NFL preseason package: Football, dentists mix well

It may not be totally accurate, but that doesn’t stop Texas dentist Dr. Ron Bosher, FAGD, from sharing a very funny line about why he chose his profession. Because while he likes to joke that dentists “hurt people,” his career involves going to great lengths to protect people, specifically athletes both young and old.

After playing college football, the 6-foot-5, 300-plus pound Dr. Bosher had to decide what he wanted to do with he rest of his life. “Not many jocks become dentists, and I was a defensive lineman for Texas Tech University. When I came out of Tech I thought, what can I continue doing that I get to keep hurting people?” he said with a laugh.

It didn’t take long for the Plano, Texas dentist to start mixing football with dentistry as he started making custom-fitting mouthguards for a number of local high schools around the Dallas area, including those in the towns of Garland, Plano and Richardson. One of the charter members of the Academy for Sports Dentistry back in the 1970s, he took countless impressions and made numerous mouthguards free of charge for high school football players.

Dr. Bosher’s generosity allowed these athletes to use custom-fitting mouthguards as opposed to the inexpensive over-the-counter variety often referred to as “boil-and-bite” mouthguards. His efforts introduced the athletes to the importance of wearing custom-fitted mouthguards, and it allowed him to become well-known in the community. It also opened up some mighty big sports dentistry doors. Dr. Bosher served as the Dallas Cowboys team dentist for 25 years and also worked with World Cup Soccer and the Olympics.

But it all starts with providing the best possible care for the athletes. As opposed to the boil-and-bite models, custom-fitting mouthguards fit and feel better, which helps with compliance. They also provide better protection and allow athletes to speak while competing, a critical factor for quarterbacks, defensive football captains who bark out signals, as well as competitors in such sports as basketball, soccer and water polo.

Getting started

Dr. Bosher credits a late prosthetics professor at the University of Texas-San Antonio Dental School with helping him learn how to make mouthguards designed specifically for athletes who need custom-fitting models that set bites so they can talk while being protected.

“Back then there was no such thing as specialty mouthguards for different positions or for different sports. So if you wanted to play basketball or you wanted to be a quarterback who could talk without taking out your mouthguard, there was really nothing for them,” he said.

Today, lab fees can range between $75 to $125 for most of the custom-fabricated mouthguards. Dentists also can purchase a machine and the materials and learn how to make them in their practices, but the fabrication can be time consuming. That is why way too many of the young athletes in the U.S. choose to go with the quick, inexpensive boil-and-bites. That’s also why dentists like Dr. Bosher are so appreciated.

“I was the team dentist for most of the local high schools. I was in Garland at that time, which is one of the suburbs and I probably did more (mouthguards) for the high schools than I did college and pro. For years I did all their mouthguards. I never charged the high schoolers for them. I was always volunteering.”

But he did have to scale back some when the requests got to be overwhelming. “It came down to the point that so many teams wanted me to make them that I really had to start limiting it to just quarterbacks and linebackers and secondary men that really need to talk with their mouthguards,” he said. “The boil-and-bites, over-the-counter, they are really limited in scope of what they can do. When you can make a specialty mouthguard they (kids) are so appreciative.”

It’s also a good way to serve your community and to create some good will.
“I suggest (interested) dentists start with those high school teams,” he advises. “Of course it’s a good practice builder; you get known in your community. Trust me it’s all volunteer. These teams don’t have the money to pay you to do this. But you’re going to do quite a service for your community and in return they get to know you. So for new doctors coming out of school it’s a great place to get going in the community.”

Going pro

In Texas, where football is king, word spread to the NFL’s Cowboys that a local dentist was providing safety and comfort to a number of football players. When they learned that Dr. Bosher’s practice was about 20 minutes from their training facility, they brought him on board. Dr. Bosher served as the team’s dentist from 1980 to 2005, overseeing the oral health for numerous Super Bowl champions and getting to know America’s Team quite well.

In his Plano practice, Dr. Bosher has a collection of Dallas Cowboys memorabilia, including autographed footballs, photos and a Waterford Crystal Dallas Cowboy helmet which was given to him by owner Jerry Jones to commemorate his 25 years with the Cowboys.

Dr. Bosher, who gave up his role as Cowboys dentist a few years ago to focus more on his practice and to allow him some much-needed free time, said the main role professional team dentists play is built around examinations and mouthguards. With the exception of one hard-hitting safety who got whacked on the jaw and needed a special appliance to return to action the next week, during his time with the team none of the Cowboys players ever came away with a dental emergency caused by an injury on the field.

Each year following the NFL draft the Cowboys bring in a medical and dental staff to evaluate the new players, he said. Then it’s up to the team dentists to take impressions and make the mouthguards for every player before training camp opens. Additionally, any existing dental issues that may cause problems need to be addressed before the players get ready for game action.

“At mini-camp, from the dental standpoint, we’re taking all the impressions for the new guys,” he said. “We do an initial exam to make sure there’s nothing big. No broken teeth or impacted wisdom teeth, anything that could take them out (of action) if it gets really bad or infected. We were at the training facility so I don’t have x-rays and such. I am just doing a real good visual exam. You can see the big stuff.”

Dr. Bosher adds that some of the athletes are not fond of dentists and can be difficult patients. Yet when his practice used to be close to the Cowboys headquarters, he treated many players and their families and built many great relationships over the years.

We make notes and get them taken care before the season starts,” he said of the new players who need dental care. “Then I was making the mouthguards for the whole team. So I’m working my tail off getting all the mouthguards ready so before they head off to training camp I get all the mouthguards to the trainer. By mid-July my sports world is pretty much done.”

He must have been doing something right if there was not much need for his services once the players headed off to camp with their mouthguards.

“I just don’t have typical injuries. I just don’t get a call that says so and so got their teeth knocked out during a game. If I’m doing my job right you’re not going to have that kind of problem. I cannot remember (any dental emergencies),” Dr. Bosher said. “One time Bill Bates got hit really hard in the right jaw and dislocated his left TMJ. We had to make a mouthguard that would protect that joint, and we had him ready for the next game.”

Dr. Wayne Scott, from Coppell, Texas, took over for Dr. Bosher as the Cowboys’ team dentist. “I’ve been through all the various coaches and did all their sports dentistry,” Dr. Bosher says proudly of his time with the Dallas football team. “I just gave it up 5 years ago. It’s so time consuming. I’ve been doing dentistry for 35 years, but I’m not trying to slow down. I am trying to simplify my life a little.”

Improved performance

Not only do custom-fitted mouthguards protect teeth and improve comfort, but there are those who believe they can also improve performance in some instances and even can reduce the incidence of concussions.

Dr. E. Kyle Dalton of Dalton Designer Smiles who has worked with NFL players and boxers, makes the Pure Power Mouthguard (PPM) for patients, and the oral appliance is said to naturally align the athlete’s jaw to enhance strength, balance and oxygen flow during training and competition. “Athletic mouthguards have traditionally been used over the past several years as a protective device, that is prevention of injury to teeth and jaws,” he said. “With advances in technology and application of Neuromuscular dentistry, appliances are now available that not only provide protection but improve performance in almost any sport. By finding the ideal mandible-maxilla relation or ‘sweet spot’ we can increase strength, balance and flexibility.

“Most humans occlusal relationship is not in the ideal physiological position or ‘myocentric position’ and the muscles of mastication are constantly having to adjust and maintain the mandible. This causes overwork of these muscles and an overload to the brain’s sensory receptors. The bad bite also robs energy by not allowing correct muscle recruitment and maximization of the body’s muscle potential. I have had personal experience with athletes that had 15-25% increase in upper body strength when the mandible is placed in the ideal myocentric position.”

Gerald J. Maher, DMD, has served as the New England Patriots team dentist since 1979, a position he got after working with boxer Marvin Hagler. With the help of research from Dr. Jack Stenger at the University of Notre Dame, his company Mahercor Laboratories LLC developed The Maher Mouth Guard, an appliance said to aid in the prevention of concussions for all athletes playing in contact sports. The company has been working with the National Hockey League, a sport in which concussions have become all too common, and this type of oral appliance also can benefit soldiers.. He recently spoke to a group of Pop Warner players and parents and stressed the importance of avoiding the OTC mouthguards.

“Because the models off the shelf fit so poorly, the players don’t wear them or they chew on them and distort them,” said Dr. Maher, whose company works with the Appliance Therapy Group in manufacturing the custom mouthguards. “TMJ is my area of expertise and we have designed a mouthguard to cut down the incidence of concussions.”

Mark Picot, Executive Vice President of Mahercor Laboratories, LLC, describes the Maher Mouth Guard as more of “medical device” than a mouthguard, noting that other versions available do not address the creation of a more stable relationship between the jaw and skull at he temporomandibular joint (TMJ), which better enables athletes to dissipate the force that comes from a hard blow to the chin area. He adds that a recent peer-reviewed publication in Dental Traumatology should help teams and athletes become more aware of the link between violent blows to the jaw area and concussions, and how a TMJ device such as the Maher Mouth Guard can place teeth in a better position to withstand such violent blows.

Performance clothing manufacturer Under Armour just got involved in the mouthguard business with the introduction of the Under Armour Performance Mouthwear™, powered by ArmourBite™ technology. The product, distributed by Patterson Dental, is featured in the September 2009 issue of Dental Products Report.

TeamSmile

Kansas City dentist Dr. Bill Busch is passionate about dentistry and caring for kids. And oh yes, he also likes football quite a bit.That’s why, along with the help of Henry Schein Cares, he formed TeamSmile in an effort to provide dental care to underserved children. It all started in 2006 with a Kansas City Chiefs event, but the organization has grown to include college football, pro baseball, a PGA golf event, and multiple NFL stops. At the first-ever Bears event on Aug. 1, 10 volunteer dentists sporting Bears scrubs provided care to numerous children who also had their days brightened by appearances from Bears head coach Lovie Smith and several players.

Anyone interested in working with TeamSmile in their community or in donating to the organization can visit the Web site at teamsmile.org.

Learn to make them yourself

If you plan to start providing a lot of custom-fitted mouthguards in your community, Dr. Ray Padilla is someone you should contact. The longtime sports dentist works with the UCLA athletic programs, has served as team dentists for professional soccer and football squads, and has also done dental work with World Cup Soccer events and with the Olympics in both 1984 and 1988.

Like Dr. Bosher, Dr. Padilla does not charge his patients for his custom-fitted mouthguards. Also, he lectures nationally in an effort to teach dentists how to use the pressure machines to eliminate the lab fees by fabricating the appliances in-office and. He also stresses the importance of educating parents and teams of the major differences between the OTC versions and the ones provided by dentists.

“The parent needs to realize that these are not the same as the stock ones,” he said. “I have not ever had anyone injured wearing one of these mouthguards ever. And you can not ever get a good fit with the boil-and-bite ones.”

Dr. Padilla said Olympic water polo athletes also have started to take advantage of the benefits provided by these mouthguards. Dr. Padilla’s Web site is a good resource for information on sports dentistry (sportsdentistry.com) and a list of his lectures, including a hands-on course Nov. 6 titled “Appliance Fabrication with the Drufomat Scan,” a Denstply Raintree Essix seminar in Los Angeles.

So while it’s fall and football fans everywhere are getting ready for another exciting season, dentists need to keep in mind that they can and should be quite involved in football and dentistry.