Sports Dentistry
Much more than mouthguards

"ln all, there is much to be done in the field of sports dentistry. Participation by the dentist can be very rewarding, for the goodwill generated as well as for the personal satisfaction derived when it is realized that the dentist has not only treated the injured athlete but may have prevented many more potential injuries from occurring."

Godwin, W., "The Role of the Sports Team Dentist," Sports Dentistry—The Dental Clinics of North America Vol. 35, No 4, W B. Saunders Co

Dentists assist athletes—professional, amateur, and weekend warriors—in three basic ways:

Pre-season screening

Pre-season screening helps to identify disease or abnormalities that might impact or be affected by a particular sport or activity. The screening includes taking a history and performing a soft tissue exam along with a visual check for decay, missing teeth, failing restorations, erosion, and fluorosis.

Specific conditions to be alert for include lingual erosion (which might indicate bulimia), general enamel erosion (perhaps caused by exposure to chlorine and not uncommon in swimmers and divers), and suspicious lesions in known users of smokeless tobacco. The dentist can play an important role in counseling athletes on the dangers of smokeless tobacco.

Injury treatment

Emergency trauma care can be provided either on-site or in the office. Differential diagnosis of soft and hard tissue injuries or fractures is achieved through specific questions: How, where, and when did the injury occur? Was there loss of consciousness and, if so, for how long? Any other symptoms, such as headache, nausea, vomiting, or amnesia? Any bite or sensitivity problems? Suspected or known medical consequences of the injury are referred to a physician.

Common orofacial sports injuries include soft-tissue contusions. abrasions, lacerations, and hematomas. These conditions can hide underlying hard tissue damage, which should be investigated with x-rays. Tooth fracture, intrusion, luxation, and avulsion are prevalent sports-induced injuries.

An emergency kit for dentists at sporting events includes in addition to traditional trauma kit items, are exam gloves, a mouth mirror, tongue depressors, a pen light, sterile gauze pads, a small sterile wire cutter for removing broken orthodontic wires, rope wax, temporary filling material,commercial mouthguards to replace one lost at the event, scissors, and a 3M Save-A-Tooth kit.

Mouth guards

Many practitioners and most patients probably immediately think of the prevention of oral and facial injuries as the main component of a typical "preventive" regimen for maintaining good oral health. Those actively involved in sports dentistry, however, know that promoting and dispensing mouth pro-tectors is simply another aspect of a preventive program that also includes brushing, flossing, professional visits, sealants, fluoridation, and education.

The use of mouthpuards is known to dramatically reduce the incidence of injury to the teeth, lips, gums, tongue, and mucosa. Properly fitted mouth-guards also minimize the risk of other injuries: jaw fracture, dislocations and trauma to the TMJ, neck injuries, concussion, cerebral hemorrhage, unconsciousness, serious central nervous system damage, and even death.

Among the many stated goals of Healthy People 2000, the federal government's agenda for improving the health of the U.S. population, is the following: "All organizations, agencies, and institutions sponsoring sporting and recreation events that pose risks of injury will require the use of effective head, face, and eye protection by the year 2000 "

In support of this goal, Oral Health America/American Fund for Dental Health, through its Oral Health 2000 initiative, is focusing specifically on mouthguard use by encouraging "collaborative efforts among athletic trainers, coaches, educators, and school administrators in concert with dental professionals, including dentists, hygienists, dental assistants, and dental technicians."

While dental professionals seem united in their support of mouthguards for a variety of athletic and recreational activities, resistance and or lack of awareness exists on the part of indi-viduals participating in these activities or those making decisions about requiring mouthguards. Many mention cost and "the hassle factor" as reasons for not wearing mouth protection. In many organized sports, much of the reluctance stems from the belief that mouthguards impair the ability to communicate and may hamper breathing.

Although it is generally agreed that any mouth protection is better than none, custom fitted mouthguards are considered the best option. The various types of protectors available each have their advantages and disadvantages.

Purchased ready-to-use, stock mouthguards are the least expensive. They are readily available at sporting goods stores and come in small, medium, and large sizes. Stock protectors must be held in place by constant occlusal pressure. Their bulk and inaccurate fit tends to interfere with speech and sometimes breathing.

Also widely available and relatively inexpensive, boil-and-bite guards may provide a more accurate fit, and thus better retention, than stock protectors if properly handled.

"To reduce gagging, many athletes alter their stock and boil-and-bite mouthpuards by cutting down the posterior region, thus greatly increasing their chances of injury, especially concussion."

Custom fitted mouth protectors, when properly fabricated and adjusted, offer the best adaptation, retention, and comfort as well as the least interference with speaking and breathing.

"Vacuum-formed mouth-guard provides protection far superior to stock or boil-and-bite protectors.

In addition to clinical functions, practitioners involved in sports dentistry may find themselves involved in education (professional and patient), research, and community service.

The Dentist's responsibility related to sports dentistry extends beyond the office. A dentist in practice has a professional responsibility to become involved. Sports dentistry is certain to be a part of dentistry.

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