1Prevention ofPrevention ofAthleticAthleticDentalDentalTrauma and Sports DentistryTrauma and Sports DentistryDENT 5402DENT 5402February, February, 20082008Mark Roettger DDS, FASDMark Roettger DDS, [email protected]@umn.eduDefinition of Sports DentistryDefinition of Sports DentistrySports dentistry involves the prevention and Sports dentistry involves the prevention and treatment of orofacial athletic dental treatment of orofacial athletic dental injuries, and related diseases as well as injuries, and related diseases as well as the collection and dissemination of the collection and dissemination of information on dental athletic injuries and information on dental athletic injuries and the encouragement of research on the encouragement of research on prevention and treatment of such injuries.prevention and treatment of such injuries.Sports Related Oral DiseaseSports Related Oral DiseaseOral PiercingOral Piercing••Tooth injuryTooth injury••InfectionInfectionEnamel ErosionEnamel Erosion••Sports drinks pH<3Sports drinks pH<3••19981998--2003 sales up 2003 sales up 465%465%••Bulimia; wrestling, body Bulimia; wrestling, body image sportsimage sportsUse of Spit Tobacco in SportsUse of Spit Tobacco in Sports••Widely used in many Widely used in many sports; all agessports; all ages••Athletes claim Athletes claim performance performance enhancementenhancement••Not a safe alternative to Not a safe alternative to smokingsmoking••Increases risk of Increases risk of developing oral cancerdeveloping oral cancer••Question athletes in your Question athletes in your practicepractice2Athletic Dental TraumaAthletic Dental TraumaComplex injuries involving multiple tissues with great Complex injuries involving multiple tissues with great healing potential healing potential if properly treatedif properly treatedDental Trauma: MechanismDental Trauma: MechanismDirectDirectDirect TraumaDirect Trauma••The tooth itself is The tooth itself is struckstruck••Injuries usually to Injuries usually to anterior teethanterior teeth••Energy of impact: low Energy of impact: low mass, high velocity; mass, high velocity; high mass low high mass low velocityvelocityDental Trauma: Mechanism Dental Trauma: Mechanism IndirectIndirectIndirect TraumaIndirect Trauma••Lower arch is forcefully Lower arch is forcefully closed against the closed against the upperupper••Crown/root Fx in Crown/root Fx in posterior teethposterior teeth••Jaw FxJaw Fx••TMJ injuryTMJ injury••ConcussionConcussion??Dental Trauma: Crown FractureDental Trauma: Crown FractureDental Trauma: Root FractureDental Trauma: Root FractureDental Trauma: LuxationDental Trauma: LuxationLuxation InjuriesLuxation Injuries••SubluxationSubluxation••Lateral Lateral ••ExtrusiveExtrusive••IntrusiveIntrusive3Dental Trauma: AvulsionDental Trauma: AvulsionAvulsion requires prompt TreatmentAvulsion requires prompt Treatment: Re: Re--implantation or proper implantation or proper transport medium 30 min (isotonic)transport medium 30 min (isotonic)••HankHank’’s Balanced Salt Solutions Balanced Salt Solution••MilkMilk••Contact lens solutionContact lens solutionDental Trauma: Alveolar Bone Dental Trauma: Alveolar Bone FractureFractureDental Trauma: Soft Tissue InjuriesDental Trauma: Soft Tissue InjuriesDental Trauma: SignificanceDental Trauma: Significance••Half of all children will suffer a dental Half of all children will suffer a dental injury by the time they graduate high injury by the time they graduate high schoolschool••Sports activities cause the greatest Sports activities cause the greatest percentage of traumatic injuriespercentage of traumatic injuriesGutmann JL. Cause, incidence and prevention of trauma to Gutmann JL. Cause, incidence and prevention of trauma to teeth. Dent Clin North Am 1995;39(1):1teeth. Dent Clin North Am 1995;39(1):1--13.13.Epidemiology of Dental TraumaEpidemiology of Dental TraumaFootballFootball••Prior to MG mandate Prior to MG mandate 50% of injuries to mouth 50% of injuries to mouth and faceand face••After MG mandate After MG mandate injuries to mouth and injuries to mouth and face decrease to 1.4%face decrease to 1.4%••MG use prevents 150,000 MG use prevents 150,000 to 200,000 injuries per to 200,000 injuries per year in the USyear in the USEpidemiology of Dental TraumaEpidemiology of Dental TraumaUniversity of Minnesota StudyUniversity of Minnesota Study••Studied basketball, soccer and wrestling in Studied basketball, soccer and wrestling in Minnesota high schoolsMinnesota high schools••25% of soccer players had dental injury25% of soccer players had dental injury••50% of basketball players had dental injury50% of basketball players had dental injury••75% of wrestlers had dental injury75% of wrestlers had dental injury••Athletes reported > 100 injuries while trainers Athletes reported > 100 injuries while trainers reported < 10reported < 10••Orthodontic appliances increased chance of Orthodontic appliances increased chance of injuryinjury4Participation, high school sportsParticipation, high school sports20042004--20052005USAUSAMinnesotaMinnesota> 7 million 233,070> 7 million 233,070• Numbers have increased for 16 consecutive years• Many trauma studies predict a 1 in 10 chance of a dental injury per season• Translates to 700,000 oral sports injuries per year in the US; 23,000in MNPrevention: Who Should Wear Prevention: Who Should Wear MouthguardsMouthguards••Athletes in at risk Athletes in at risk sports (compared to sports (compared to football)football)••Athletes with history Athletes with history of orofacial injuryof orofacial injury••Orthodontic patientsOrthodontic patientsMouthguard HistoryMouthguard History••18001800’’s boxings boxing••1962 football 1962 football mandatemandate••1974 hockey mandate1974 hockey mandate••1993 MSHSL mandate1993 MSHSL mandateTypes of Mouthguards: StockTypes of Mouthguards: Stock••No customizationNo customization••Poor fitPoor fit••Interferes with Interferes with speechspeech••Interferes with Interferes with breathingbreathing••Low athlete Low athlete satisfactionsatisfactionTypes of Mouthguards: MouthTypes of Mouthguards: Mouth--formedformed••Customized in the Customized in the mouthmouth••Marginal fitMarginal fit••BulkyBulky••Large