the jaw. I asked him to explain how this improves our ability to exercise:

The most likely mechanism relates to the concepts of motor cortical overflow… The interconnectivity of motor areas [in the brain] from one cortical hemisphere to the other means that when one area of the motor cortex is active, this activity overflows into other areas. In other words, when the area of the motor cortex that controls jaw musculature is firing, this activity can enhance activation of other motor cortical areas. The available literature demonstrates improvements several force production variables such as peak force, rate of force development, and time to force development.

Unlike previous research, Dr Allen’s used jaw-clenched and relaxed conditions while using jaw repositioning mouthpieces, and traditional mouthguards. He found the jaw-repositioning mouthpieces did not improve performance beyond this clenching.

the benefit we get from these devices is probably from clenching your jaw

Wearing a mouthpiece can help protect your teeth if you clench your jaw while lifting weights. But that’s about all it does.

Can we wear a performance mouthpiece just in case?

That depends on the type of exercise you are going to do. Boil-and-bite mouthguards (and potentially these performance mouthpieces too) reduce our performance in maximal aerobic exercise, as it reduces our VO2max. This isn’t an issue with custom-fitted mouthguards.

But if you’re only lifting weights, it won’t hurt. After all, you do get a performance benefit from placebos – if you think it works, it probably does. And you definitely get a performance benefit from clenching your jaw when lifting weights. So if you’re comfortable wearing one, and want to, go for it.

What can we conclude from all this research?

The expert consensus is more underwhelming than the claims of New Age Performance. Dr Allen thinks that “to achieve any benefit via jaw alignment, a custom made/fitted mouthpiece would be needed.”

He also highlighted the the fact that earlier research had not accounted for clenching the jaw, as his research did:

The few research articles that demonstrate performance enhancements from wearing an off-the-shelf mouthpiece did not control for jaw clenching as a confounding factor. In fact, the methodologies of those studies either suggest or explicitly say that the participants were instructed to clench maximally around the mouthpiece. This of course is a major issue given that jaw clenching has ergogenic effects, and those effects could be responsible for the observed performance improvements and not the mouthpiece.

So even the research showing a performance benefit from custom-fitted mouthpieces may not be as clear as they seem at first.

What’s our verdict?

New Age Performance use unconvincing evidence. Opinions, testimonials, and shoddy demonstrations are not compelling enough. When they use research evidence to support their product, they do so incorrectly.

None of the research conducted to date specifically looks at New Age Performance products. But the consensus of the evidence so far doesn’t look good. Dr Allen adds more:

As a scientist I am sceptical. With that said, from a powerlifting standpoint, many of those athletes clench their jaw and create tension in their face and neck during their lifts so something in the mouth to protect the teeth and facilitate the clench is probably a good idea, but that could be any mouthguard or mouthpiece.

Dr Allen also proposes that a placebo effect is behind a lot of the perceived benefit. And that probably contributes to the effect that the Mr Charlton, Furious Pete, and those who promote the product, report when they use it. And that’s ok.

But the effects are going to be small. If you need treatment for TMD, see your dentist. But if you just need to protect your teeth when you clench your jaw, any product will do.



Source link

Previous Post
chiro-cover.jpg
EN

The education of chiropractors is not all it’s cracked up to be

Next Post
alkaline-water-really-work.jpg
EN

Does alkaline water really work? We review the claims.

Leave a Reply

Your email address will not be published. Required fields are marked *