31 Jul Sports Dentistry
As summer will soon come to a close, we’ll be embracing my favorite time of the year, fall! Not only do we get a little reprieve from the scorching heat and the long car trips with the kids in the back seat yelling and fussing, (not to mention the smells) but it’s the beginning of school and thus school related sports! It’s a good time to talk about sports related dental injuries, how to help prevent these injuries, and finally what to do in case of an injury.
I had the privilege of playing football through my “younger years” including my time at Western Kentucky University. Following graduation from University of Kentucky College of Dentistry and return to the Bowling Green area in the late 90’s, I was fortunate to become a member of the medical staff and named one of the team’s physicians at WKU. This allowed me to stay connected and continue my passion with athletics in combination with dentistry. I’m committed to this area of dentistry and an active member of the Academy of Sports Dentistry.
Unfortunately, dental related sports injuries are pretty common. In an article “Sports Related Dental Injuries and Sports Dentistry-Statistics,”it’s reported there are approximately 5 million teeth a year avulsed or “knocked out.” The Journal of Sports Medicine reports that over a billion(+) dollars are spent each year to replace or fix injured teeth in pediatric patients alone. Dental injuries happen to both boys and girls but are two times more likely in boys. And they can happen in all sporting activities; not just full contact sports such as football. Basketball has the highest incidence of sports related oral injuries.
Through the years of first-hand experiences, I’ve seen more oral related trauma and injuries in basketball followed by baseball than any other sports combined. But, I’ve seen and treated injuries in many sports ranging from women’s soccer to rugby. Just because a sport requires protective gear or equipment covering most of the body, an athlete isn’t necessarily less susceptible to dental trauma, in fact, they may be at greater risk!
Some of the most common oral injuries are :
- avulsion (tooth is out of the socket and mouth and knocked out)
- displacement or subluxation (tooth remains within the socket but is pushed backward, forward, or almost out)
- intrusion (tooth is pushed “deeper” into the socket or bone)
- concussion (tooth is hit and remains in socket but inflammation to supporting structures-periodontal ligament)
- vertical and/or horizontal tooth fractures
- Type I – mild with a slight “chip” of the enamel or outside part of the tooth
- Type II – enamel and dentin
- Type III – enamel, dentin, and nerve Exposure
- Type IV – most severe which involves the enamel, dentin, and nerve-root)
- root Fractures
- damage to existing crowns and dental work
- fractures to the maxilla (upper jaw), mandible (lower jaw), and orbit (eye socket),
- lacerations to lip and/or gum tissue
There are mandates at all levels (peewee, high school, NCAA) requiring athletes in specific sports to wear a mouthpiece. Those sports include football, field hockey, lacrosse, ice hockey, and wrestling (if wearing orthodontic appliance). If you play in any sport where there is potential contact with another player or with a ball or moving equipment, wear a well-fitted mouthpiece.
For years, the biggest complaint was mouthpieces were uncomfortable, ugly, and uncool. And the thing I hear most, “It’s never going to happen to me.” Mouthpieces have advanced in technology thus helping with the comfort and cool factors. Well known sports stars in the NBA like Lebron James and Stephen Curry wear them and take the precaution to protect their teeth, lips, and jaw.
Mouthpieces need to have the appropriate thickness of approximately 3mm (pediatrics/youngsters with mixed dentition) up to 5mm (extreme sports like boxing, kickboxing, martial arts, football, ice hockey, etc.). However, with most sports, the recommendation is 3.5mm of thickness. This thickness not only protects the teeth from vertical and horizontal forces, but protects the jaw and temporomandibular joint from those forces, and although not founded, there is ongoing research on the effects it has with aiding in concussions. Research is also showing that athletes who wear custom made mouthpieces can breathe and speak better than they would if wearing a non-fabricated mouthpiece.
A mouthpiece also needs to fit over the entire tooth surfaces including front and back of the tooth to the gums, which will aid in the prevention of laceration to gums and lips but protect the teeth from horizontal forces and increase the stability of the appliance.
There are several types of mouthpieces and ranging from a few dollars to hundreds of dollars. Two common types are stock and boil-and-bite, and they can be found at any sporting or big chain super store. Although they are better than nothing, the problem with these appliances is they lack the appropriate thickness, support, stability, and comfort for them to be effective. Boil-and-bites are better than stock mouthpieces because they are at least somewhat adapted to your teeth. The boil-and-bites have gotten better over the years with the thickness, comfort, and colors/designs but still lack the total support and stability.
The custom fabricated mouthpiece is the best. Although they are more expensive and require multiple appointments with your dentist, (impressions and typically a few days for fabrication, delivery, and fit) it will have the required thickness of the material, surround your teeth/dentition perfectly, and can be made in multiple colors and designs. There are two forms of custom fabricated mouthpieces: vacuum and pressure laminated. Discuss with your dentist which system they use.
Athletes with Mouthpieces
What do you if you forget to wear your mouthpiece or if a freak accident occurs?
The immediate course of action when there’s an injury depends on if the tooth is a primary (baby) or permanent (adult) tooth. If the tooth is a permanent tooth (adult crown and root larger in size and well-formed and usually those 6-8 years of age and older-for the front teeth)and is completely avulsed or “knocked out” of the mouth, pick the tooth up by the crown and not the root surface. If debris such as dirt is on the root then carefully take bottle water, milk, or even put in your own mouth if no clean liquid is near, to clean it off very carefully and then re-insert in the socket as soon as possible.
People ask how do they know which way it goes into the socket? Look at the tooth beside it or on the other side of the mouth and use it as a guide. It takes only seconds to minutes for the cellular activity and nerve of the tooth to die so the quicker the tooth can be re-implanted the better. If you are too uncomfortable or scared to re-implant, then contact your dentist as soon as possible to meet them at their office to re-implant and splint the tooth in position.
With a primary (baby tooth), the crown and root of the tooth will be much smaller, and the root may be small and have the appearance of being “eaten up,” which indicates the normal exfoliation or loss of baby tooth process. If in question contact your dentist.
It’s critical that your dentist is on call or they have the ability to have someone cover for them if they are out. Check to see if your dentist has emergency care coverage. At Bluegrass Oral Health Center, we have five dentists on staff and take coverage for not only our offices but for the ER Departments at both local hospitals. If your dentist cannot be contacted or you don’t have a dentist, then go to the nearest ER Department.
When teeth become avulsed, displaced, subluxated, or traumatized, the likelihood of the teeth becoming necrotic or dying is very high and depending on the severity of trauma and length of time can factor the prognosis. With these injuries, the following will likely happen:
- cleaning of the area and/or tooth for re-implantation or re-positioning within the socket
- x-rays as needed
- splinting of the tooth or use of an appliance to fixate in the proper position for several weeks (1-2 months)
- suturing of any lacerations to lip or gum
- placement on an antibiotic regimen
- soft diet
- monitoring very closely on a monthly basis over the next three months, then once every three months, then once every six months or at your regular Recare appointments.
Unfortunately, most of the time when a tooth, or teeth, receive a forceful traumatic injury they will die or in time may go through a resorption process and thus require root canal therapy and restorative work, such as a crown, or even at worse an extraction. This then will require future treatment to replace the missing tooth such as an implant, bridge, or partial denture. That’s why it’s critical to have a plan of action and a dentist that can take care of these needs.
If the trauma to the tooth is a “chip” of the enamel or dentin and does not expose nerve or root surface, then these types of injuries can be addressed with your dentist at the earliest appointment. As above, if the nerve or a “pink” spot is seen then immediately contact your dentist. It is wise to contact them to explain the nature of the accident and the trauma received.
This is a lot of information to absorb but can be very helpful in a critical time. Remember always to stay calm and do not panic.Have your dentist on your contact list for emergencies. Also, remember we are dealing with the part of the body that heals very well and with the wonderful advancements and technology in dentistry, most teeth or areas can be either fixed or replaced. Unfortunately, sports related injuries including to the oral cavity will occur. Just be prepared and have a team in place to help in those times of need. If we can ever be a service to you or your family in the fabrication of a custom mouthpiece or discuss a plan of action for any injuries or emergency care, please do not hesitate to contact.
Andrew Burt DMD