Heat-related illness continues to be a serious concern for student-athletes throughout the United States. In August, at least six teenage football players died, all linked to either heatstroke or head injuries.

One of those tragedies hit home in the greater Baltimore community as Franklin High School junior, 16-year-old lineman, Leslie Noble IV, collapsed at practice on Aug. 14 and died later that day. The Maryland Medical Examiner has not yet released a cause of death, but dispatchers that day referenced possible heatstroke.

Hearing these stories, Howard County dentist Dr. George Garbis became increasingly frustrated.

“I got angry,” Garbis said. “I got angry because I see this local kid dies. Then all of a sudden, I’m seeing this kid in Alabama. It’s like, ‘Wait a minute. This shouldn’t be happening.’”

Garbis has previously worked on preventing these kind of tragedies. In 2022, he and his partner, Viron Wildy, created the ThermoPact MouthShield.

The ThermoPact MouthShield is a custom-fit color-changing mouth guard meant to be an early detection device for heat-related health issues. When an athlete’s oral temperature rises to roughly 102 degrees, the mouthpiece changes color, warning coaches or trainers to take the athlete off the field and further examine them. It is also designed to absorb more force than a standard mouthpiece.

“Every single one of those deaths that occurred, every single one of those deaths could have been prevented,” Garbis said. “There’s no question in my mind that they all could’ve been prevented. It’s a simple thing. You have to wear a mouth guard anyway. Why not have something that’s going to detect if there’s an elevated temperature?”

Garbis, Wildy and the product’s seven-person sales team have worked to increase its awareness throughout the United States. They are partnered with the Jordan McNair Foundation and are the official mouthpiece of the Big 33 Football Classic, an all-star event featuring the top high-school football players in Pennsylvania and Maryland, and the Hula Bowl, a college all-star game in in Orlando, Florida.

In January, Garbis led a presentation about the ThermoPact MouthShield to all the team trainers and medical staff of the Canadian Football League. The ThermoPact MouthShield is now being utilized by some college athletic programs, including Southern University, which purchased 150 of them, and McNeese State University in Louisiana.

Dr. Jessica Robinson, Southern University’s Director of Sports Medicine, was first introduced to the product by ThermoPact partner and friend Ed Gardner. Robinson wanted to sample the product and invited Garbis to campus in March to fit the entire football team ahead of spring practice.

During the presentation, Garbis and Robinson emphasized to the players the importance of self-awareness and recognizing when their mouthpiece changed color. He also showed the athletic trainers how to custom fit the product.

“After we started talking and getting into it, they said, ‘You know what, there have been times when I feel like I was getting hot. But I didn’t know and I didn’t want to come off. I don’t like to wear a mouth guard because they’re uncomfortable,’“ Garbis said. “I got a lot of information out of them. Then, one by one as they’re coming up and getting fitted, we’re asking them questions: How do they wear the mouthpiece? Why do they wear one? All of that information and all of that education, I think sparked something in that program and said, ‘You know what, we have to wear something. We might as well wear something that’s going to help us be better and make sure that we get the best of our athletes.’”

With practices in the intense Louisiana heat, Robinson saw the product’s benefit. Throughout the spring she saw several players take themselves off the field after their mouthpiece changed color. She observed the color change and the product returning to its normal color after the players hydrated and the oral temperature decreased.

When a player’s mouthpiece changes color, Robinson and the training staff give the whole group a break. They direct players to the “cooling zone” under mist-blowing fans, hydrating with Powerade and water. After practice, all the players receive cold towels and head to the ice baths.

“If they’re starting to get overheated, the mouth shield will turn into a white color and you’ll see it in their mouth and say, ‘OK, it’s time to hydrate,’” Robinson said. “It allows you to be more alert and aware of what’s going on with your players. It’s really beneficial because it also helps with concussions. It prevents their jaw from shifting. We also used it for a study with the insurance to help drop our insurance premiums because of the heat exhaustion and concussion-based formula that’s part of the mouth shield.”

Robinson and the Southern University football team are still using the ThermoPact MouthShield. Most players have two, one for practice and one for games, while Robinson is also planning to have the men’s basketball team use them.

Since its release, the ThermoPact MouthShield has undergone multiple changes. From January to March 2023, the ThermoPact Mouthshield partnered for a study with the University of Connecticut’s Korey Stringer Institute, named for the former Minnesota Vikings lineman who died in 2001 from heatstroke complications.

Their study of 12 participants (six men and six women) found that the ThermoPact MouthShield can aid in recognizing if an athlete’s oral temperature is above 39 degrees Celsius (102.2 degrees Fahrenheit). It also showed that the ThermoPact MouthShield had a 100% sensitivity rate when body temperature is in a safe range, meaning it would not show false positives.

After the study’s findings, they redesigned the product to add the ThermoPact logo on the front as another visual indicator. As the mouthguard changes color, the logo becomes more pronounced.

Because of supply issues with the foam part of the mouthguard, they substituted a new material, partnering with D3O, which makes padding material for Olympic skiers. The new material absorbs more force compared with the old one, according to ballistics testing from the Canadian company Biokinetics. Biokinetics found that the initial mouthguard absorbed 20% to 50% more force than the other tested name-brand mouthguards, while the updated version absorbs about 20 to 60% more force than the original.

Every ThermoPact MouthShield now comes with a guard guide, which allows an athlete to mold the mouthguard better and create more of a custom fit. Garbis is hopeful the product will become more widely used as more people learn about its benefits.

“For me, if one life is saved, I’m ecstatic,” Garbis said. “These young men telling the coaches about the color change, it gives me the chills. It makes me so happy that this is happening and that they’re aware. I thought this was going to be an overnight thing. But what I’ve noticed, is that little by little we’re getting out there. More people know about it this year. More people are asking questions.

“It’s almost like people are afraid to try something new. They’re so used to that old cheap mouthguard that they can just throw away. I feel like there’s this dam and it’s just starting to trickle out little by little. … I’m hoping that this mouth shield will help trainers, coaches and athletes see something before it happens again.”