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Original Issue


Fast, fast, fast relief from pain and puny performances is on the way, thanks to Dr. Richard Kaufman and MORA, the mouthpiece for athletes suffering from TMJ distress

For anyone who watched the luge competition at the Lake Placid Olympics, the most profound impression left by the sport was one of weirdness. Striking a weird pose on a weird contraption, these weirdly dressed athletes—they wore flimsy, skintight jumpsuits of the most sinister hues—went careening down a weirdly twisting course. Ah, but perhaps the weirdest thing of all about the lugers, at least those on the U.S. team, went unnoticed. They wore mouthpieces. Nothing strange about that—except that the Americans wore them not to protect their teeth but because they believed the mouthpiece to be a secret weapon that infuses its wearer's muscles with extra strength, heightens his concentration and, especially, makes pain go away. Crazy, right? Well, what do you expect from people who voluntarily go shooting through icy turns at 60 mph while lying on their backs?

That's just the point. Lugers must keep their heads slightly raised so they can see to steer their rocketing sleds. This means their head and neck muscles are constantly tensed during runs, and that strain is exacerbated by forces of two to four Gs. All this stress causes severe headaches. There's hardly anything a luger will not try if it promises to alleviate the throb of nagging headache pain, and this was what the mouthpieces were said to do. As it turned out, they did, really. In addition, the U.S. luge team achieved its best results ever in an Olympics, and the bobsledders, who were quick to put the bite on the magic mouthpieces after hearing of the lugers' success with them, performed better than they had in 24 years.

The mouthpiece in question isn't the horseshoe-shaped soft rubber thing that can be bought in a sporting goods store for a couple of dollars. This mouthpiece is small and nearly weightless, two strips of acrylic material that fit precisely over the lower molars and the bicuspids. They're held painlessly in place by two small stainless-steel clasps that latch between the first and second bicuspids and a bridge of stainless-steel wire that passes behind the lower incisors. It's very comfortable and easy to install, and most wearers can speak clearly with it in their mouths. They can even eat while wearing one.

The mouthpieces used by the lugers and bobsledders were made to measure by Dr. Richard Kaufman, a 42-year-old orthodontist from Oceanside, N.Y. Kaufman belongs to a small group of doctors who are active in the virtually unheard-of field of sports dentistry. 'The head is often ignored in the development of an athlete," says Kaufman. "A dentist can control 50% of the body." Over the past six years, Kaufman has helped people to perform better and feel better by giving them something to sink their teeth into.

The luge team first learned of Kaufman's magic mouthpiece from Carole Maddox, mother of luger Jim Maddox. Carole, a registered nurse, had seen Kaufman being interviewed on TV and urged her son to be fitted for the appliance. After a while not only did Jim notice he didn't get headaches when he wore the piece, but U.S. Coach Piotr Rogowski also observed that Maddox didn't crash as often as he had, that, in fact, he seemed better at controlling his sled. Rogowski, a native of Poland who came to the U.S. in 1974, recalls that he had to submit to thorough dental examinations as a competitor in that country in the 1960s and suspects that all the top Eastern European lugers have been wearing mouthpieces for years.

Last January Kaufman was invited to come to Lake Placid and make mouthpieces for 16 lugers who were training for the U.S. Olympic team. Debbie Genovese, a 25-year-old dental assistant from Rockford, Ill. who wound up 15th in the Games, tying the best finish for an American woman ever, said, "I feel the mouthpiece really improved my performance. I felt more comfortable on the sled when I was wearing it. It reduced my headaches and kept my teeth from chattering."

Joe Tyler, 32, of Saranac Lake, N.Y. is one of eight bobsledders who ordered mouthpieces and, together with Brent Rushlaw, came in a respectable sixth in the Olympic two-man competition. "Our sport is just as jarring as the luge," he says, "and the mouthpiece acts as a shock absorber. But the greatest benefit I got from wearing it was an increase in strength while lifting weights. The biggest change took place in my legs."

Tyler says that he was able to do four soleus calf raises of 135 pounds without the mouthpiece. Wearing the mouthpiece, he is able to do as many as 20 reps. Tyler, a brakeman, does most of the pushing at the start of a bob run. Once he started using his mouthpiece he lowered his push time over the first 50 meters to less than five seconds. "I had been trying to break the five-second mark for six years," he says.

All this seems to call for comparing Kaufman's mouthpiece with Samson's hair, but, according to Kaufman, the mouthpiece doesn't add power, it simply releases strength a person already has that's tied up by stress. Strength is sapped when one's jaw is out of whack or when one's teeth are not properly aligned. One may even have such manifestations of TMJ distress without knowing it. Those initials refer to the temporomandibular joint, which connects the lower jaw to the skull. If the TMJ is under stress because of an imbalance, it uses up muscle strength, causing fatigue and pain. "It's like sitting on the edge of a chair," says Kaufman. "You can't do it for long without straining all sorts of muscles." Kaufman estimates that about 80% of the U.S. population suffers from TMJ misalignment but that most people are unaware of the cause of their discomfort.

"What Happens is that the brain picks up the fact of the misalignment from the bite when you swallow, from your teeth when they touch," says Kaufman. "Then the brain sends the message to, let's say, your arm to compensate for the misalignment, and the arm has to work that much harder and it will tire faster."

Kaufman's mouthpiece, which he calls MORA—for mandibular orthopedic repositioning appliance—and which he custom-makes for $350, corrects the misalignment. It fills in any unevenness between the upper and lower teeth, even spaces where teeth are missing, and lines the teeth up properly. It also lowers the bottom jaw and brings it forward, taking pressure off the TMJ. Consequently, most headaches disappear, even cases of scoliosis (curvature of the spine) can improve, and the wearer experiences a feeling of well-being enhanced by extra energy and strength. While this may sound like a snake-oil pitch, the fact is that these improvements can be measured.

Paul Anderson, a 22-year-old decathlete at C.W. Post College in New York, has been training and competing with his MORA since January. He has discovered that it helps him most in the pole vault and the weight events. "I used to average 14 feet to 14'6" in the vault," he says. "The week after I got the mouthpiece I cleared 15 feet for the first time, and now I clear it pretty regularly. My personal best in the shotput has gone up by almost three feet."

Before the 1979 fall college baseball season, Kaufman fitted New York Tech pitchers Hank Iervolino and Nick Melito with mouthpieces. After the season, Iervolino said, "I was definitely throwing harder. I used to rely mainly on my curve and slider. This fall I went more to my fastball, and I was blowing it by the batters more frequently. I pitched more than 250 innings this year. I should have been tired, but I wasn't."

Melito added, "I don't know if I was throwing the ball faster, but I was throwing longer without getting tired. I seemed to have more strength and stamina. When I tried pitching without the mouth guard I got tired quicker and I felt more pain in my arm afterward. Some might say it's psychological, but I don't think so."

Kathy Martin, an 18-year-old lacrosse player at Massapequa (N.Y.) High, has had a severe case of TMJ distress since childhood. She suffered frequent headaches and her jaw was often sore. When she was 10 she wore braces, and her orthodontist made her wear a chin strap at night. Other doctors told her not to eat apples. She bought her first mouthpiece, the standard plastic kind, for protection when she began playing lacrosse in ninth grade, but it was so cumbersome that she had trouble breathing while wearing it, nor could she talk. "When I wanted to yell something to my teammates, I had to take the mouthpiece out," she says. "I play 'cover point,' I'm right in front of the goal, and when the ball's anywhere near our goal, I really have to yell a lot." Besides, the mouth guard did nothing to alleviate Kathy's headaches, which were especially severe when she ran, and a lacrosse game amounts to almost an hour of constant sprinting.

Last March, Kaufman fitted Kathy with a MORA, and she has been free of headaches ever since. She used to wake up in the middle of the night with headaches, but now that she has gotten used to wearing the mouthpiece while sleeping, she no longer wakes up before morning. When she gets out of bed she feels "full of energy."

The MORA will cushion a blow to the top of the head or under the chin, and it may help prevent concussions, but it isn't recommended for heavy contact sports, such as boxing or football (except perhaps for quarterbacks), where more complete protection is needed. For athletes in these sports, Kaufman makes a larger mouthpiece that covers the top and bottom front teeth. Even though this mouthpiece is made of softer plastic material, it, too, has been shown to increase strength, but to a lesser degree than the more precisely fitted, more rigid MORA.

Most athletes who visit Kaufman have come to get the MORA. Typically, during a patient's first session, when Kaufman takes impressions of the patient's bite, he also uses a few simple demonstrations to persuade the patient of the Tightness of his decision to get a MORA. Kaufman sticks his pinkies into the patient's ears and asks him to open and shut his mouth. The patient will most likely feel either his jaw pressing back against the pinkies or a popping sensation in one or both of his jaw joints, a phenomenon that is known in the jaw biz as "the click." Each of these signals a misalignment of the TMJ, but the click indicates a more severe problem. It means that the disk separating the condyle (top of the jaw) from the skull doesn't move in unison with the condyle. Therefore, the condyle snaps over the thick part of the disk and produces an audible click.

Next, Kaufman shows how the TMJ and the bite are tied to muscle strength. He asks the patient to stretch out one arm and resist while Kaufman tries to push the arm down. Kaufman, whose arms tend to flab rather than brawn, doesn't succeed. Then the patient is asked to press down with two fingers on his right TMJ—the spot where the lower jaw meets the skull in front of his right ear—while his left arm remains outstretched. This time, Kaufman lowers the extended arm with ease. Kaufman then realigns the patient's jaw—which usually means pushing it forward—to simulate the effect a MORA would have and gives him two cotton wads to bite on while he again presses on his right TMJ and attempts to resist Kaufman's push on his outstretched left arm. The patient finds that his strength has returned. In fact, measured on a kinesimeter, his strength while biting the wads registers considerably higher than in the first phase of the demonstration.

The relationship between bite and strength is borne out in a study conducted by a doctor who isn't a dentist. Jeffrey Cartwright-Smith, Ph.D., of the department of psychology at Vassar College, measured the effect of a grimace—a facial expression made by altering the position of the bottom jaw—on the strength of the hands. Working with 32 subjects, he found that grimacing produced a significant increase in hand strength.

Dr. Stephen Smith, director of the Temporomandibular Orthopedics Center at the Philadelphia College of Osteopathic Medicine, has for several years been fitting some members of the Philadelphia Eagles with his custom-made protective mouthpieces and "bite-adjusting" the regular mouth guards of others. "What we have been finding through the use of mouthpieces is an increase in body muscle strength," says Smith. "Even if you take someone who has a good solid bite to start with, he gets better muscle bracing with the mouthpiece. And we definitely had fewer concussions. In fact, the players who wore mouth guards all the time have had none. Physically you have a change in the stress factor. It seems to be a very deep-seated neurological change, a change in the electrical firing pattern from the motor cortex in the brain. With the mouthpiece in, the muscle is suddenly stronger. In some cases, you get a doubling in muscle strength all over the body."

One of Kaufman's mentors in his study of TMJ syndrome has been Dr. Harold Gelb, the former director of a temporomandibular joint clinic in Manhattan. Dr. Gelb has dealt with TMJ cases for 25 years, primarily working to cure such problems as backaches and headaches. "My practice deals strictly with pain," he says. Interest in relieving pain is only part of what led Kaufman to his study of the MORA's use in sports. Six years ago it hit him that his profession might actually be doing harm by straightening a person's teeth solely with braces without giving much thought to repositioning the jaw as well. So, for these patients and others with head, neck and back aches from TMJ distress, he prescribed MORAs. To his surprise, some of the high school and junior high school athletes he treated came back saying that while wearing MORAs they were able to hit a baseball farther or lift more weight. Kaufman took to studying these unexpected side benefits of the device and now, several years later, his offices at the Medical Center in Oceanside are becoming a mecca for athletes.

A couple of months ago, Kaufman was visited by Al Oerter, who lives in nearby West Islip and often trains at C.W. Post College. Oerter won the gold medal in the discus in four consecutive Olympics—1956, '60, '64 and '68—and now, at the age of 43, is pursuing a comeback.

"You are overdosed," Kaufman said as he examined Oerter's teeth.

"I have a history of upper-spine problems," Oerter said. "I had to wear a cervical collar for eight years of competition. I don't wear it anymore because of the muscle I've been putting on in my shoulders through new training techniques, but the spine problem is still there."

"You should see a change with this," Kaufman said, producing a MORA he had made for another patient.

Oerter, manager for Grumman Data Systems Corp., began acting as if he were investigating a contract proposal: "Do I wear it all the time? What are the dangers? I've been lifting weights a lot lately, and when I feel really strong, I worry about knee problems."

Kaufman: "Your body will work more efficiently and you may be able to take more stress."

Oerter: "Should I bite down very hard?"

Kaufman: "If you bite hard normally."

Oerter: "I don't bite hard normally. I don't really know how much I bite down during the execution of a throw. I've never been aware of it. I'll have to experiment. There's no way I can bite the device in half or something?"

Kaufman: "Plastic can wear. It can fray at the edges. But I can just smooth it off or add more plastic to build it up. You just go in and do your thing as you've always done it. The more you get used to it, the more comfortable it is."

Oerter: "No trouble with ingesting?"

Kaufman pointed to the small wires that would hook onto Oerter's teeth. "You can eat with it, Al," he said. "If you take it out you may lose it. I knew a luger who took it out and put it on his lunch tray. He lost it.

"In 10 days your mouthpiece will be finished. It's also a non-surgical face lift, you know. As the jaw is moved down and out, it takes away wrinkles."

Oerter: "That's not important in discus throwing."

In the ensuing strength test, Kaufman managed to lower Oerter's arm about five or six inches when Oerter pressed on his TMJ without the cotton wads to bite on. Oerter acknowledged this weakening reluctantly.

After taking impressions of Oerter's upper and lower teeth, Kaufman found that his new patient's lower teeth are one half tooth off center. Oerter is also missing his upper 12-year-old molars, and his jaw is out of alignment. The MORA for him would be built to take all these flaws into account.

Recently Oerter was asked to comment on the benefits of his MORA after having worn it for several weeks. "What the hell is a MORA?" he asked. "Oh, the bite plate." Then he reported, "It certainly doesn't hurt to wear one, but to what extent it helps isn't known yet. It does help my lifting. I seem to be able to apply a little more strength by biting down on the plate and holding. There is less tension in the upper neck—which is very important to me because of my neck problems. There is less pressure with the bite plate. I don't think I experience the same increase in throwing, but if I can get an increase in lifting, it will eventually help the throwing. One drawback during competition is that it makes your mouth dry, which can be very disconcerting. Also, if you forget to bite down on it during competition, the effect is zero, at least as far as I am concerned. But so far it hasn't hurt, so I'll continue using it. The only way I can find out what it could eventually do for me is by continuing to experiment."

However, wearing the mouthpiece at the Mt. SAC Relays in April, Oerter won the discus with a throw of 214'3", beating both Mac Wilkins and John Powell. "It's the first time I've been able to get in front of them," he said. At the UCLA-Pepsi Invitational three weeks later. Oerter finished third, behind Wilkins and Powell, with a throw of 211'3". Considering that Oerter won his last Olympic gold medal with a 212'6½", it all conjures up visions of a Miracle Mouthpiece-equipped Oerter as a straight-jawed septuagenarian still going for gold medals.



Kaufman, an orthodontist, theorizes that his mouthpiece doesn't add strength, it simply allows a person to make lull use of what power he's got.



Lacrosse player Kathy Martin got rid of her chronic headaches and now talks up a storm with MORA.



First time he wore a MORA, Oerter beat Wilkins and Powell.



Kaufman's portrait of the U.S. luge team: bad bites abounding.