SPORTS DENTISTRY

Presented by:
SUMAIYA MOHD ALI
Batch (03-04)
 CONTENTS:

1. Introduction
2. Definition
3. What is sports dentistry?
4. Incidence of dental sports injuries
5. Facts from the American Dental Association
6. Mouth guards: History, benefits, design, types, properties
7. Effect of mouthguards on dental injuries and concussion
 treatment of avulsed permanent tooth

 prevention of concussion

8. Conclusion
 Introduction:

 Prevention is an obligation of dentistry as well as a

critical patient responsibility.

As the young athletes in our practices become

involved in organized sports or recreational activities, it
is important for dentists to take a proactive role and
encourage parents of these kids to wear proper
protective equipment to prevent oral injuries. Dentists
must educate themselves and their young patients about
the prevention of such injuries. Safe sports participation
should be the goal of any sports program and the dental
professionals should enthusiastically work to achieve this
goal in every community.
 Definition:

 Sports Dentistry is the prevention and treatment of

oral/facial athletic injuries and related oral diseases and
manifestations.
 What is sports dentistry?
 In sports, the challenge is to maximize the benefits of
participation and to limit injuries.

 Prevention and adequate preparation are the key elements in

minimizing injuries that occur in sports.
These include:
 teaching proper skills such as tackling technique,
 purchase and maintenance of appropriate
equipment,
 safe playing areas and
 Certainly the wearing and utilization of properly fitted
protective equipment.
 Treatment of oral/facial injuries, simple or complex, is to include
not only treatment of injuries at the dental office, but also
treatment at the site of injury, such as a basketball court or
football or rugby field, where the dentist may not have the
convenience of all the diagnostic tools available at their office.

 Knowledge and ability to do "on site" differential diagnosis is

essential, without the use of radiographs and dental operatories,
to determine the future treatment and prognosis of the injury.
Sports Dentistry includes:
 Preseason screenings and examinations which are essential in
preventing injuries.
Examinations: are to include:-
 health histories,

 at risk dentitions,

 diagnosis of caries,

 maxilla/mandibular relationships

 Orthodontics and malocclusions

 oral hygiene,

 loose teeth,

 dental habits,

 crown and bridge prostheses,

 missing teeth,

 artificial teeth, and

 The possible need for extractions for orthodontic concerns or

wisdom teeth.
 Determination of the need for a specific type and design of mouthguard
is made at this time.
 Sports Dentistry also includes the need for recognition and
referral guidelines to the proper medical personnel for non
dental related injuries which may occur during a dental/facial
injury. These injuries may include:
 cerebral concussion,
 head and neck injuries, and
 drug use.

 It is NOT suggested that dentists treat these injuries, but as

health professionals dentists should be able to recognize these
entities and refer these patients to the proper medical
personnel.

 Smokeless tobacco: is often associated with certain sports,

and the public should be educated on the dangerous
properties and consequences of using smokeless tobacco
What you may find…
 Is not uncommon for dentists to recognize the symptoms of
anorexia and bulimia through dental examination. Eating
disorders are not as infrequent as one may think in female
athletics.

 Erosion patterns in the teeth, caused by gastric acids, often help

dentists in the differential diagnosis of eating disorders. These
patients need to be referred to the proper medical and
psychological health professional.

 Woman's gymnastics, volleyball, and basketball are just a few

sports where eating disorders have been documented in the
medical/dental literature.
 Incidence of dental sports injuries:
 The National Youth Sports Foundation for the prevention of Athletics
injuries, reports that the dental injuries are the most common type of
oral, facial injuries that are sustained during participation in sports.

 The 1990 report of the "Better Health Program" entitled, "Sports

injuries in Australia, Causes, Costs and Prevention" estimated that
sports injuries cost Australia (population 18 Million) about $1.4 billion
per year and that between 30-50% of these injuries are preventable.

 Multiply these numbers for the United States (population 260 million).

 It is estimated by the American Dental Association that mouthguards

prevent approximately 200,000 injuries each year in high school and
collegiate football alone.

 Victims of tooth avulsions who do not have the teeth properly

preserved or replanted will face lifetime dental costs estimated from
$10-15,000 per tooth, the inconvenience of hours spent in the dental
chair and possible other dental problems
 Facts from the American Dental Association
 A properly fitted
mouthguard reduces the
chances of sustaining a
concussion from a blow to
the jaw.

 Mouthguards should be
worn at all times during
competition; in practice as
well as in games.

 Local dental society and

associations should keep
information on dentists and
mouthguard programs in an
area.
 The American Dental Association recommends wearing custom
mouthguards for the following sports:

 acrobats,  racquetball,
 basketball,  roller hockey,
 boxing,  rugby,
 field Hockey,  shot putting,
 football,  skateboarding,
 gymnastics,  skiing,
 handball,  skydiving,
 ice hockey,  soccer,
 lacrosse,  squash,
 surfing,
 volleyball,
 water polo,
 weightlifting,
 Wrestling
 martial arts,
 Mouth guards
History:
 The first recorded use of mouthguards was by boxers,
and in the 1920s professional boxing became the first
sport to require mouthguards.
 Advocacy by the American Dental Association led to the
mandating of mouthguards for US high school football in
the 1962 season.
 Currently, the US National Collegiate Athletic Association
requires mouthguards for four sports (ice hockey,
lacrosse, field hockey and football).
 However, the American Dental Association recommends
the use of mouthguards in 29 sports/exercise activities.
 Benefits of mouthguards:

 Meta-analyses indicated that the risk of an orofacial sports

injury was 1.6-1.9 times higher when a mouthguard was not
worn.
 Types of mouth guards

 Mouthguard design and fabrication is extremely

important. There are four types of mouthguards according to
the dental literature.
 Stock,

 Boil and Bite,

 Vacuum Custom made, and

 Pressure Laminated Custom made.

Materials used for mouthguards included
are:

 polyvinylacetate-polyethylene or ethylene vinyl acetate (EVA)

copolymer;
 polyvinylchloride;
 latex rubber;
 acrylic resin; and
 polyurethane.
What to do when a tooth is knocked
out...
 Researchers have developed methods of saving most of these
teeth.
 Precautions:
1. Locate and pick tooth by crown or enamel and NOT by the root.
2. Do not re-implant deciduous teeth.
3. Assess for head injury and never re-implant in an unconscious
patient.
4. The American Association of Endodontists (2004) recommends
reimplanting the fully formed tooth (closed apex) if it has been
in a storage medium of milk, saline or saliva tooth even up to 60
minutes or less of extra-oral dry time (tooth out of bony socket).
Recommendations are milk and HBSS when available.
 Treatment of the
Avulsed Permanent Tooth
Recommended Guidelines of the American
Association of Endodontist (AAE)
I. Management at Site of Injury
 Replant immediately, if possible. If contaminated, rinse with

water before replanting.

 When immediate replantation is not possible, place tooth in the

best transport medium available.

II. Transport Media

 Hank's Balanced Salt Solution (H.B.S.S.)

 Milk

 Saline

 Saliva (buccal Vestibule)

 If none of the above is readily available, use water.

III. Management in the Dental Office:
 Replantation of Tooth (depeding on the extra oral dry time)
 Management of the Root Surface
 Management of the Socket
 Management of Soft Tissues - tightly suture any soft tissue
lacerations, particularly in the cervical region
 Splinting (indicated in most cases)

IV. Adjunctive Drug Therapy Considerations

 Systemic antibiotics
 Referral to physician for tetanus consultation within 48 hours
 Chlorhexidine rinses
 Analgesics
V. Endodontic Treatment
 Tooth with open apex (divergent apex) and less that one hour
extraoral dry time:
 Tooth with open apex (divergent apex) and greater that one
hour extraoral dry time:
 Tooth with partially to completely closed apex and less than
one hour extraoral dry time:
 Tooth with partially to completely closed apex and greater
than 2 hours extraoral dry time:

VI. Restoration of the Avulsed Tooth

 Recommended Temporary Restorations (placed prior to final
obturation)
 Recommended Permanent Restorations (placed immediately
after final obturation)
VII. Additional Considerations
 Avulsed primary teeth should not be replanted.
 Avulsed permanent teeth require follow-up evaluations for a
minimum of 2-3 years to determine the outcome of therapy.
 Inflammatory resorption, replacement resorption, ankylosis and
tooth submergence are potential complications when avulsed
teeth are replanted.

The Guidelines are based on a review of the pertinent literature

and clinical experience in managing cases. The literature is
divided into four general categories:
(1) Clinical trials,
(2) Simulated injuries,
(3) Case reports
(4) Opinion articles.
 Concussion Prevention
 Concussion is an alteration of consciousness, disturbance in
vision and equilibrium caused by a direct blow to the head,
rapid acceleration and/or deceleration of the head, or direct
blow to the base of the skull from a vertical impact to the
chin.
There are several levels of concussion:
 Asymptomatic: No headache, dizziness or impaired
orientation, concentration or memory during rest or exertion.

 Grade 1 (mild): No loss of consciousness (LOC) and Post

traumatic amnesia (PTA) less than 30 minutes.

 Grade 2 (moderate): LOC less than 5 minutes or PTA

greater the 30 minutes.

 Grade 3 (severe): LOC greater than 5 minutes or PTA

greater than 24 hours.
 During a blow to the chin, in most instances, the temporal bone is
violated as it houses and ports cranial nerve trunks as they exit the
base of the brain, blood supply to the brain, and auditory and
balance mechanisms.
 In football, when mouthguards are not worn, the mandible is
placed in the most vulnerable position for injury and concussion,
upwards and back into the fossa and base of the skull. It is no
coincidence that the position that least wears a mouthguard
(quarterback) is the position that sustains the most concussions
from blows to the chin.
 Conclusion:

 The importance of protection during various types of sports

activities cannot be overemphasized. The use of mouth
guards has been instrumental in preventing dental injuries.
Dentists, however, must be knowledgeable in the pitfalls of
these various types of protective devices.
Factors affecting fabrication of mouth
guards:

1. Dentition
2. gender
3. the same sport under the same conditions
4. the same experience and played the same position at the
same level of competition,
5. age
6. size mouth
7. number
8. shape of teeth
Design of mouthgurads:
 The thicker materials (3-4mm) are more effective in absorbing
impact energy and the thinner materials show marked
deformation at the site of impact. These mouthguards are not
bulky and uncomfortable.

 The clinician cannot expect that a 3mm thick material will

remain 3 mm thick after fabrication. This is a physical
impossibility due to shrinkage during fabrication adaptation.
Vacuuming a commercially laminated 3mm sheet of EVA will
give the same unsatisfactory results. Therefore, laboratory
pressure lamination procedures must be used incorporating
two or more EVA materials to achieve our end result of 3mm -
4mm thickness occlusally. This will allow the clinician to
monitor and measure these results before delivery of these
mouthguards.
 Properties of mouthguards:

 Ideal properties stated are:

 be protective(shock absorbing)

 comfortable

 resilient

 tear resistant (durable)

 odorless

 tasteless

 not bulky

 have excellent retention

 fit

 sufficient thickness in critical areas.

 Water absorption

 cause minimal interference to speaking and breathing