That’s how Bode Miller won Olympic gold in the men’s combined race today. But it’s also how he used to ski as a tyke on the cold, shady slopes of New Hampshire’s Cannon Mountain when no one was looking.

And what made him most thrilled today was not the color of his medal – his third this week – but the fact that despite all that was riding on his skis today, he was able to put that all aside and ski with the same joy and freedom he had back then.

“When I ski like that, it’s how I used to ski when I was little,” said Miller, after coming back from seventh in the downhill this morning to lay down an amazing slalom run. “You’re not thinking about all the things that old people are supposed to think about.”

Fatigue can be as much psychological as it is physical, especially for an NFL lineman who weighs in excess of 300 pounds late in a 16-game season.

After misplacing his neuromuscular mouth guard for a few games, Derrick Dockery, a 6-6 guard now in his second stint with the Washington Redskins, immediately recognized the difference.

Or so he thinks.

“The hardest part is to distinguish if it’s psychological,” Dockery says. “Is it? … I got more winded the games I didn’t have it in compared to the games I did have it. My breathing felt different when I wore it. It seems like you have more energy.”

All mouth guards are designed to direct and distribute the impact of force to the jaw to minimize injuries such as lacerations, damaged teeth and concussions. Neuromuscular mouth guards are different from the traditional boil-and-bite ones that can be purchased at sporting goods stores, and even from the custom-fitted ones dentists often make for individual players of pro sports teams.

Rather than focusing on the pre-existing relationship where the teeth come together and the jaw joints set in the sockets to find the bite like traditional dentists, neuromuscular dentists relax the muscles for a “verifiable position” that usually results in a joint socket position that’s typically more down and forward.

“If you pull the jaw forward, your tongue is forward, you have more space in the back. It’s that simple,” says Alex Naini of AestheticDentalSpa.net, a neuromuscular dentist in Vienna, Va., outside Washington D.C., who fitted Dockery. “Anything that pulls the jaw forward opens the airway and automatically releases tension in your jaw joints. You have more space to let oxygen into your lungs.”

Pro athletes from various disciplines, including the NBA, soccer, mixed martial arts, boxing, golf and Major League Baseball, have worn neuromuscular mouth guards because they believe they can maximize their natural abilities such as endurance, strength and flexibility.

By aligning the lower jaw over the C1 and C2 vertebrae, which sit atop the spinal column to connect the skull to the spine, a clear path is created to increase air intake. The oxygen bump is supposed to help the muscles perform stronger tasks and repeat those tasks longer.

Use of the appliance — originally developed to treat jaw joint disorders, which includes migraine headaches and ear, neck and joint pain — still isn’t widespread and has yet to gain acceptance among athletic trainers.

“Everybody’s looking for that edge over their opponent,” says Dockery, who also cites better balance and isn’t paid to endorse the product. “If it works, why not try it?”

The power train

It began with a theory in 1950 by the late Bernard Jankelson, the father of neuromuscular dentistry. He coined the name in 1967 after researching with H.H. Dixon, a muscle physiologist, at University of Oregon School of Medicine.

Jankelson graduated from dental school at Oregon in 1924, but biophysics had the imaging technology he needed to test his theory that stimulation could restore muscles to their normal function and resting length to eliminate muscle pain. That technique could then be applied to the jaw and facial muscles to kick-start a chain reaction to make the human body perform at a higher level.

“What we hypothesized is if you can get the muscle healthy before you set the jaw position, you will have a much more desirable muscle to help you generate efficiency for either force or speed,” says Robert Jankelson, 70, who joined his father in 1963 and has practiced for 45 years in the Seattle area.

The teeth function as the “gears,” he says, and it is imperative that they’re in sync with the joints and muscles to make recruitment of strength throughout the body easier.

The key lies in the temporomandibular joint (TMJ) — two three-dimensional ball sockets, one on each side of the face, that connect the lower jaw to the skull. The goal is to restore the ideal position of the balls in those sockets to align the muscles.

“That’s where that mouthpiece comes in. It allows the best joint function and recruitment of the power muscles of the jaw, that’s when you increase your athletic efficiency,” Jankelson says. “This power train goes all the way down, from the teeth, to the neck, the vertebrae, the back. The more you can get those articulations in a chain that will recruit the power muscles, that is your ultimate goal in repositioning the jaw.”

Since the advent of Gatorade in 1965, researchers of all stripes, athletes, athletic trainers and even dentists have sought alternative methods, liquids and devices to boost performance. Most notably, the U.S. Olympic bobsled and luge teams wore custom mouth guards produced by an orthodontist at the 1980 Winter Games. They claimed it was responsible for the bobsledders’ best results in 16 years and best-ever results for the lugers.

The mandibular orthopedic repositioning appliance, or MORA, was touted as a stress reliever for the TMJ that made decathletes stronger and college pitchers throw harder.

The Journal of the American Dental Association, however, published a 1984 study after 14 Louisville football players were tested using no mouth guard, a placebo and a MORA. It concluded there was no difference.

While the MORA was a start, it amounted to educated guesswork.

“It was hard for it to be reproducible, so the studies on its effectiveness were mixed because there was no predictability behind the technique,” says Gary Lederman, a New York-area neuromuscular dentist who has fit athletes such as Shaun Ellis (New York Jets) and Paulie Malignaggi (junior welterweight boxer). “There was no way to evaluate the athlete and find the precise point that it worked.”

David May, his West Coast partner at Fightdental.com, has fit a number of mixed martial artists, including Anderson Silva (UFC middleweight champion) and Lyoto Machida (UFC light heavyweight champion).

The difference between the MORA and a neuromuscular mouth guard?

Science, Jankelson says. The MORA relied on an orthodontist’s pinkie fingers being inserted into a patient’s ears to determine if the TMJ is misaligned. Then, in an attempt at realignment, the jaw was pushed forward.

Neuromuscular dentistry relies on the J5 and K7, the latter of which received the Seal of Acceptance from the American Dental Association in 1986 for its safety and effectiveness. The J5 machine uses low-frequency pulses to relax the facial muscles so the optimal position of the jaw can be found by the K7 using computer-assisted tracking.

Struggle for acceptance

Although there are notable athletes who have worn the mouth guard, such as Terrell Owens (Buffalo Bills), Shaquille O’Neal (Cleveland Cavaliers), Michael Redd (Milwaukee Bucks) and Suzann Pettersen (LPGA), it has not become mainstream or picked up by a pro sports league the way Breathe Right strips became commonplace in the NFL.

The New Orleans Saints this season began using neuromuscular mouth guards, which are not available over the counter. Marketing of the product has been minimal, and depending on the fee charged by the lab that makes it, it can cost as much as $2,000, though Naini says she can produce it for less.

The ADA, however, doesn’t recommend neuromuscular mouth guards. Even though it gave the K7 its Seal of Acceptance, the organization doesn’t recognize neuromuscular dentistry as one of the nine specialties. As of 2006, there were 179,594 active dentists in the USA, but neuromuscular dentists aren’t accounted for in those numbers (estimates are about 3%, or 5,388).

“Dentists push your jaw back. That’s what’s taught in dental school. Even though the science is overwhelming, there’s still resistance,” Jankelson says. “Nobody wants to be proven wrong that pushing the jaw back doesn’t make sense.”

John Norwig, the president of the Professional Football Athletic Trainers Society, wants to see the science tested through independent study in the USA, which has yet to happen.

“In the athletic training literature, there hasn’t been any landmark studies. This appliance may be a great breakthrough, but there’s not any hardcore research in any of my professional journals,” says Norwig, who has worked with the Pittsburgh Steelers for 19 years.

“What we try to do is use something that has some science behind it. Years ago, they didn’t use sports beverages, but now sports beverages are the standard of care. … If it’s something that works, I’m sure it’ll make its way into the NFL.”

Says Naini: “A lot of people just haven’t been exposed to it. They don’t understand it. And let’s face it, a lot of athletes who use it like keeping the edge to themselves.”

The undefeated New Orleans Saints are putting their money where their mouths are.

Forty of them are wearing custom-fitted mouthguards that retail for $2,000 each and are designed to give them increased strength, flexibility and endurance by optimizing their bite.

“I wouldn’t have dreamed in a million years that I’d be wearing a $2,000 mouthpiece,” Saints cornerback Tracy Porter said. “That’s like a grill.”

Regardless, Porter does wear one, and he and other proponents of the device — the Makkar PPM (Pure Power Mouthguard) — swear that, for them, it’s worth the investment.

“If there’s 2%, 5%, any percent of benefit, and it’s good for your safety, who are we kidding?” NFL coach-turned-broadcaster Jon Gruden said. “This is a game of inches, man.”

Gruden gave the PPM some priceless publicity this week, when he raved about it on “Monday Night Football” during the Saints’ victory over Atlanta. He said the mouthguards — the mouthguards! — were among the factors that gave the Saints an advantage.

A few days earlier, Gruden had undergone his own PPM fitting, and he plans to wear it while working out. The company has trained about 400 dental experts around the country to conduct the fitting sessions, which can take up to two hours. The company doesn’t just make mouthguards for football players, but for all types of athletes including baseball and basketball players (Shaquille O’Neal is a client), boxers, and even swimmers and golfers.

During the fitting, a computer monitors the muscles in an athlete’s face and a low voltage is delivered through the jaw to determine the optimal bite location. The mouthguard — an upper, lower or both — is then built to those specifications.

(According to a spokesman for PPM, which is based in Ontario, Canada, neither Gruden nor the Saints are affiliated with the company but did receive their mouthguards at cost, about half the retail price.)

So what makes the PPM the Maybach of mouthpieces, setting it apart from the boil-and-mold versions you would find in a sporting-goods store?

The difference is what the devices are meant to achieve. Both protect teeth. The PPM, based on neuromuscular dentistry, is designed to align the lower jaw in an optimal position and thereby help align the rest of the body.

“When the jaw is down and forward, the back of your neck starts aligning with the back of your spine,” said Dr. Anil Makkar, a dental surgeon who developed the product in 2006. “When you have total alignment you have increased strength, balance, range of motion, and an increase in flexibility and endurance.”

There are three versions of the PPM, ranging in price from $595 (a basic model that doesn’t require computer fitting) to $2,000.

Research funded by PPM and conducted at Rutgers University concluded the mouthguard “appears to enhance peak power output and performance in explosive, short duration bouts of exercise. However, it does not appear to enhance sustainable power output or muscular endurance.”

The study looked at 22 amateur and professional athletes and conducted several tests comparing their performances while wearing traditional mouthguards versus the PPM.

“I was fairly surprised at what it did to the power output, at least to the magnitude that it did it,” said Dr. Shawn Arent, who conducted the study as the school’s director of the Human Performance Lab. “We didn’t test aerobic or cardiovascular endurance for, say, a distance runner or a cyclist. What we were testing was more like a sprinter, or a football player, or a wrestler.”

The mouthguard doesn’t work magic. Arent said the PPM had beneficial effects when the subjects were biting into it, but “when you start breathing real heavily and you open your mouth, now it’s just a mouthpiece. Your jaw goes back into its normal position.”

Gruden, for one, is convinced. He said players have told him the mouthguard makes a difference, and he believes that sets it apart from the constant stream of gimmicks and devices people have pitched to him.

“I’m the most skeptical guy there is,” he said. “I’ve heard people say, ‘Hey, I’ve got a gimmick for you. You’ll have washboard abs in three days, and a 48-inch vertical jump in three weeks.’ I’ve had people try to sell me things, ‘Hey, wear this jersey and you won’t have any heat problems. Put this sunscreen on and this will work for you.’ There’s a billion gimmicks, and I’m skeptical of all of them.

“But this thing is worth people looking into, I’ll say that. It’s one of the most interesting things I’ve seen. . . . You’d have a hard time fooling with pro players. An NFL player would not put a $2,000 mouthpiece in his mouth if it didn’t work. That I do know.”

Because, even for a millionaire athlete, that isn’t chump change for a chomp change.

sam.farmer@latimes.com

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“Plain and simple, the PPM™ is the most important piece of equipment in my golf bag! I will never play without it again.” – SCOTT McCARRON

The PPM KEY is available only through our network of certified PPM™ dentists. Through patent-pending diagnostic and performance testing processes, a PPM™ dentist works with you to evaluate various alignment-performance measures to determine your personal “performance key” – the position that is demonstrated upfront to provide instant improvements in strength, range of motion, range of vision, balance and flexibility. You will see the potential improvements in your PPMTM dentist’s office and will know right there and then how the PPM Key will help you improve in your sport or athletic activity.