All Things Oral Health: Mouthguards vs. Nightguards

Overview

• Answers to commonly asked questions by parents
• The importance of oral hygiene and how it affects general health
• The most important parts of an athletic mouth guard
• TMJ and Bruxism in kids

Video Transcript

Dr. Monroe Elkin: So tell me, where'd you go to the dental school?

Dr. Rodney Jackson: I ended up coming to the University of Kentucky College of Dentistry here in Lexington. I went, got my bachelor's in biology from University of Louisville and then switched the school rivals to come to Lexington for dental school. I graduated in 2001, and then I immediately went into my pediatric dental residency and completed that in 2003.

I initially started out undergrad, pre-med until I shadowed the type of position that I ideally wanted to be, which was an OBGYN and just realized that I didn't want that type of lifestyle. During the time I was in orthodontics and I went to this pre-med, pre-dental program prior to college, that stressed the importance of shadowing. That's why I was shadowing the OBGYN. My orthodontist at the time was located here in Lexington. I'm from Eastern Kentucky. He had a satellite practice there and he had a friend in Louisville that he knew that would allow me to shadow cause I was potentially interested in dentistry. I shadowed Dr. Goldson a couple weeks later and never looked back.

Dr. Monroe Elkin: I personally think that every college should be that way. My granddaughter, I saw her last night. She was going to go for physical therapy and she shadowed somebody and said, “Nah, I don't, I don't think I want to do that”. Which is good because she figured it out now.

Dr. Rodney Jackson: Especially if the person you're with is open and transparent with you. Unless you know the ins and outs of the job and truly lets you see their schedule and, and what their lifestyle is ultimately. Well, it’s the ultimate lifestyle you can have, so I think that was a key factor in my decision to switch to dentistry.

Dr. Monroe Elkin: Exactly. What did you think was the best part of dental school?

Dr. Rodney Jackson: The best part of dental school, I think, and I think what drew me to dentistry is probably the immediacy of  the profession. I like the fact that it's preventative in nature. The vast majority of problems that we have and that people have with dental issues are preventable. But the immediacy of being able to respond to any issue that they have is what really drew me. I like the fact that you could identify a problem, you could do the diagnosis of the problem, identify it, and then go about, fixing the issue then and there as opposed to the prolonged treatment of a lot of medical specialties. There's no instant gratification with other specialties. You get patient medication, you wait for the response. I really like the fact that, if a patient is presented to  my clinic in dental school with a broken tooth, I could fix it immediately that day, and they would be immediately happy with the results.

Dr. Monroe Elkin: Yes. Well, that's what I liked about doing endo. A patient would come into the office in pain and when they walk out they're not in pain.

Dr. Monroe Elkin: What is the age range of your patient population?

Dr. Rodney Jackson: Well it just depends on whatever practice you want. When I initially started, my patient base hadn't really grown yet. I would see [my patients] all the way through college with the caveat that I'd let the parents know once they were in college, that was beyond the scope of pediatric dentistry. Then they would have to go to a general dentist. Then once I really got busy, I cut it back to 20. Now I'm down to 18. And the issue that we're having is that we have so many people trying to get in as new patients that we're unable to see a lot of the younger patients who really are pediatric because our older college ACE patients are kind of blocking up the schedule. So I'll see them through high school graduation and typically we graduate them out from the practice to a general dentist office at that time.

Dr. Monroe Elkin: So when parents come in, generally what kind of questions do they ask?

Dr. Rodney Jackson: It really depends on the stage of life that the patient is in. In the initial exam we'd like for every patient to come in within six months of getting their first teeth to establish their dental home. That's a big push from the American Academy of Pediatric Dentistry. Right. Typically at that stage  the parents are just looking for anticipatory guidance, which is going over dietary  instructions, brushing instructions and doing a thorough exam. Also, trying to get to the bottom of if there's any genetic issues that might play a factor in their child's dental health when they're older. If we have a new patient establishing care when they're, I say eight or nine, it's usually due to the fact that the teeth aren't coming in straight like the parents ideally think they should. So that's one of the major reasons we're consulted with patients who are a little bit older or who have pain. So, itt really depends on each patient and the stage of life in which they’re in.

Dr. Monroe Elkin: Do you do Ortho (Orthodontics) in your practices?

Dr. Rodney Jackson: I do not do Ortho. The ironic thing is, when I started out in dental school, I wanted to do ortho until I had my first ortho class. I wasn't intrigued by it. The immediacy wasn't there. The immediacy is what kind of drew me to dentistry. With ortho, the process is more prolonged. You have to wait two years for the final result. I don't think I'm patient enough for that, so I don't do the ortho. I'll do simple two moves, like a crossbite correction of things of that nature, but like banding and bonding, I don't do any of that. I don't do Invisalign. I'll leave that to the experts who prefer to do that.

Dr. Monroe Elkin: That was the one specialty that I felt, if you didn't know what you were doing, you could really mess somebody up.

Dr. Rodney Jackson: Oh, definitely.

Dr. Monroe Elkin: So do you find that, when parents bring their kids, the primary thing on their mind is getting their teeth cleaned?

Dr. Rodney Jackson: You know, not necessarily. Lately I’ve seen more and more patients whose parents bring them in and they have a question. They don't necessarily want their teeth cleaned, unless they see visible plaque or tartar. And then if they see some, some calculus or tartar present, then they definitely want it removed. I'll probably do two to three new patient exams where the parents will say they don't want their child's teeth cleaned because they don't want to traumatize them. But for the vast majority, once they've been established, which is what most people's parents want, they want to see their kids' teeth cleaned primarily because they think they should be perfectly white and shiny. The reality is a lot of kids don't have really pearl white teeth and parents can be somewhat dismayed when the teeth are cleaned and they’re not as white as they ideally think they should be.

Dr. Monroe Elkin: Do you talk to the parents about the importance of oral hygiene and how it affects general health?

Dr. Rodney Jackson: Oh, definitely. We do that with the first appointment. The assistants tend to go over all the oral hygiene instructions. Then we sit down and review medical history with parents and depending on their medical issue, we discuss the connection between mouth and overall health. It's definitely something that's on our radar and we really try to promote within our practice, just cause it is an important part of your general health. It's the gateway to the body. It starts with the mouth and then everything can kind of go from there.

Dr. Monroe Elkin: The research lately is that oral health effects, heart, lungs, kidney, low birth weight in babies. I did a very unsophisticated survey in my practice and I found that 100% of the patients who had diabetes had periodontal disease.

Dr. Rodney Jackson: Oh yeah.

Dr. Monroe Elkin: So the cleaning part is really important because of the breeding ground for bacteria.

Dr. Rodney Jackson: Definitely.

Dr. Monroe Elkin: You know, which affects your overall health. What do you do in your practices with regard to athletic mouth guards?

Dr. Rodney Jackson: We promote them as much as possible. We tell the patients, I always make small talk with the patients, just kind of see how they're doing in school, what they're doing, the athletics. And then I always say, You wear a mouth guard and inevitably it's, it's amazing to me how few sports really have their players wear mouth guards. It doesn't make any sense to me. Right. In fact, my older son plays basketball, and football and he runs track. He doesn't wear a mouth guard for track, but I make him try to wear a mouthguard for basketball because I see just as many oral injuries from basketball as I do, even more so with football because at least they have protection from a helmet. Right. In baseball, I see injuries almost every day, especially from sports related activities. It just boggles my mind that the coaches don't really stress the importance of mouthguards.

Dr. Monroe Elkin: Are you a member of the Academy of Sports Dentistry?

Dr. Rodney Jackson: No, I'm not.

Dr. Monroe Elkin: Yeah. So do you carry the mouth guard in the office?

Dr. Rodney Jackson: Yeah, we have a few. I have some of the Under Armor ones at my Georgetown location, then we have some of the game on mouth guards at the Langton.

Dr. Monroe Elkin: Yeah. The Under Armor ones, I don't think you can get 'em anymore.

Dr. Rodney Jackson: No, and that's why I'm saying this is one, these are some that we bought from Under Armor had a deal with Patterson Dental years and years ago where, you know, Yeah. You probably, you were probably aware of it.

Dr. Monroe Elkin: Well, yeah, that's Bob. Bob and I were involved with a company called Bite Tech. Mm-hmm. The Under Armor one was also my patent.

Dr. Rodney Jackson: Okay.

Dr. Monroe Elkin: There was a licensing agreement, but that's no longer, Yeah. And anyway, you know, the Game On is an improvement on that one anyway.

Dr. Rodney Jackson: Mm-hmm. Definitely it is. Yeah. I've never used an Under Armour one, but I've fitted myself with the Game On when I had my son wear it and the fit of it is by far superior to the Under Armor.

Dr. Monroe Elkin: One. Yeah. So, did you have one of the display stands in your office with the mouth guard?

Dr. Rodney Jackson: I do not. Well, what I do is I put the mouth guards we, cause our display in Georgetown is a, is a much broader area. So we have the actual Under Armor display case there in our Lexington office. We are at the checkout area, the receptionist has all of our products that we sell behind her. So we have toothbrushes and the mouth guards back there with the pricing there. So parents can choose.

Dr. Monroe Elkin:  Okay.

Dr. Rodney Jackson: It's just as easy for me to tell the patients to go to Amazon and order 'em there, or go directly to the website and order whatever they need.

Dr.Monroe Elkin: Yeah. What do you consider the most important parts of an athletic mouth guard?

Dr. Rodney Jackson: I think definitely the fit of it. Because if it's not comfortable, no one's gonna wear it. I also really like the protection that the mouth guards provide. The fact that it has the ADA sale approval is great. but, you know, especially with CTE, it is as rampant as it is. I mean, with two of, did you see the other day, two of the, the quarterback, how he suffered a concussion I mean, so many issues can be, I'm not saying that a mouth guard would've completely prevented that, but I think it would've, it would've lessened the blow that he received with some cushioning between his teeth.

Dr. Monroe Elkin: Yeah, so I was on this Florida concussion task force mm-hmm. , where we were able to get legislation passed with regard to back to play.

Dr. Rodney Jackson: Okay.

Dr. Monroe Elkin: I had a woman call me and say, you know, my son's had three concussions and I saw your mouth guard. And I said, Whoa, whoa, whoa, slow down. I'm not making any claims that this mouth guard is going to prevent the fourth concussion. The average person really doesn't understand, and we don't fully understand how a concussion happens. A lot of the literature says it's more about the number of hits you get as opposed to a single one. So it’s really an accumulation of hits and then all of a sudden you get a hit and because there's an accumulation that triggers it. We will never make a claim because the Federal Trade Commission- they sent the letter to mouth guard companies saying, do not make any claims about mouthguards and concussion. Brain Pad is under a 20 year restriction from the FTC. Cause they did that.

Dr. Rodney Jackson: So they issued the statement even after they received a warning saying not to do so?

Dr. Monroe Elkin:  No, no. They had been promoting their brain pad mouth guard to prevent concussions and the FTC came in and said, No, you can't say that. And if you do it again, you're gonna get fined.

Dr. Rodney Jackson: Okay.

Dr. Monroe Elkin: So they kind of backed off naturally.

So actually Bob and I were looking this afternoon when people searched for mouth guards on Google. The interesting thing is that when they put in mouth guards as two separate words, they get three times more responses than if they put the word in as mouthguards, as one word.

Dr. Rodney Jackson: Really?

Dr. Monroe Elkin: Yeah. It's really interesting. So when you refer to a math guard, do you refer to it as a mouth guard or mouthguard?

Dr. Rodney Jackson: Yeah. I say mouthguard. I don't say mouth- guard.

Dr. Monroe Elkin: Yeah.

Dr. Rodney Jackson: So you get three times the number of hits with separating the words?

Dr. Monroe Elkin: Yeah.

Dr. Rodney Jackson: That's interesting.

Dr. Monroe Elkin: Yeah. And I kind of suspect that the same thing is happening with night guards.

Dr. Rodney Jackson: I'm sure. Yeah. It only makes sense that the same algorithm would be used.

Dr. Monroe Elkin: Yeah. Do you use night guards in your practice?

Dr. Rodney Jackson: Not a tremendous amount because for the pediatric population, their mouths are so rapidly changing and expanding. I typically do tell parents about the Game On mouth guard, because it can be reconstituted back to the original form. Right. Especially with the younger patients, for prior to Game On, I would say to get like a boiling bite and just fit it and change it every three to four months because their mouths are rapidly expanding.

That's one of the most common complaints that I get from parents, of the really young patients, usually four to five, is that they grind their teeth and, you know, it's not the fact that the parents are worried about the teeth, they're worried about the noise that is creating. Because the grinding noise is driving them insane.

Dr. Rodney Jackson: So they wanna do anything they can to prevent it. So, I've sold a couple, and  I gave a couple patients some of the Game On and have them try it- and they liked it. I think the important thing is that it's fitting appropriately, especially at night because it's just so easy to take a mouth guard out of your mouth and throw it off if it doesn't fit snugly. And that's one thing I like about the Game On mouth guard is it fits really well and once the patients get used to it, they're more likely to keep it in the mouth throughout the night when it's intended to be used.

Dr. Monroe Elkin: Yeah. It's the same with our actual FDA cleared night guard, which can be remodeled. It has a hard occlusal, so you get freedom of movement of the jaws, and when you wake up in the morning, they're still in your mouth and not on your pillow.

Dr. Rodney Jackson: Right.

Dr. Monroe Elkin: Yep.

Dr. Rodney Jackson: Bob gave me a sample of the [night guard], and I like that product.

Dr. Monroe Elkin: I kind of figured that in pediatric practices, there's really not a lot of night guard usage.

Dr. Rodney Jackson: Not a tremendous amount, no.

Dr. Monroe Elkin: Yeah. Now, the interesting thing is when I went to Chicago to make a presentation to the scientific committee in support of getting the ADA seal for the Game On mouthguard,  I did the whole presentation with a clear mouth guard in because the ADA had always had this philosophy that you cannot get a custom mouth guard unless you take an impression pour of a model. So they asked me, did I have that made by a lab or did I do it in my office. And I said, I did it in a microwave. And they said, What! Yeah. But the interesting thing that came out of that is that one of the people on the committee was Dr. So Lucido, who is head of the oral surgery TMJ department at UPenn Dental School. He did what you're doing. He actually started using our athletic mouth guard as a TMJ system appliance because our material is so durable.

I've got athletes with more than 10 years of using the same mouth guard.

Dr. Rodney Jackson: Really.

Dr. Monroe Elkin: Yea. A friend of mine who was an athletic trainer, who recently passed away, had his mouth guard from 2004 to 2021.

Dr. Rodney Jackson: That's impressive.

Dr. Monroe Elkin: Yeah. We have the best product on the market. I had some other questions about night guards, but it sounds like they don't really apply to your practice.

Dr. Rodney Jackson: No, typically if I have a patient who has a lot of issues with their tmj, I'll refer, I mean, we're, I'm very fortunate with the fact that we have like one of the world experts for temporal mandibular, joint disorders. Dr. Jeffrey Osen, he's the dean of the College of Dentistry here, and they have an OR official pain residency at UK as well. So, and there's a pediatric dentist on staff that was trained in, OR official pain as well. So she's always welcoming new patients, because she can do them much better justice than I can in my practice.

Dr. Monroe Elkin: I've talked to her about the game on mouth guards and everything. So I think, you know, they're interested. It's just a matter of them trying to get it in the door and really trying out on their patients.

Yeah. I guess, you know, it always comes down to you having to know what you don't know.

Dr. Rodney Jackson: Right.

Dr. Monroe Elkin: That's why I was never afraid to refer patients. Anything else you wanna share with regard to people's dentistry, oral health?

Dr. Rodney Jackson: I mean, I tell my patients all the time, it's easy to, to prevent a lot of the dental problems that you could potentially have as an adult. If you learn the proper ways of taking care of your dentitian while you're young and continue those practices, then you will hopefully avoid a lot of the issues that a lot of the elderly population are currently experiencing. We have a sign in in our Georgetown office. Brush and floss the teeth that you wanna keep. I mean, it's just that simple. Take care, do what you're supposed to do to help avoid the problems. Cause like I said, dental issues are for the most part preventable if you just do the proper things.

Dr. Monroe Elkin: Yeah. Do you recommend water picks?

Dr. Rodney Jackson: We do water picks, especially for patients with ortho. The other thing we recommend a lot too is, SonicCare has this thing called an air flosser in it. It does a puff of air and water at the same time. I actually used that with my son, why did I have him use it when he had orthodontics? My oldest son, he tended to like it, and it made a mess, but it seemed to make a little bit less mess than the actual water pick did because the water reservoir wasn't as big. He usually had to close his mouth to get in the appropriate areas. So it was just a little easier to control, I think.

Thank you for this and as a gift, I'm gonna send you a wheel of cheese.