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Sports-Related Dental Injuries and Sports Dentistry

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Sports-Related Dental Injuries and Sports Dentistry
This continuing education course is intended for general dentists, hygienists and dental assistants. Whether
for exercise, competition or the simple enjoyment of participating, increasing numbers of health conscious
Americans are involved in sporting activities. This course is designed to explain the various sports-related
dental injuries, discuss the three types of mouth guards utilized and the dental team's role in sports-related
injuries and sports dentistry.
Conflict of Interest Disclosure Statement
The authors report no conflicts of interest associated with this work.
ADA CERP
The Procter & Gamble Company is an ADA CERP Recognized Provider.
ADA CERP is a service of the American Dental Association to assist dental professionals in identifying
quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses
or instructors, nor does it imply acceptance of credit hours by
boards of dentistry.
Concerns or complaints about a CE provider may be directed to the provider or to ADA CERP at:
http://www.ada.org/prof/ed/ce/cerp/index.asp
Overview
Whether for exercise, competition or the simple enjoyment of recreational activity, increasing numbers of
health conscious Americans are involved in sporting activities.
1
Approximately 20 million children participate
in various sports programs in the United States and another 80 million are involved in unsupervised
recreational sports.
2
Dentistry plays a large role in treating oral and craniofacial injuries resulting from
sporting activities.
Wendy Schmeling Smith, RDH, BSEd;
Connie M. Kracher, PhD(c), MSD, CDA
Continuing Education Units: 2 hours
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Course Contents
• Glossary
• Statistics
• Common Athletic Injuries
Soft Tissue Injuries
Fractures
TMJ Injuries
Tooth Intrusion
Crown and Root Fractures
Avulsion
• Emergency Treatment
• Mouthguards
Stock Mouthguards
Mouth-Formed Protectors
Custom Made Mouth Protectors
• Dental Team's Role
Dental Emergency Kit for Sporting Events
• Summary
• Course Test
• References
• About the Authors
Glossary
ankylosis – abnormal fusion (joining together)
avulsed – Entire tooth is knocked out.
axially – Referring to the long axis of the tooth.
condyle – The posterior bony process that
extends up from the mandible.
crazing – to become covered with fine cracks
edema – swelling
extrusion – Tooth is partially forced out due to
injury or purposeful orthodontic treatment.
intrusion – Tooth is driven into the alveolar
process.
malocclusion – The contact between the
maxillary and mandibular arches, whereby the
positioning of the teeth are not in accordance with
the usual rules of anatomic form.
mobility – state of being mobile
Prior to the 1980’s, little was available in the scientific literature in terms of sports-related injury assessment.
Several injury surveillance systems have been established in an attempt to track sports-related accidents
and injuries. While all injury surveillance systems provide valuable information on generalized sports
injuries, very little information is available regarding dental or craniofacial injuries. In terms of data
collection and analysis, the field is open for dentistry to assume a major leadership role in assessing dental
injuries resulting from sporting activities.
3
One reason for such lack of scientific studies regarding this issue
is the absence of academic training in sports dentistry. A survey by Kumamoto and others was sent to
69 dental schools in the United States and Canada regarding course offerings, opinions about offering a
course, construction of mouthguards, and provision of treatment for trauma. Of the 19 dental schools with
sports dentistry courses, 17 taught the course in the undergraduate curriculum, 12 as a required course
and the remaining 5 as an elective. Two schools offered the course on a graduate level. Data from the
study also concluded that more than half of the schools that teach sports dentistry do not treat any outside
athletic group on a regular basis.
4
This course is designed to explain the various sports-related dental injuries, discuss the three types of
mouthguards utilized and the dental team’s role in sports-related injuries and sports dentistry.
Learning Objectives
Upon the completion of this course, the dental professional should be able to:
Discuss various statistics relating to sports dental-related injuries.
Discuss soft tissue injuries, jaw fractures, TMJ injuries, tooth intrusion, crown and root fractures, and
avulsion due to sports accidents.
Explain emergency treatment with sports-related injuries.
Differentiate various observed patterns of mouthguard wearing by males and females, cultural
differences, and the influence of peer pressure.
Identify and differentiate the three mouth-guards available and identify the ideal mouthguard.
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necrotic – death of living tissue
pulpal necrosis – death of pulpal tissue
Sports dentistry – Involves the prevention and
treatment of orofacial athletic injuries and related
oral diseases, as well as the collection and
dissemination of information on dental athletic
injuries and the encouragement of research in the
prevention of such injuries.
Statistics
More than 5 million teeth are avulsed each
year; many during sports activities, resulting in
nearly $500 million spent on replacing these
teeth each year.
1
In an issue of the Journal of
the American Dental Association (JADA) it was
reported that 13-39% of all dental injuries are
sports-related, with 2-18% of the injuries related
to the maxillofacial. Males are traumatized twice
as often as females, with the maxillary central
incisor being the most commonly injured tooth.
Studies of orofacial injuries published over the last
thirty years reflects various injury rates dependent
on the sample size, the age of participants, and
the specific sports.
30,31
Even in football, a sport
requiring protective gear, only about 75% of
athletes are in compliance. In soccer, where rules
are not uniform on wearing mouthguards, only
7% of the participants wear them.
1
In baseball
and softball, again only 7% wear mouth-guards.
Recent studies show basketball had the highest
injury rate with both male and female students due
to hand or elbow contact or by collision with other
players. The close contact of basketball players,
as well as the speed of the game increases the
potential for possible orofacial trauma.
37
Currently,
the National Federation of State High School
Associations (NFHS) mandates mouthguards for
only four sports: football, ice hockey, lacrosse,
and field hockey.
32
However, many high school
and college administrators continue to support
mandatory protective equipment relating to many
more high school contact sports.
29
It is evident
from past research studies there is a need for
more research on the topic of sports dentistry.
There is also a need to educate communities of
interest including more regulations for mouthguard
use in sports.
In 1962, high school and collegiate football
players were required to wear faceguards and
mouth protectors during practice sessions
and in competition. Several studies confirm
that since this requirement, the percentage of
orofacial injuries in football has dropped from
approximately 50% to one-half of 1%, depending
on the study cited.
The American Academy of Pediatric Dentistry
recommends a mouthguard for all children and
youth participating in any organized sports
activities. The American Dental Association
recommends wearing a mouthguard for the
following sports:
study conducted on high school varsity basketball
teams in Florida assessed the benefit of
mouthguard use in sports other than football. It
was found that 31% of surveyed Florida varsity
basketball players sustained orofacial injuries
during the season. 53% reported more than one
injury during the season. Of the 1,020 players,
fewer than half wore mouthguards and only 2
of these sustained oral injuries not requiring
professional attention during the season.
5
It was
concluded by the authors that there is a high
risk of orofacial injury competing in basketball
without a mouthguard, which would increase
a player’s chance of orofacial injury almost
sevenfold.
6
Soporowski and others found that of
all the injuries presented to dental offices, 62%
occurred while the patient was participating in an
unorganized sport. Children between the ages of
seven and ten have the highest number of injuries
(59.6%). Baseball had the most injury sites, 72 of
159 injuries, biking followed with 59, and hockey
and basketball were third and fourth respectively.
7
Another study was conducted with 3,411 athletes.
The highest incidence of orofacial injury for
the male athletes was noted in wrestling and
basketball. For females, it was basketball and
field hockey. None of the athletes who sustained
an injury was wearing a mouthguard.
4
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A study conducted on high school athletes, in
which researchers interviewed 2,470 junior and
senior high school football players, showed 9%
of all athletes sustained some form of orofacial
injury with 3% reporting loss of consciousness.
Fifty-six percent of all concussions and 75% of
all orofacial injuries occurred while the athlete
refrained from mouthguard protection.
4
In
Alabama, a study on 754 football players
revealed that 52% of all orofacial injuries
occurred in sports other than organized football.
Basketball, baseball and unorganized football
were a few of the sports which showed a high
incidence of oral trauma and concussions when
mouthguards were not used.
4
Morrow and
Kuebker conducted surveys in selected Texas
high schools to determine the incidence of
orofacial injuries on approximately 122,000 male
and female athletes. They measured the types of
mouthguards worn and dental injury experienced
in football, and later indicated that soccer and
basketball had higher dental injury rates than
football. The number and nature of dental injuries
experienced by male athletes showed that lip
and tongue lacerations were the most frequently
reported injuries. In addition, fourteen jaw
fractures were reported with as many fractures in
baseball and soccer as there were in football.
8
All athletes constitute a population that is
extremely susceptible to dental trauma. Dental
injuries are the most common type of orofacial
injury. An athlete has a 10% chance of receiving
an orofacial injury every season of play. In
addition, athletes have a 33-56% chance of
receiving an orofacial injury during their playing
career.
9
It is estimated that mouthguards prevent
between 100,000-200,000 oral injuries per year in
professional football alone.
7
Common Athletic Injuries
1. Soft Tissue Injuries
The face is often the most exposed part of
the body in athletic competition and injuries
to the soft tissues of the face are frequent.
Abrasions, contusions, and lacerations are
common and should be evaluated to rule out
fracture or other significant underlying injury.
1
0
These usually occur over a bony prominence
of the facial skeleton such as the brow, cheek,
and chin. Lip lacerations are also common.
11
2. Fractures
Fractures of the facial bones present an even
more complex problem. The most frequent
site of bony injury is the zygoma (cheekbone).
Fractures of the zygoma account for
approximately 10% of the maxillofacial
fractures seen in sports injuries, occurring
as a result of direct blunt trauma from a fall,
elbow, or fist.
12
In a study by Linn and others,
of the 319 patients treated for sports-related
injuries, males proved to be more prone to
zygomatic fractures than females because
of the powerful physical contacts during
sports.
13
Like the zygoma, the prominent
shape and projection of the mandible cause it
to frequently be traumatized. Approximately
10% of maxillofacial fractures from sporting
activities occur in the mandible when the
athlete strikes a hard surface, another player,
or equipment. In a mandibular fracture,
airway management is the most important
aspect of immediate care.
14
In both children
and adults, the condyle is the most vulnerable
part of the mandible. Fractures in this
region have the potential for long-term facial
deformity. Recent data suggest that condylar
fractures in children can alter growth of the
lower face.
11
3. TMJ Injuries
Most blows to the mandible do not result
in fractures, yet significant force can be
transmitted to the temporomandibular disc
and supporting structures that may result in
permanent injury. In both mild and severe
trauma, the condyle can be forced posteriorly
to the extent that the retrodiscal tissues are
compressed. Inflammation and edema can
result forcing the mandibular condyle forward
and down in acute malocclusion. Occasionally
this trauma will cause intracapsular bleeding,
which could lead to ankylosis of the joint.
4. Tooth Intrusion
Tooth intrusion occurs when the tooth has
been driven into the alveolar process due
to an axially directed impact. This is the
most severe form of displacement injury.
Pulpal necrosis occurs in 96% of intrusive
displacements and is more likely to occur in
teeth with fully formed roots. Immature root
development will usually mean spontaneous
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who will deliver immediate treatment at sporting
events understand the proper protocol for orofacial
injuries, such as displaced teeth, avulsed teeth,
lacerations, and crown fractures. The ADA has
urged its members to work together with schools,
colleges, athletic trainers and coaches to develop
mouthguard programs and guidelines to prevent
sports injuries.
The main method for preventing orofacial injuries in
sports is the wearing of mouthguards and headgear,
consisting of a helmet and face protector. Yet, a
study by the National Institute of Dental Research
reported that children do not consistently wear
mouthguards and headgear during organized
sports. Even in football, a sport that requires the
use of mouthguards, as earlier noted, only about
75% of students are in compliance.
15
Parental perceptions of children’s risks to injury,
expenses associated with protective gear, and
peer pressure may influence use of mouthguards.
Interestingly, lower socioeconomic parents are
reported to be more aware of threats to their
children’s safety than are affluent parents.
16
The
observed patterns of mouthguard wearing by males
and females can represent cultural differences, peer
pressure, and/or nature of sports played, including
the following:
1. perceptions that females are less aggressive
and thus, a reduced risk of injury may exist,
2. perceptions regarding the absence of long-term
commitment to a sport may result in a differential
willingness to devote resources to females,
3. aesthetic appeal may influence protective
orofacial gear usage,
4. females may play in non-league-based sports
with fewer or less stringent rules or may play
less combative sports than males.
15
re-eruption. Mature root development
will require repositioning and splinting or
orthodontic extrusion.
5. Crown and Root Fractures
Crown fractures are the most common injury
to the permanent dentition and may present
in several different ways. The simplest
form is crown infraction. This is a crazing
of enamel without loss of tooth structure.
It requires no treatment except adequate
testing of pulpal vitality.
14
Fractures extending
into the dentin are usually very sensitive to
temperature and other stimuli. The most
severe crown fracture results in the pulp
being fully exposed and contaminated in a
closed apex tooth or a horizontal impact may
result in a root fracture. The chief clinical
sign of root fracture is mobility. Radiographic
evaluation and examination of adjacent teeth
must be performed to determine the location
and severity of the fracture as well as the
possibility of associated alveolar fracture.
12
Treatment is determined by the level of injury.
6. Avulsion
Certainly one of the most dramatic sports-
related dental injuries is the complete
avulsion of a tooth. Two to sixteen percent
of all injuries involving the mouth result in
an avulsed tooth. A tooth that is completely
displaced from the socket may be replaced
with varying degrees of success depending,
for the most part, on the length of time outside
the tooth socket. If the periodontal fibers
attached to the root surface have not been
damaged by rough handling, an avulsed
tooth may have a good chance of recovering
full function. After two hours, the chance for
success is greatly diminished. The fibers
become necrotic and the replaced tooth will
undergo resorption and ultimately be lost.
11
Emergency Treatment
Due to the high incidence of sports-related
dental injuries, it is vital that primary health care
providers such as school nurses, athletic trainers,
team physicians and emergency personnel are
trained in the assessment and management of
dental injuries. Interested dental team members
can assist these providers by offering to speak to
schools, so that the primary health care providers
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provides a high degree of comfort and fit to the
maxillary arch
remains securely and safely in place during
action
allows speaking and does not limit breathing
is durable, resilient, tear resistant, odorless,
and tasteless
Mouthguards typically are made of thermoplastic
copolymer and designed to fit over occlusal and
facial surfaces of the maxillary teeth and gingival
tissues.
36
The American Society for Testing and
Materials (ASTM) and the manufacturers of
mouthguards have classified the mouthguards
into three types:
1. Stock Mouthguards – Stock mouthguards
may be purchased from a sporting goods
store or pharmacy. They are made of rubber,
polyvinyl chloride or a polyvinyl acetate
copolymer.
21
The advantage is that this
mouthguard is relatively inexpensive, but the
disadvantages far outweigh the advantages.
They are available only in limited sizes, do
not fit very well, inhibit speech and breathing,
and require the jaws to be closed to hold the
mouthguard in place.
22
Because the stock
mouthguards do not fit well, the player may
not wear the mouthguard due to discomfort
and irritation. The Academy of Sports
Dentistry has stated that the stock mouthguard
is unacceptable as an orofacial protective
device.
23
2. Mouth-Formed Protectors – There are two
types of mouth-formed protectors: the shell-
liner and the thermoplastic mouthguard. The
shell-liner type is made of a preformed shell
with a liner of plastic acrylic or silicone rubber.
The literature indicates the use of mouthguards
by athletes is most influenced by their coaches.
17
However, studies indicate mouthguard compliance
by athletes is usually not insisted upon by their
coaches or referees.
35
Coaches may feel that do
not have sufficient knowledge of mouthguards.
Coaches report most information about
mouthguards comes from sales representatives
(72%), educational materials (33%), and dentists
(11%).
18
In 1995, the ADA House of Delegates revised
their policy recognizing "the preventive value of
orofacial protectors" and endorsed their use "in
sports activities with a significant risk of injury at
all levels of competition."
19
Mouthguards
When athletes are surveyed as to why they
don’t wear mouthguards, results indicate
participants believe their mouthguards will affect
their breathing. However, Rapisura, Coburn,
Brown, and Kersey recently tested two types of
mouthguards with female athletes and found there
was no effect on aerobic performance with their
subjects with either the custom or prefabricated
mouthguards they tested.
34
When considering recommendations, an ideal
mouthguard:
1
protects the teeth, soft tissue, bone structure,
and temporomandibular joints
diminishes the incidence of concussions and
neck injuries
exhibits protective properties that include
high power absorption and power distribution
throughout expansion
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The advantages include fit, ease of speech,
comfort and retention.
20
By wearing a protective
mouthguard, the incidence of a concussion by a
blow to the jaw is significantly reduced because
the condyle is separated from the base of
the skull by placing the mandible in a forward
position.
25
Dental Team's Role
Dentists need to educate patients on the need
and benefits of protective devices. The American
Dental Association publishes brochures which
explain the different types of mouthguards
and their advantages. The National Youth
Sports Safety Foundation (NYSSF), a non-
profit educational research organization working
to promote the safety of youth in sports, has
published a fact sheet on dental injuries that
includes statistics, costs of injuries, resource
information regarding standards for mouthguards,
videos, and mouthpieces and dental care.
9
A field
emergency kit is a simple and inexpensive item for
the dentist attending a sporting event (Table 1.).
"Fitting mouthguards is a perfect activity for a
dental society," says Robert Morrow, D.D.S.,
Professor of Prosthodontics, University of Texas-
San Antonio Dental School. "You simply get a
group of dentists together at the school and begin
making impressions. It spreads out the costs and
cuts down on the time. And it’s worthwhile."
2
"It’s
a great practice builder," says Robert Donnelly,
D.D.S., a general practitioner in San Marcos,
Texas, and dentist for the Southwest Texas State
The lining material is placed in the player’s
mouth and molds to the teeth and then is
allowed to set. The preformed, thermoplastic
lining (also known as "boil and bite") is
immersed in boiling water for 10-45 seconds,
transferred to cold water and then adapted to
the teeth. This mouthguard seems to be the
most popular of the three types and is used by
more than 90% of the athletic population.
2
4
3. Custom Made Mouth Protectors – This
is the superior of the three types and the
most expensive to the athlete. Dental
professionals believe this to be well worth
the cost to protect an athlete’s teeth from
injury. Most parents will spend quite a bit
of money on athletic shoes, but might not
think about protecting their child’s teeth. This
mouthguard is made of thermoplastic polymer
and fabricated over a model of the athlete’s
dentition.
21
The mouthguard is made by the
dentist and fits exactly to the athlete’s mouth.
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Sports dentistry should encompass much more
than mouthguard fabrication and the treatment
of fractured teeth. As dental professionals,
a responsibility exists to become and remain
educated and pass that education on to the
community regarding the issues related to sports
dentistry and specifically to the prevention of
sports-related oral and maxillofacial trauma.
Organizations such as the Academy for Sports
Dentistry, which was founded in 1983, contribute
to overall efforts to eliminate dental injuries in
sporting activities. The Academy for Sports
Dentistry conducts educational programs,
publishes a biannual newsletter, offers an
annual symposium for dentists and other health
professionals interested in trauma and preventive
therapy, and promotes legislative efforts and
encourages research in all dentally related sports
issues.
3
Summary
With the many sports that children play, such as
soccer, basketball, football, baseball, and "in-line"
skating or roller blades, it is recommended that
dentists fabricate mouthguards for all patients –
especially children who participate in organized
and unorganized sports. Dentistry should be
working diligently to require mandatory use of
mouthguards in all sports, which starts at the
local and state levels.
University football team. "I don’t charge for my
time or the materials to make a mouthguard. I do
it for free. As a result, we get a lot of referrals."
22
Due to the increasing participation in sporting
events by children of all ages, a need for
mouthguard implementation is of extreme
importance. Dental professionals need to
develop effective ways of conducting research
to determine the prevalence of sports related
injuries in their communities.
By combining research with preventive efforts,
legislation can be determined. Mouthguard laws
would help to reduce the number of orofacial
sporting injuries and protect athletes. The sports
dentistry field is a challenging, yet rewarding one.
With efforts from dentists and dental auxiliaries
in the country, a better awareness of the types of
injuries, treatment procedures, and mouthguard
prevention can be conveyed to parents and
athletes.
The role as dental assisting professionals should
include:
Good impression techniques and knowledge
of mouthguard materials/manipulations in
mouthguard creation.
Communications with children and parents/
guardians. Dental charting should include
questions about involvement in sports and the
use of mouthguards. If patients are unwilling
or unable to pay for an office-made guard,
the dental assistant should educate patients
about affordable boil and bite-type guards for
minimal protection.
Basic instructions on emergency treatments of
dental emergencies such as avulsion, fracture,
extrusion and intrusion that an adult can
perform immediately until dental treatment can
be attained.
33
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Course Test Preview
1. In sports, males are traumatized twice as often as females.
The maxillary canine is the most commonly injured tooth.
a. Both statements are true.
b. The first statement is true and the second statement is false.
c. The first statement is false and the second statement is true.
d. Both statements are false.
2. The teeth most susceptible to trauma are _______________.
a. mandibular molars
b. maxillary canines
c. mandibular lateral incisors
d. maxillary central incisors
3. ____________ is/are sport(s) which require(s) a mouthguard.
a. Football
b. Basketball
c. Soccer
d. Hockey
e. A and D
4. The American Academy of Pediatric Dentistry recommends a mouthguard for all children
and youth participating in sports.
The Academy of Sports Dentistry has stated that the stock mouthguard is unacceptable as
an orofacial protective device.
a. Both statements are true.
b. The first statement is true and the second statement is false.
c. The first statement is false and the second statement is true.
d. Both statements are false.
5. The most common facial bone to be fractured during sports is the _______________.
a. condyle
b. coronoid of the mandible
c. mandible
d. zygoma
6. As stated, males are more prone to ____________ than females in all types of sports.
a. lip lacerations
b. zygoma fractures
c. crown fractures
d. tooth avulsions
7. The most frequent site of bony injury is the zygoma.
In TMJ injuries inflammation and edema can result forcing the condyle down and forward.
a. Both statements are true.
b. The first statement is true and the second statement is false.
c. The first statement is false and the second statement is true.
d. Both statements are false.
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8. In a mandibular fracture, _______________ is the most important aspect of immediate care.
a. airway management
b. tooth reimplantation
c. sutures
d. spinal stabilization
9. The most severe form of displacement injury in regard to oral injuries of teeth is __________.
a. intrusion
b. extrusion
c. None of the above.
10. The most common injury to the permanent dentition during sports is _______________.
a. avulsion
b. crown fractures
c. tooth intrusion
d. None of the above.
11. If the _______________ attached to the root surface has/have not been damaged by rough
handling, an avulsed tooth may have a good chance of recovering to full function.
a. periodontal ligament
b. cementum
c. periodontal fibers
12. After ______ hours, an avulsed tooth’s chance for success diminishes greatly.
a. 2
b. 3
c. 4
d. 6
13. Lower socioeconomic parents are ____________ aware of the threats to their children’s
safety than affluent parents.
a. more
b. less
c. equally
14. Athletes are most influenced to wear a mouthguard by their ____________.
a. coach
b. parents
c. teachers
d. dentists
15. Coaches receive most information about mouthguards from _______________.
a. dentists
b. sales representatives
c. educational materials
d. None of the above.
16. An ideal mouthguard _______________.
a. remains securely and safely in place during action
b. protects the teeth, soft tissue, bone structure and temporomandibular joints
c. diminishes the incidence of concussions and neck injuries
d. A and C
e. All of the above.
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17. Of the three available mouthguards, the _______________ is recommended.
a. stock mouthguard
b. mouth-formed protector/mouthguard (boil and bite)
c. custom mouthguard
18. The mouthguard that requires a dentist to fabricate a mouthguard from an impression is the
_______________.
a. stock mouthguard
b. mouth-formed protector/mouthguard (boil and bite)
c. custom mouthguard
d. None of the above.
19. The mouthguard that is immersed in boiling water, transferred to cold water then adapted to
the teeth is called the _______________.
a. stock mouthguard
b. mouth-formed protector/mouthguard (boil and bite)
c. custom mouthguard
d. None of the above.
20. The advantages of the custom-made mouth protector are _______________.
a. ease of speech
b. retention
c. comfort
d. B and C
e. All of the above.
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References
1. [No authors listed]. Dentistry and sport. Meeting the needs of our patients. J Am Dent Assoc. 1996
Jun;127(6):809-18.
2. Smith C. The Sporting Life. AGD Impact, 1989:4-8.
3. Elliott MA. Professional responsibility in sports dentistry. Dent Clin North Am. 1991 Oct;35(4):831-40.
4. Kumamoto DP. Sports Dentistry at the State Level. JADA, June, 1996, 127(6):816.
5. Koch T, Moavenian N, Parker J, Waston M, Westfall A. The Use of Mouthguards in High School
Contact Sports. U of M School of Dentistry, Class of 1996. Medline Site.
6. Flanders RA, Bhat M. The incidence of orofacial injuries in sports: a pilot study in Illinois. J Am Dent
Assoc. 1995 Apr;126(4):491-6.
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Jun;52(3):270-80.
13
Crest
®
Oral-B
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at dentalcare.com Continuing Education Course, Revised March 4, 2011
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34. Rapisura KP, Coburn JW, Brown LE, Kersey RD. Physiological variables and mouthguard use in
women during exercise. J Strength Cond Res. 2010 May;24(5):1263-8.
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Resources
See the Academy for Sports Dentistry website for specific emergency treatment instructions and the
American Academy of Pediatric Dentistry website relating to avulsed teeth recommendations for dental
professionals called: Decision Trees for Management of an Avulsed Permanent Tooth.
About the Authors
Wendy Schmeling Smith, RDH, BSEd
Wendy Smith is a Clinical Instructor in the Dental Hygiene Program at Indiana University School of
Dentistry.
Connie M. Kracher, PhD(c), MSD, CDA
Dr. Connie Kracher is Chair and Associate Professor of the Department of Dental
Education and Director of the Dental Assisting Program at Indiana University - Purdue
University Fort Wayne (IPFW). Connie is finishing her dissertation for her PhD in
Global Leadership, with a minor in Corporate Management at Lynn University in
Boca Raton, Florida. She holds a Master of Science in Dentistry from the Indiana
University School of Dentistry in Oral Biology with a minor in Diagnostic Sciences, and
a Bachelor of Science in Health Occupations Education. In addition to her CDA, she
holds a Certificate in Expanded Restorative Procedures (EFDA). Ms. Kracher is a
frequent contributor to the Dental Assistant Journal and is author of several ADAA courses.
E-mail: kracher@ipfw.edu
... • Self-limiting dislocations can be taken care of easily, and they don't require any further management. • TMJ dislocations involving a non-self-limiting displacement of the condyle can be taken care of by manually guiding the jaw back to the position by giving downward, backward and upward pressure to the mandible by placing the thumb over the occlusal surface of molars bilaterally and supporting the base of the mandible with remaining fingers 15 . ...
... emergency dentAl KIt f o r sPort events 15 A dental emergency kit should be kept ready on the field with the following items, Gloves, mask, Mouth mirror, Probe. ...
... Depending on the location of the root fracture, treatment varies. • Referral to the dental clinic should be given for definitive treatment.15 ...
Article
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Sports-related dental injuries are very common among athletes. Many of these injuries can lead to permanent damage in their aesthetics, reflecting back on their confidence and performance. It is very important to immediately treat sports-related injuries and hence, prevent future permanent complications. Sporting events in India are organized without appointing a dentist "on the field, " which leads to reduced chances of attending to the orofacial injuries immediately. A good amount of literature is available regarding the management of dental injuries in the dental office. Since there is no information available regarding 'on field' immediate management of these injuries, we have tried to provide collective information regarding immediate management of dental injuries occurring 'on field' by the dental professional.
... As lesões podem ser divididas em lesões de tecidos moles, lesões em estruturas dentais e lesões em estruturas periodontais. As lesões em tecidos moles são as mais prevalentes e compreendem as abrasões, as contusões e as lacerações, principalmente, na região de lábios, bochechas e língua (SMITH; KRACHER, 1998). ...
... Entre esses dispositivos podem ser citados: piercings, próteses parciais ou totais removíveis ou mesmo aparelhos ortodônticos, fixos ou removíveis. Sempre que possível é preferencial que o atleta remova todos os objetos e dispositivos durante a atividade física SMITH;KRACHER, 1998). Além dos riscos às estruturas orais, danos podem ocorrer aos componentes utilizados na movimentação ortodôntica, atrapalhando o andamento do tratamento. ...
... Entre esses dispositivos podem ser citados: piercings, próteses parciais ou totais removíveis ou mesmo aparelhos ortodônticos, fixos ou removíveis. Sempre que possível é preferencial que o atleta remova todos os objetos e dispositivos durante a atividade física SMITH;KRACHER, 1998). Além dos riscos às estruturas orais, danos podem ocorrer aos componentes utilizados na movimentação ortodôntica, atrapalhando o andamento do tratamento. ...
Article
O trauma orofacial esportivo em pacientes ortodônticos fixos poderá implicar em lesões com diferentes graus de severidade, reversíveis e irreversíveis, podendo acometer tanto tecidos bucais moles quanto duros. As lesões, normalmente, ocorrem pelo contato destes tecidos com o agente traumatizante e pelo próprio contato do aparelho com os tecidos intrabucais. Portanto, em pacientes sob tratamento ortodôntico com aparelho fixo, a recomendação do uso do protetor bucal deve ser enfatizada, pois, em casos extremos, pode ocorrer também a perda parcial ou total de elementos dentais. O protetor bucal pode ser definido como um dispositivo recomendado para a proteção das estruturas orais de pacientes durante a prática de atividade esportiva. Dependendo da atividade esportiva, como nos esportes de contato, há obrigatoriedade estabelecida por federações e confederações para o seu uso como equipamento de proteção individual. O presente trabalho apresenta o passo a passo de uma técnica simples e de baixo custo para a confecção de um protetor bucal personalizado, através da modificação da técnica convencional, promovendo um alívio durante a moldagem, o que permite o uso confortável e seguro em pacientes ortodônticos. Além disso, o presente artigo reforça a importância do dentista em prescrever e conscientizar, tanto o atleta profissional quanto o amador, no uso deste dispositivo preventivo, que pode ser confeccionado em uma sessão, evitando possíveis prejuízos bucais e resguardando o paciente de danos físicos, psicológicos, sociais e financeiros. Palavras-chave: Protetor Bucal. Esporte. Ortodontia. Abstract Sports orofacial trauma in fixed orthodontic patients may result in different degrees of severity, reversible and irreversible injuries, in soft and hard oral tissues, by their contact with the traumatizing agent and by the device contact with intraoral tissues. Therefore, in these conditions, the recommendation for the use of mouthguards should be emphasized because, in extreme cases, partial or total loss of dental elements may also occur. The mouthguard can be described as a device with the purpose to avoid injuries to patients’ oral structures during the practice of sports activity. Depending on the sporting activity, as in contact sports, the use as personal protective equipment is imposed by federations and confederations. The objective of this article is to present the step by step of a simple and low-cost technique for the confection of a personalized mouth guard, through the conventional technique modification, creating a relief during molding, which allows the comfortable and safe use in orthodontic patients. In addition, this article aims to reinforce the dentist’s importance in prescribing and raising awareness, both professional and amateur athletes, in the use of this preventive device that can be made in one session, avoiding possible oral damage and also protecting the patient from psychological, social and financial injuries. Keywords: Mouthguard. Sport. Orthodontics.
... There are various dental trauma that can be encountered during sports such as soft tissue injuries, fractures, TMJ injuries, tooth intrusion, tooth extrusion, crown and root fractures, and avulsion. [7] Teachers are generally present at the time dental trauma occurs, as such accidents often take place during or after school activities. However, they have few/limited knowledge regarding the recommended course of action in such situations. ...
Article
Full-text available
Introduction: Traumatic dental injuries (TDIs) are widespread in the population and are a serious dental public health problem among children. Dental trauma may cause both functional and esthetic problems, with possible impacts on the patient's quality of life. Aim: To investigate teacher's knowledge and attitudes of Mathura city about emergency management of TDIs in children. Materials and Methods: A total of 352 teachers from total 23 schools of Mathura city were included in the study. Data were collected through a survey, which included a self-administered questionnaire. The questionnaire consisted of three major parts containing multiple-choice questions. Results: Among the teachers 51.1% were males and 48.9% were females. Majority of the respondents, that is, 33.5% were between 31 and 40 years of age. Most respondents (34%) had more than 10 years of teaching experience. Majority of the teachers (39.2%) had educational qualification other than B.Ed. and M.Ed. degrees. Physical education teachers comprised the largest group of school teachers. Regarding knowledge and attitude, the teachers with 10-20 years of teaching experience, physical education teachers, and the teachers other than B.Ed. and M.Ed. qualifications had given more correct answers to the questions when compared with other groups. Conclusion: For the teachers having a low level of knowledge, there is a need for greater awareness to improve teachers' knowledge and attitudes related to the emergency management of TDIs in children by organizing educative and motivational programs.
... [3][4][5][6][7][8][9][10][11][12][13] With the increasing number of new participants and popularity of sports practices, the number of sport-related injuries also continues to grow. [14][15][16] Sport-related injuries can occur to the soft or hard tissues, depending on the anatomical site and direction of the forces that caused the trauma. 17,18 The number of sport-related orofacial injuries ranges between 11 and 40% considering all types of sport-related trauma and it is the most common type of trauma in this population. ...
Article
Full-text available
Background/aims: As the popularity of sports activities grows, so do the number of sport-related injuries. Furthermore, sports that use equipment or vehicles that modify the speed of the player can present more serious injuries. The aim of this systematic review was to identify the overall prevalence of orofacial trauma in wheeled non-motor sports athletes. Methods: The search strategy was applied in eight electronic databases (Embase, LILACS, Livivo, PEDro, PubMed, Scopus, SportDiscus, and Web of Science). Additionally, a complementary search of the gray literature (Google Scholar, OpenGrey, and ProQuest Dissertations & Theses Global), reference lists of included articles, and studies indicated by experts on the subject was done. The included articles were observational studies with sufficient data of orofacial trauma (type and anatomical site) in wheeled non-motor sport athletes, regardless of the competition level. Risk of bias was assessed by using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. The meta-analysis was performed using R Statistics software, and the strength of cumulative evidence was assessed by The Grading of Recommendations Assessment, Development, and Evaluation. Results: From 4042 identified studies, after the removal of duplicates and phase one of selection (title and abstracts screening), 251 studies remained for phase two (full-text screening). Five articles were finally included. One study was considered to have a low risk of bias and four had a moderate risk of bias. The cumulative prevalence of orofacial injuries in wheeled non-motor sport athletes was 21.7% (CI: 8.7-34.7; I2 :97.6%) and the prevalence of dental injuries in these sports was 7.5% (CI:4.3-10.7; I2 :61.9%). The certainty in cumulative evidence was considered to be very low. Conclusion: About 22% of the wheeled non-motor sport athletes have suffered orofacial injuries. The most prevalent type of injury was classified as dental trauma.
... Various dental traumas are encountered by sports such as soft tissue injury, fracture, tooth intrusion, crown and root fracture, and avulsion. 8 Traumatic dental injuries are widespread among the population and are considered as one of the serious public health problems among children. 9 Such types of dental injuries mostly occur during school hours and in the presence of teachers. ...
Article
Aim: An avulsion is defined as one of the most common dental injuries where the tooth is displaced completely from its socket, followed by trauma. The most important time in managing the avulsed tooth is the first few minutes and as children spend their most of waking time in school so the teacher is considering their immediate caregiver. Hence, this study was done to carry out the knowledge and attitude of school teachers regarding emergency management of avulsed permanent tooth in schools located in the southern region of Saudi Arabia. Materials and methods: The study was conducted at Najran School of Saudi Arabia. All teachers who are willing to participate in the study were involved. A questionnaire was made after reviewing several studies and was administered through emails to 318 teachers. The questionnaire consists of part I regarding demographic questions and part II information related to knowledge, action taken, education, and their way of managing the avulsed tooth at accident place. Statistics analysis was done using SPSS version 16. Results: Fifty percent of the participants know about the tooth avulsion. Fifty percent of the teachers who get information from the school health dental program get the tooth back to the dentist. There is a significant association found between the source of information and choice of treatment. Fifty-nine percent of the participants do not know about the management of tooth avulsion. And workshop plan then 89% was interested to attend the training. Conclusion: The present study revealed that knowledge regarding the management of avulsed tooth is low among the school teachers. There is a strong need for a school health dental program for the management of avulsed teeth among the school teachers. How to cite this article: Khan SDAA, Assiry AA, Al Yami SMH, et al. Assessment of Knowledge and Attitudes of School Teachers Regarding Emergency Management of an Avulsed Permanent Tooth of Southern Region of Saudi Arabia. Int J Clin Pediatr Dent 2020;13(6):644-649.
... Integral care with the sportsman's health has been widely studied, since the athlete needs to be physically and psychologically healthy to obtain good results. However, Dentistry is not still properly valued as a science that contributes significantly to the athlete's sporting performance and few professionals study and communicate this interrelation 11 , as observed in the results presented in this research (Table 3). There are 18 specialists in Sports Dentistry, while Sports Medicine has 739 specialist physicians. ...
Article
Full-text available
The aim of this study was to quantitatively assess the number of dentists who are specialists in Sports Dentistry and Specialist Physicians who are specialists in Sports Medicine, according to the Brazilian regions. The total number of dentists and doctors in Brazil and specialists in Sports Dentistry and Sports Medicine was collected on the websites of the Federal Council of Dentistry (CFO) and the Federal Council of Medicine (CFM), respectively. All data used in this research are publicly accessible. Rio de Janeiro and Minas Gerais are the Brazilian states with the largest number of specialist dentists in Sports Dentistry (n = 5) and São Paulo, the state with the highest number of sports medicine specialists (n = 236). By Brazilian regions, it was observed that most professionals specialized in Sports Dentistry (55.6%) and Sports Medicine (49.5%) are located in the Southeast region. In the Northeast region, for each specialist in Sports Dentistry, there are 109 physicians specialized in this therapy (1/109). There is a small number of dentists who are specialists in Sports Dentistry, when compared to the number of physicians specialized in Sports Medicine, mainly in the North and Northeast regions of the country. Keywords: Dentistry. Sports. Sports Medicine. Oral Health. ResumoO objetivo deste estudo foi avaliar quantitativamente o número de cirurgiões-dentistas especialistas em Odontologia do Esporte e médicos especialistas em Medicina Esportiva, de acordo com as regiões brasileiras. O número total de cirurgiões-dentistas e médicos no Brasil e de especialistas em Odontologia do Esporte e Medicina Esportiva, foi coletado nos sites do Conselho Federal de Odontologia (CFO) e Conselho Federal de Medicina (CFM), respectivamente. Todos os dados utilizados nesta pesquisa são de acesso público. O Rio de Janeiro e Minas Gerais são os estados brasileiros com o maior número de cirurgiões-dentistas especialistas em Odontologia do Esporte (n=5) e São Paulo, o estado com o maior número de médicos especialistas em Medicina Esportiva (n=236). Por regiões brasileiras, observou-se que a maioria dos profissionais especialistas em Odontologia do Esporte (55,6%) e em Medicina Esportiva (49,5%) estão localizados na região Sudeste. Na região Nordeste, para cada especialista em Odontologia do Esporte, existem 109 médicos com especialização nesta terapia (1/109). Há uma pequena quantidade de cirurgiões-dentistas especialistas em Odontologia do Esporte, quando comparados ao número de médicos especialistas em Medicina Esportiva, principalmente nas regiões Norte e Nordeste do país. Palavras-chave: Odontologia. Esportes. Medicina Esportiva. Saúde Bucal.
... Different types of indoor or outdoor activities involve various ages, from children and young adults to persons up to the 6-7 decades of life. Many families are raising their children from an early age in the spirit of a healthy life, and enroll them in team sports in order for them to practice physical activities on a regular basis (Kracher & Smith, 2017;Saini, 2011). Protective gears have improved over time and they have become more comfortable, user-friendly, and safe (Nielsen & Yde, 1989). ...
Article
Background: Baseball is 1 of the most played sports among adolescents in the United States. Yet, youth baseball players experience the greatest number of oral and facial injuries, compared to other athletes involved in other sports. Methods: The National Electronic Injury Surveillance System was analyzed for all hospital admissions for youth baseball athletes (5-19-year-old) experiencing a baseball-related craniofacial injury. These included concussions, head contusions, head lacerations, facial contusions, facial fractures, facial hematomas, face lacerations, eye contusions, mouth lacerations, dental injuries, and neck contusions. Descriptive statistics were performed, and injury incidence was described by sport, injury type, and age group. Results: Nearly half of the injuries (45.0%) occurred among 10- to 14-year-old patients, followed by 5- to 9-year-olds and 15- to 19-year-olds. Of all age groups, the most common type of injury was facial contusions, compromising one fourth of the injuries. Other frequent injuries included facial lacerations (19.9%), facial fractures (19.7%), and concussions (13.4%). Conclusions: Overall, this analysis underscores the need for increased implementation of protective equipment, such as faceguards and safety balls. Although facial fractures are less common amongst the pediatric population, physicians and coaches need to be better educated about the most frequent injury patterns and management. Further prospective studies are warranted to better characterize these findings and to prevent injuries.
Article
Background/Aim Rugby union represents a high‐risk sport for orofacial trauma due to its impact collisions and repetitive tackles. The aim of this study was to investigate the prevalence of orofacial trauma according to mouthguard use among a sample of Brazilian rugby union players. Methods An online questionnaire was sent to the 16 best rugby union clubs in Brazil, which contained questions about the training history of each athlete, prevalence of orofacial trauma and details about mouthguard use. Only participants who reported using a mouthguard were selected for this analysis. Results A total of 244 individuals were included. The prevalence of orofacial trauma was 34.4%, and 61.9% of them did not wear a mouthguard at the time of the incident. The only type of mouthguard reported was the pre‐fabricated (“boil and bite” and “ready to wear”) type. A stronger association was observed between the reason for using a mouthguard and the outcome, whereas a lower proportion of trauma was observed among individuals who claimed mandatory mouthguard use at the gym/sport (20.0%). Time since the respondent started playing rugby union and who instructed them to use a mouthguard was not associated with orofacial trauma. Conclusion Prevalence of orofacial trauma was high among this sample of rugby union players from Brazil, even with the use of pre‐fabricated mouthguards. This study encourages further investigation on the use of custom‐made mouthguards in rugby union and the role of coach/physical educators to reduce the prevalence of orofacial trauma.
Article
Background/Aim Sports practices carry a risk for orofacial injuries and to avoid them, preventive measures are necessary. The aim of this study was to investigate a web of extrinsic determinants for orofacial trauma in sports. Materials and Methods Through a scoping review, eight extrinsic risk factors for sports‐related orofacial trauma emerged from the thematic analysis. These were sports modality, sports philosophy, competition rules, level of competition, accessory equipment, environmental conditions, acting regimen, pitch conditions and human resources. The data collection was conducted on seven databases, using terms based on health science descriptors and keywords related to orofacial trauma and sports. Results From the 1155 articles found, 157 were selected based on eligibility criteria and classified according to the mentioned factors. After the full reading of the articles, the most cited risk factor was sports modality while acting regimen and environmental factors were the least mentioned. Therefore, a scheme following the web of determinants was constructed with the purpose of establishing a risk profile, which was based on the interactions between the determinants and on the frequency that they were mentioned as contributors to injury. From this, it was observed that each traumatic event is possibly a result of the interrelationships among the eight suggested determinants. Conclusion Sports modality was the most cited extrinsic determinant observed in the literature, while environmental conditions and acting regimen were the least cited. In addition, more than establishing the determinants, it is necessary to comprehend how they relate, once preventive strategies should intercede on these relations, to help reduce sports injuries.
Article
Full-text available
Although mouthguards have been found to reduce injury, many athletes choose not to use them because of the belief of negative effects on breathing with mouthguard use. Therefore, this study investigated the effects of mouthguard use on physiological variables in women using a self-adapted mouthguard made for women and a universal self-adapted mouthguard. Eleven subjects (mean +/- SD; age: 22 +/- 3.3 y; height: 159.8 +/- 4.3 cm; body mass: 63.7 +/- 8.9 kg) performed 3 separate maximal cycle ergometer tests with either 1 mouthguard or no mouthguard. Heart rate (HR), rating of perceived exertion (RPE), oxygen consumption VO2), minute ventilation VE), and respiratory exchange ratio (RER) were measured at each exercise intensity and at the end of each test. HR, RPE, and VO2 increased for each mouthguard condition across power levels. VE and RER increased more from 110W to max with the no mouthguard condition than for either mouthguard. However, there was no significant difference in VE or RER at any given power level between mouthguard conditions. The results indicated mouthguard use did not affect HR, RPE, VE, VO2, or RER at any given power level during exercise, including the guard made specifically for women. Therefore, athletes are encouraged to use mouthguards without fear of negative aerobic performance effects.
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With children in this country becoming involved in organized sports at younger and younger ages, the incidence of dental and orofacial injuries is on the rise, and the practice of sports dentistry is needed more than ever. This article focuses on the costs of dental injuries and measures that can be taken to significantly reduce the risk of injury.
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All dental emergencies must be considered true emergencies until determined otherwise. Prompt diagnosis and treatment of sports-related traumatic injuries to the teeth and supporting structures are essential to successful long-term clinical outcome. Emergency and long-term treatment techniques for crown fractures, tooth fractures, displaced teeth, and avulsed teeth are described from an endodontic perspective.
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This article assesses the relationship between parents' perceived risk of childhood injuries and familial, sociocultural, and situational variables. Data were obtained through a random digit dial telephone survey of 1,200 households with a preschool child in a southeastern metropolitan area. Perceived risks of childhood injury measures were based on social science theory and childhood injury epidemiology. Multiple item measures included dimensions of seriousness and likelihood for both injuries and hazards. When risk perceptions were viewed as individual items, parents underestimated the risk of some hazards and injuries and overestimated the risks of others, and parents whose children have sustained a recent injury had higher risk perception overall. When risk perceptions were viewed as summed scales, sociodemographic variables and parental safety behaviors were not significant predictors. Sociocultural factors of having a child previously injured, the parent reporting stress, having a household with self-reported risk factors, and the perception of the child as active and hard to manage are related to summed scales of risk perceptions, with some interactions by race of the parent. Findings illustrate the role of situational and sociocultural characteristics of respondents in risk perception research.
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Our professional responsibility related to sports dentistry extends beyond the office. By our active involvement in continuing dental education, we can become more knowledgeable in this relatively new area of sports dentistry. Although it is still in its infancy, sports dentistry is an ever-expanding field. As dentists in practice, whether as general practitioners, specialists, academicians, or researchers, each one of us has a professional responsibility to become involved. Sports dentistry is certain to be a part of our future.
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The face is often the most exposed part of the body during athletic competition. This article concentrates on sports-related injuries to the zygoma and periorbital area, the maxilla, the nose, and the external ear. Discussions of the management of soft-tissue injuries and the diagnosis and treatment of underlying disruption of bone and cartilage are presented. A new piece of protective athletic equipment for the prevention of facial injuries to baseball players is introduced.