An Introduction to Sports Injuries & Dentistry

Treatment, prevention and other issues affecting athletes' performance and well-being

(Continued)

Four categories that are often used to measure risk associated with sports injuries:

Age — At present and in general terms the younger ages (prior to the teen years) tend not to be injured as often. For professional, high level collegiate, amateur, and adult players, oral-facial injuries decline from the teen years, probably due to the level of skill of the participants, however they tend to be more serious when they do occur.
Gender — Even though more females are playing high-level competitive sports every year, dental injuries still seem to still occur more often in men, although this difference is not very great.
Dental Anatomy — Most often in sports terms this simply means ‘how prominent are the front teeth’ or how much do they “stick out.” Technically this is called “overjet.” It is commonly held that over 80% of all dental injuries involve the upper front teeth. Simply put and perhaps obviously, the further the front teeth “stick out” the more likely the potential for injury and consequently the higher the need for mouth protection and orthodontic correction (braces).
Sport Type — This is the category most athletes and parents want to know about. Which sports are the most dangerous and what are the best means of protection? One look at the largest of international sports meets, the Olympic games, reminds us that the number of organized sports across the globe is practically unlimited. A simple and useful categorization of sports consisting of Low and High Velocity Non-Contact Sports, Contact Sports and Collision Sports, underscores the need for protection.

General Management

Because optimal treatment results follow immediate assessment and care, dentists have an ethical obligation to ensure that reasonable arrangements for emergency dental care are available. The history, circumstances of the injury, pattern of trauma, and behavior are important to dental health professionals in distinguishing between non-abusive injuries and those from abuse. Dentists and physicians have the responsibility to recognize, determine and either appropriately manage or refer individuals with acute oral traumatic injuries, as dictated by the complexity of the injury and the individual clinician's training, knowledge, and experience.

Compromised airway (breathing) or suspected loss of consciousness requires further evaluation by a physician. CPR (Cardio-Pulmonary-Resuscitation), heart and breathing support skills, are universal and good to know, and necessary until Emergency Services arrive.

Care for Oral-facial Injuries

To efficiently determine the extent and correctly diagnose injuries to the face, jaws, teeth and associated structures, a systematic approach to trauma is essential. Assessment includes a thorough history, visual and radiographic (x-ray) examination, and physical evaluation. Treatment also takes into consideration the patient's health and developmental status.

Most sports-related dental injuries can be classified into three broad categories resulting from impacts sustained during play to the soft tissues, the jaws and the teeth themselves:

Soft tissues — bruises, cuts and lacerations to the lips, cheeks, gums or tongue. These wounds will require careful cleaning and debridement to make sure there are no entrapped pieces of tooth or dirt. If lacerations are extensive, sutures (stitches) may be necessary. If puncture wounds are present antibiotic treatment together with tetanus toxoid shots may be necessary to prevent serious and life threatening infection.
Jaws — Dislocations of the lower jaw (mandible) and/or fractures of upper or lower jaws. Trauma to structures beyond the teeth and their supporting bone, such as jaw bone fractures will require more complex testing and scanning. Simple jaw dislocations are generally fairly simple to correct. Jaw fractures, depending on extent and location, may necessitate anything from simple fixation or splinting (joining together) of a group or groups of teeth, to open surgical fixation and pinning under general anesthesia. Jaw fractures will usually require more sophisticated imaging techniques to determine the extent and location of fractures to allow the proper methods of repair. They will usually require the skills and expertise of oral maxillofacial surgeons, dentists who have specialized in this area.

Over 80% of all dental injuries involve the upper front teeth.

Dental — Anything to do with the teeth from crazing or simple chipping, to complex fractures or avulsions (the tooth removed from its socket). More serious conditions occur when the teeth are fractured, a term that refers to a break in the outer protective layers of a tooth, the enamel and dentin. If the fracture is serious enough to expose the tooth's inner pulp, immediate attention from a dentist will be needed to reduce the risk of losing the tooth, by treating the exposed pulp and nerve tissues.

The main goal is to salvage the affected teeth whenever possible: to maintain health, function, aesthetics and avoid tooth loss. Modern dentistry can also employ methods to secure and treat chipped, fractured, loosened or displaced teeth by splinting, or otherwise stabilizing them during the healing process, as we shall see.

Assessment, diagnosis and treatment will differ for damaged baby and adult teeth depending on many factors including the state of development of underlying (un-erupted) permanent teeth — all of which will be discussed in later sections of this issue.

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Review Date: 8/1/2010
Authored By: Dr. Stephen C. Mills
Reviewed By: Dr. Garry A. Rayant, Editor-in-Chief, Dear Doctor, Inc.