How Mouthguards Reduce Concussion Risk: What 192 Studies Actually Show (2026)

Q: Do mouthguards actually reduce concussion risk?

Yes — and the strongest evidence is recent. A 2023 meta-analysis of 192 studies in British Journal of Sports Medicine found mouthguards in collision sports cut concussion incidence by 26% (IRR 0.74, 95% CI 0.64-0.89, statistically significant). Earlier reviews from 2009 and 2011 were more cautious, but the literature has accumulated. The honest framing: mouthguards are associated with reduced incidence — they don't 'prevent' concussions, and no equipment does. But 26% across 192 studies is real.

Q: Why are custom mouthguards more protective than boil-and-bite?

It's the fit. A 2014 randomized trial of 412 high school football players (Winters & DeMont) found custom mouthguards (averaging 3.5 mm thick) produced a 3.6% concussion rate. Boil-and-bite mouthguards in the same study? 8.3% — and they'd been chewed down to 1.34 mm by the time injuries happened. That 2.3× difference is what fit quality and adequate thickness look like at the population scale. Statistical significance: p=0.0423.

Q: What about Q-Collars, Guardian Caps, and other concussion gear?

Different equipment, different effect sizes. Mouthguards in collision sports: 26% concussion reduction (2023 BJSM meta-analysis). Bodychecking policy changes in hockey: 58%. Contact limitations in football: 64%. Guardian Caps: 54-62% reduction in NFL preseason data, but a separate Wisconsin high school study of 2,610 players found no significant effect. Concussion protection is multi-layer: equipment, rules, training, management. Mouthguards are one layer — and they're the layer most athletes already wear, so getting that layer right is high-leverage.

Q: Wait — the inventor of NeuroGuard+ is on one of these studies?

Yes. The 2018 cohort study of 4,010 athletes wearing the MPRP custom mouthguard discloses that the corresponding author invented the device. We disclose this every time we cite that study. We do this because (a) it's true and hiding it would be deceptive, and (b) the FTC has been actively suing mouthguard manufacturers for undisclosed conflicts of interest. The Hutchison findings are consistent with the independent 2014 Winters & DeMont RCT and the 2023 BJSM meta-analysis — so the direction of effect is supported across studies with and without the inventor relationship.

Q: Will NeuroGuard+ prevent my kid from getting a concussion?

No — and we will never say that. Equipment doesn't 'prevent' concussions. NG+ is engineered around the mechanisms peer-reviewed research links to reduced concussion incidence — jaw stabilization, force dissipation, airway maintenance — and the meta-analytic evidence is that custom mouthguards in collision sports are associated with a 26% reduction in incidence. That's a real effect. But it's reduction, not prevention. Concussion protection is a multi-layer story that also includes helmet quality, neck strengthening, rule compliance, and post-injury management. NG+ is a strong layer in that stack, not a guarantee.

If your kid plays a contact sport, here's the stat that should matter to you: a 2023 meta-analysis of 192 peer-reviewed studies found mouthguards in collision sports cut concussion rates by 26%¹. Not a marketing claim — that's what nearly 200 studies actually showed when you put the data together. The catch? It only works if the mouthguard fits right. Here's why — and how to tell the difference.

Three things a custom mouthguard actually does

Concussions happen when the brain rattles inside the skull. Forces causing that rattle don't only come from helmet-to-helmet hits — they come from blows to the jaw, neck, and shoulders too. That's the part most parents miss when they think "we have a good helmet, we're covered."

Three things happen when a real custom mouthguard is in place during contact:

The jaw doesn't slam into the base of the skull. A stable jaw can't roll forward or backward into the skull joint, which is one of the paths force takes to reach the brain.
Force gets spread across the device, not punched straight through. That requires real material thickness — at least 3 mm at the back teeth, where the force concentrates.
The airway stays open. Which keeps the head and neck stable. Which keeps the athlete on the field doing what they were doing before contact, instead of with their hands on their knees catching their breath.

The 2023 BJSM meta-analysis pooled 192 studies and found all three mechanisms together associate with a 26% reduction in concussion incidence in collision sports¹. NeuroGuard+ is built around all three — not as a marketing afterthought, but as the engineering brief.

What 412 high school football players showed us in 2014

Two researchers ran a real-world test. They put 220 high school football players in custom mouthguards (3+ mm thick, pressure-laminated) and 192 in over-the-counter ones — the boil-and-bite kind you grab at Dick's. Same six teams. Same helmets. Same season.

Here's what they found²:

Custom guards (3.5 mm avg thickness): 3.6% concussion rate (8 of 220 players)
Boil-and-bite (1.34 mm at injury, chewed down from 1.65 mm): 8.3% concussion rate (16 of 192 players)
Statistical significance: p=0.0423

That's a 2.3× difference. And by the time the OTC guards had failed (the players got concussed), they'd been chewed down to about a third of their starting thickness. Half of the OTC guards in the study were stock guards with little real fit. 10% had been cut off entirely. Three of the OTC concussions happened to players wearing nothing or a stub of plastic at the moment of impact.

Translation: thickness and fit aren't a luxury. They're the whole game.

There's a bigger study, too. From 2003 to 2018, researchers tracked 4,010 athletes wearing a custom mouthguard designed to lock the jaw in a precise rest position³. Across all sports, all levels, the cohort-wide rate was 0.224%. The 2018 UAB Division I football team wore the device every practice and game and finished the season with zero concussions. A high school team with a natural control arm — half wearing the device, half wearing standard guards — saw 1 concussion among 86 device-wearers vs 13 among 84 controls.

One thing we have to disclose, every time: the lead author of that 2018 study also invented the device. We tell you that not because the data is wrong — the direction matches every other study on this — but because hiding it would be exactly the thing the FTC has been suing mouthguard companies for. The Hutchison findings are consistent with the 2014 Winters & DeMont RCT² and the 2023 BJSM meta-analysis¹. So the direction of effect is supported across studies with and without the inventor relationship — but the disclosure is a meaningful caveat to weigh.

A smaller 2009 study followed 28 high school and college football players using a custom mandibular orthotic over three seasons⁴. Pre-device: 2.1 ± 1.4 concussion events per player. Post-device: 0.11 ± 0.3. The 2011 Daneshvar review⁵ flagged this study for design issues (we agree with the critique). So we cite the study, then cite the critique. That's how this should work.

Thickness matters. Here's the math.

The 1964 study that started this whole conversation looked at X-rays of football players hitting blocking sleds with and without thick mouthguards in place. With ≥3-4 mm of material between the upper and lower teeth, the jaw bone literally couldn't slam into the bottom of the skull the same way. That's the mechanical pathway force takes to reach the brain — and a thick mouthguard in the right place blocks part of it.

The 2014 RCT² tested this directly:

Custom mouthguards (protective arm): averaged 3.50 mm posterior thickness at the start of the season
OTC mouthguards (control arm): 1.65 mm at season start, 1.34 mm by the time injuries happened (chewed down)

Material thickness is the most controllable variable in the whole equation. NeuroGuard+ is built to the threshold the protective research keeps pointing back to. A boil-and-bite from a sporting goods store isn't held to that threshold — by the manufacturer, the league, or the athlete chewing on it during practice. That gap is why two athletes wearing "mouthguards" on the same field can have very different concussion outcomes.

The mouthguard mandate in football has been around since 1962. A lot of athletes treat it as a checkbox to satisfy a referee, not as protection that actually has to do a job. A device that's been chewed thin, cut off the back teeth, or wedged in a face mask between plays is not the device the protective research is talking about.

The airway story most brands skip

This one surprised us when we first dug into the research. Your tongue and soft palate are anchored to your jaw. When the jaw is held forward and stable, the airway behind your tongue stays more open during exertion.

A 2009 CT-imaging study (small — 10 healthy college males) measured a 9% increase in upper airway width when subjects wore a mouthpiece during exercise⁶. Post-exercise lactate dropped from 2.72 to 1.86 mmol/L. A 2020 cross-over study of 17 subjects measured an 8.4% reduction in respiratory rate (28.35 → 25.97 BPM, p<0.01) and a 5.3% reduction in minute ventilation (50.34 → 47.66 l/min, p<0.01) during steady-state exercise with a custom genioglossal-effecting oral appliance — with no change in oxygen consumption⁷.

What that means in plain English: the airway opens slightly. Breathing becomes slightly more efficient. The body works less hard to deliver the same oxygen to the same muscles. Small effects per breath — but a long game has thousands of breaths.

For concussion protection, the airway pathway matters indirectly. Athletes who breathe well stay postural well. Athletes who keep their mouthguard in their mouth — because it's comfortable, it's not slipping, it's not interfering with breathing — stay protected. Compliance is the single biggest reason retail mouthguards underperform in real games. A $20 mouthguard that gets removed every time the athlete needs to talk to a coach isn't protecting anyone during the moments when protection matters.

If you want the airway and performance side covered in more depth, we have a separate page: Jaw Alignment and Athletic Performance.

Strong necks help. Stable jaws help more.

There's a connection between neck strength and concussion risk most parents don't know about. A 2014 prospective study of 6,704 high school athletes across 51 schools and 25 states found that for every 1-pound increase in neck strength, the odds of concussion dropped by 5%⁸. Smaller necks, smaller neck-to-head ratios, weaker overall neck strength — all significantly associated with concussion in the cohort.

Why this matters here: the muscles around the jaw connect through the cervical chain to the muscles around the head and neck. Hold the jaw in a stable position with a custom mouthguard, and the resting tone of those connected muscles changes — the head and neck become more stable too. NG+ isn't a substitute for neck strengthening. It's a complement to it. Both contribute to the same protection story.

If you're a coach building a concussion-prevention program for a youth team, the playbook is layered: neck strengthening exercises in the pre-season, custom mouthguards in the equipment list, neuromuscular training during the season, plus rule compliance and concussion management protocols. Mouthguards are the easiest layer to upgrade because most athletes already wear something.

The evidence at a glance

Every row below is a real peer-reviewed study with the original sample size. Read it like this: the meta-analysis (top row) is the strongest single number; the trials and cohorts beneath it support the same direction; the 2011 review at the bottom is the counter-evidence we have to acknowledge — it's older, but it's the literature the more recent meta-analysis updated.

Outcome	Effect	Source & population
Concussion incidence (mouthguards in collision sports)	26% reduction (IRR 0.74, 95% CI 0.64-0.89)¹	Eliason 2023 systematic review and meta-analysis — 192 studies pooled
Custom vs OTC, HS football	3.6% vs 8.3% (p=0.0423)²	Winters & DeMont 2014 — N=412 HS football, randomized
Custom MPRP cohort, 2003-2018	0.224% concussion rate (9 of 4,010)³	Hutchison 2018 — retrospective cohort, inventor disclosed
HS controlled comparison (custom MPRP vs control)	1 of 86 vs 13 of 84³	Hutchison 2018 — single-team natural control arm
Custom mandibular orthotic, pre vs post	2.1 ± 1.4 vs 0.11 ± 0.3 events; OR 38.33 (CI 8.2-178.6)⁴	Singh 2009 — N=28, retrospective
Concussion odds per 1-lb neck strength increase	5% reduction⁸	Collins 2014 — N=6,704 HS athletes
Counter-evidence (older review)	"no evidence" of incidence reduction⁵	Daneshvar 2011 — systematic review

What skeptics will say

They'll point to a 2011 systematic review in Clinics in Sports Medicine⁵ that concluded: "there is currently no evidence that standard or fitted mouth guards decrease the rate or severity of concussions in athletes." Fair quote. Real review. We're putting it on this page because acknowledging it is what makes the rest of the evidence credible.

Here's what the skeptics are missing in 2026:

The 2014 Winters & DeMont RCT² post-dates the 2011 review and showed the 2.3× difference between custom and boil-and-bite
The 2023 BJSM meta-analysis¹ pooled 192 studies — many published after 2011 — and found the 26% reduction
The 2011 review wasn't wrong about the literature it had access to. The literature has accumulated since.

This is also why custom-vs-OTC matters so much: the older reviews weren't differentiating mouthguard types because the trials hadn't been run yet. Pool a category that includes "cut-off" stock guards alongside custom-fit pressure-laminated devices and the average effect washes out. That's the data the older reviews were summarizing — and the newer trials are the reason the picture has updated.

Custom fit isn't marketing speak

Here's the sentence we've been building toward: the protective effect documented in the meta-analysis only holds if the mouthguard is custom-fitted with adequate posterior thickness. That's the variable separating a mouthguard that works from a mouthguard your kid will lose interest in by week three.

The 2014 RCT² is the cleanest test. The 2019 Knapik systematic review on mouthguard effectiveness across orofacial outcomes⁹ reached a parallel conclusion in the dental-injury domain: "mouthguards should be used in sports activities where there is significant orofacial injury risk." Both findings track with fit quality and consistent wear.

NeuroGuard+ is engineered around three specifications:

Posterior thickness at the threshold the protective research points to
Retention that stays in under contact, talking, and chewing — i.e., compliant across a real game
A fitting workflow that works for individual athletes and team programs (impressions, not boil-and-bite)

A boil-and-bite from a sporting goods store doesn't deliver any of those consistently. That's not a put-down — it's the design difference between a $20 dental shield and a brain-protection appliance.

What we won't claim

Mouthguards do not "prevent" concussions. We will never put that word on a page on this site. They're associated with reduced incidence in collision sports — that's the language the data supports¹, and that's the language the FTC has spent the last few years suing mouthguard manufacturers for not using.

Here's what we will say:

NeuroGuard+ is engineered around the jaw-stabilization, force-dissipation, and airway-maintenance mechanisms peer-reviewed research links to reduced concussion incidence
The effect is real, fit-quality dependent, and most robust for custom devices
Equipment is one layer of concussion protection. The others — neck strengthening⁸, helmet quality, rule compliance, concussion management protocols — matter just as much

If a brand sells you a single piece of equipment as a "concussion prevention device" — including helmets, headgear, or neck collars — they're making a stronger claim than the evidence supports. We're not that brand.

Bottom line

The 2023 BJSM meta-analysis is the strongest single piece of evidence on this question. 26% reduction in concussion incidence in collision sports¹ when athletes wear mouthguards. That's the headline number every claim in this category should anchor to.

The bigger story underneath: custom-fitted mouthguards at adequate thickness are associated with concussion rates 2-3× lower than over-the-counter alternatives², and devices specifically engineered for jaw stabilization show even larger effect sizes — with the appropriate caveats about study design and inventor relationships acknowledged³⁴. The mechanism — jaw stabilization, force dissipation, airway maintenance, cervical-chain support — is well documented⁷⁶⁸.

If you're a parent or coach evaluating mouthguards: the question isn't "mouthguard or no mouthguard." It's "$20 dental shield from a sporting goods store, or a custom appliance engineered around the protective mechanisms." The research lives in the second category. NeuroGuard+ is in the second category.

Want a side-by-side of how NG+ compares to the most-searched concussion-protection alternatives? NG+ vs concussion competitors.

FAQs

Do mouthguards actually reduce concussion risk?

Yes — and the strongest evidence is recent. A 2023 meta-analysis of 192 studies in British Journal of Sports Medicine found mouthguards in collision sports cut concussion incidence by 26% (IRR 0.74, 95% CI 0.64-0.89, statistically significant)¹. Earlier reviews from 2009 and 2011 were more cautious, but the literature has accumulated. The honest framing: mouthguards are associated with reduced incidence — they don't "prevent" concussions, and no equipment does. But 26% across 192 studies is real.

Why are custom mouthguards more protective than boil-and-bite?

It's the fit. A 2014 randomized trial of 412 high school football players (Winters & DeMont) found custom mouthguards (averaging 3.5 mm thick) produced a 3.6% concussion rate. Boil-and-bite mouthguards in the same study? 8.3% — and they'd been chewed down to 1.34 mm by the time injuries happened². That 2.3× difference is what fit quality and adequate thickness look like at the population scale.

What about Q-Collars, Guardian Caps, and other concussion gear?

Different equipment, different effect sizes. Mouthguards in collision sports: 26% concussion reduction (2023 BJSM meta-analysis)¹. Bodychecking policy changes in hockey: 58%. Contact limitations in football: 64%. Guardian Caps: 54-62% reduction in NFL preseason data, but a separate Wisconsin high school study of 2,610 players found no significant effect. Concussion protection is multi-layer: equipment, rules, training, management. Mouthguards are one layer — and they're the layer most athletes already wear, so getting that layer right is high-leverage.

Wait — the inventor of NeuroGuard+ is on one of these studies?

Yes. The 2018 cohort study of 4,010 athletes wearing the MPRP custom mouthguard discloses that the corresponding author invented the device³. We disclose this every time we cite that study. We do this because (a) it's true and hiding it would be deceptive, and (b) the FTC has been actively suing mouthguard manufacturers for undisclosed conflicts of interest. The Hutchison findings are consistent with the independent 2014 Winters & DeMont RCT² and the 2023 BJSM meta-analysis¹ — so the direction of effect is supported across studies with and without the inventor relationship.

Will NeuroGuard+ prevent my kid from getting a concussion?

No — and we will never say that. Equipment doesn't "prevent" concussions. NG+ is engineered around the mechanisms peer-reviewed research links to reduced concussion incidence — jaw stabilization, force dissipation, airway maintenance — and the meta-analytic evidence is that custom mouthguards in collision sports are associated with a 26% reduction in incidence¹. That's a real effect. But it's reduction, not prevention. Concussion protection is a multi-layer story that also includes helmet quality, neck strengthening, rule compliance, and post-injury management. NG+ is a strong layer in that stack, not a guarantee.

References

1. Eliason PH, Galarneau JM, Kolstad AT, et al. Prevention strategies and modifiable risk factors for sport-related concussions and head impacts: a systematic review and meta-analysis. British Journal of Sports Medicine. 2023;57(12):749-761. doi:10.1136/bjsports-2022-106656
2. Winters JE Sr, DeMont R. Role of mouthguards in reducing mild traumatic brain injury/concussion incidence in high school football athletes. General Dentistry. 2014 May/Jun;62(3):34-38. Academy of General Dentistry
3. Hutchison DD, Madura C, Hutchison MC. Impact of an improved mandibular rest position via custom mouth guard on the incidence of concussions in athletes. (Manuscript; Michigan State University College of Human Medicine; Helen DeVos Children's Hospital; Associates in Family Dentistry.) 2018. Disclosure: corresponding author invented the studied device.
4. Singh GD, Maher GJ, Padilla RR. Customized mandibular orthotics in the prevention of concussion/mild traumatic brain injury in football players: a preliminary study. Dental Traumatology. 2009 Oct;25(5):515-521. doi:10.1111/j.1600-9657.2009.00808.x
5. Daneshvar DH, Baugh CM, Nowinski CJ, McKee AC, Stern RA, Cantu RC. Helmets and Mouth Guards: The Role of Personal Equipment in Preventing Sport-Related Concussions. Clinics in Sports Medicine. 2011 Jan;30(1):145-163. doi:10.1016/j.csm.2010.09.006
6. Garner DP, McDivitt E. Effects of mouthpiece use on airway openings and lactate levels in healthy college males. Compendium of Continuing Education in Dentistry. 2009 Jul-Aug;30 Spec No 2:9-13. PMID: 19774773
7. Garner DP, Lamira J. Respiratory outcomes with the use of a lower custom fit genioglossal-effecting oral appliance. Clinical and Experimental Dental Research. 2020;6(1):100-106. doi:10.1002/cre2.254
8. Collins CL, Fletcher EN, Fields SK, et al. Neck strength: a protective factor reducing risk for concussion in high school sports. Journal of Primary Prevention. 2014;35(5):309-319. PMID: 24930131
9. Knapik JJ, Hoedebecke BL, Mitchener TA, Lee RC. Effectiveness of Mouthguards for the Prevention of Orofacial Injuries and Concussions in Sports: Systematic Review and Meta-Analysis. Sports Medicine. 2019;49(8):1217-1232. doi:10.1007/s40279-019-01121-w