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In their well-designed, case–control investigation of mouthguard use in youth ice hockey players and the risk of concussion, Chisholm and colleagues1 report that those wearing a mouthguard—whether custom-made or off-the-shelf—had lower rates of concussion than control participants. The point estimate suggests a considerably reduced risk, although the CIs are broad. The authors report differences in the estimate of reduced risk for custom-made and off-the-shelf mouthguards, with the latter (perhaps surprisingly) having a greater reduction, although again the CIs are broad. The authors are explicit that their study is not powered for precise estimates of this secondary analysis, so we must all be cautious in interpreting this latter observation.
The primary observation—that mouthguards are associated with a lower rate of concussion—is an important contribution to the literature. The finding differs from that of the most recent systematic review of whether mouthguards can protect against concussion in contact sports, which concluded that ‘the effect of mouthguards on concussion risk was minimal’,2 although …
Contributors Both authors have contributed to the intellectual preparation of and drafting and finalising the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Commissioned; internally peer reviewed.