Posted March 13, 2017
By Kurt Andrews M.S., ATC, PES, CES
It’s not even day 1 of the new season yet. It’s the first time the lights have been turned on in the athletic training facility since an early exit in playoffs gave rise to a dramatic ending and unexpected offseason. Memories of the holidays remain fresh but need to be stored in the long-term memory bank as it is now time to get things prepared for the upcoming season.
The offseason has brought many changes within the organization as old faces have gone on to new challenges where new and old faces have assumed new positions. In preparation for the upcoming physicals, it’s encouraging to know that the medical staff has remained the same, thus ensuring continuity and efficiency at the doctor’s office.
All stations are set, the orthopedic doctors are set to do their exams, the podiatrist is confirmed to come down and scan everyone and the primary care providers are all set for electrocardiogram (EKG) testing. The doctor’s office has hired nurses to run all the tests for general health, the ophthalmologist is ready to do the annual eye exam and the chiropractors are coming by to do spinal evaluations. The dietician is ready to sit down and do one on one evaluations with all the athletes, the neuropsychologist is ready to impact test everyone and the performance staff is ready to put the team through physical test to get an understanding of the performance perspective. Amongst the organized chaos in the doctor’s office is a familiar face, one that doesn’t get much sideline attention during games. But, one who is a crucial component of the sports medicine staff, the team dentist.
Sports dentistry is a new area of sports medicine specialization, not so much in terms of utilization amongst the athletes and athletic departments, but more so in its utilization in prevention principles of potential oral and facial injuries involved in the related sports. Sports dentistry also focuses on the prevention of any oral diseases and manifestations that may occur along with the maintenance and treatment of oral and facial injuries.
Dental trauma in sports is the major link between sports and dentistry, thus making dentists a necessity at pre-participation examination (PPE). During the team physicals the team dentist conducts oral health screenings and is involved with the fabrication of custom made mouth guards for certain sports such as football, hockey, lacrosse, basketball or wrestling. They also make themselves available for any sort of emergency care or dental procedures that need to take place before the season starts preventing athletes from missing time during the season. Dentists should also be playing an active role in educating the public and athletes on the use of protective equipment for sporting activities not only to prevent injuries but also to reduce healthcare costs (Ramagoni et al., 2014).
Many sports related traumatic dental injuries are preventable with the use of appropriate, properly fitted and protective athletic equipment. These include but are not limited to helmets, facemasks and custom mouth guards. The National Youth Sports Foundation for the Prevention of Athletic Injuries, Inc. estimates that during the season of play athletes have a 10 percent chance of sustaining an injury to the face or mouth (Ramagoni et al., 2014). The most common orofacial sports related injuries include soft tissue injury and hard tissue injury including those to the teeth and facial bones such as tooth intrusions, luxations, crown/root fractures, complete avulsions and dental facial fractures (Saini, 2011).
The front teeth are the most affected by dental trauma with the maxillary central and lateral incisors being the most commonly injured teeth. The most common tooth injury is an uncomplicated crown fracture (Soares et al., 2014). Most of the time these injuries occur from a direct hit by a ball or from player to player contact. On the rare occurrence, while on the road for a game, it can be critical for an Athletic Trainer to have the team dentist available via phone or text to assist in the trouble shooting of a problem and come up with a short-term solution until the team comes back home.
By having a team or university dentist involved during the entrance physical, this professional can help facilitate the custom fabrication of mouth guards for the athletes involved in contact sports. These custom made mouth guards are superior to the stock or “boil and bite” mouth guards because of their adaptability and retention but are also believed to interfere the least with breathing and speech. Mouth guards should be worn when there is a possibility of any sort of physical contact with an opponent because they can help to prevent injuries to the teeth, lips, gingiva, tongue and mucosa. They cushion the blows that could cause jaw fractures, dislocations and trauma to the temporomandibular joint (Saini, 2011). According to the American Dental Association, the use of faceguards and mouth protectors prevent more than 200,000 orofacial injuries in football annually (Saini, 2011).
During the Athens Olympics in 2004, dental services were the second most utilized service in the Olympic village behind physiotherapy. The most common procedures were dental fillings (313 permanent and 31 temporary), root canals, pericoronitis treatment and mouthguard fabrications. The entrance physical is a perfect place for the dentist to be involved so every athlete can have a dental assessment. This will ensure that their oral health status is verified and cleared and any issues that may come up can be handled in the preseason.
In a study from 2003 to 2006, professional soccer players from the Spanish team Barcelona were compared with students of Dentistry and Medicine from the University of Barcelona. The researchers found that the average active dental cavity was significantly higher among professional soccer players compared to the dental student (Soares et al., 2014). What this shows is that the students practiced what they preached and were more willing to participate in dental hygiene practices, but that’s because they are familiar with them. The take home message from a study like this is that these dental issues are more widely spread amongst athletes and the team dentist needs to establish a program encouraging oral health to the athletes of a university, college, professional or amateur teams.
A different study looking at 400 medical records of 353 amateur and 47 professional soccer players, found the results of poor oral health far worse for amateurs than the pros. In the amateur athletes, they found 283 cavity lesions (71 percent), 109 root canals (27 percent), 33 abscesses (9 percent) and 78 tooth extractions (22 percent). When compared to the professional athletes, they found 32 cavity lesions (68 percent), 11 root canals (23 percent), no cases of abscesses (0 percent) and 24 tooth extractions (51 percent) (Soares et al., 2014).
Swimmers have also been found to have a higher than normal tooth enamel decay. Researchers have found that swimming athletes are affected with biocorrosion of enamel because of the chlorine used to keep the pools clean; the acidic water in contact with the teeth causes irreversible tooth structure wear especially to the anterior teeth (Soares et al., 2014).
It is easy to understand now how important it is to have a dentist involved within the sports medicine team, and why they could and should be involved during the PPE or entrance physical exam. The duty of the sports dentist is to work alongside the athletic training staff to ensure the oral healthcare of the athletes, identify any individual risks, and develop prevention plans so that the athletes can avoid any major dental issues. The inclusion of a dentist to your sports medicine program can be a major component of your injury prevention model.
Dr. Padilla’s (Team Dentist for LA Galaxy) Top Tips for Dental Health
1. Regular scheduled dental exams and professional cleanings.
2. Be proactive rather than reactive. Complete any necessary treatment in a timely manner. Don’t put off treatment because it doesn’t hurt yet. This will insure minimal treatment performed.
3. Have good home dental hygiene care. Brush and floss at least twice a day.
4. Diet can contribute to dental problems. Limit excessive acidic drinks like sodas, fruit juices and sports drinks. These acidic drinks may dissolve tooth enamel which may contribute to tooth erosion and cavities. Rinse and hydrate with water after taking these acidic drinks.
5. Avoid smokeless tobacco, which can cause periodontal and oral cancer complications.
6. Wear custom made athletic mouth guards in competing in trauma related sports.
Ramagoni, N. K., Singamaneni, V. K., Rao, S. R., & Karthikeyan, J. (2014). Sports dentistry: A review. Journal of International Society of Preventive & Community Dentistry, 4(Suppl 3), S139.
Saini, R. (2011). Sports dentistry. National journal of maxillofacial surgery, 2(2), 129.
Soares, P. V., Tolentino, A. B., Machado, A. C., Dias, R. B., & Coto, N. P. (2014). Sports dentistry: a perspective for the future. Revista Brasileira de Educação Física e Esporte, 28(2), 351-358.
About the Author
Kurt Andrews, originally from the metro Detroit area, graduated with his bachelor’s degree in Exercise Science in 2008 from Oakland University. He has been a BOC Certified Athletic Trainer since 2011 where he earned his master’s in Athletic Training from the entry level master’s program at the University of Arkansas. He currently is in his fifth year as an assistant Athletic Trainer for the Major League Soccer (MLS) club LA Galaxy. He currently holds memberships with NATA, CATA and PSATS where he serves on the sponsorship, continuing education and research committees and was presently serving as the Western Conference senator.