More than 5 million teeth are knocked out each year; many during sports activities, resulting in nearly $500 million spent on replacing these teeth each year. In an issue of Dental Traumatology it was reported among children ages 13-17, sports-related activities were associated with the highest number of dental injuries. 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. In soccer, baseball, and softball, a small percentage of children wear mouthguards. The National Federation of State High School Association (NFHS) indicated that of all injuries, less than 1% are oral injuries because football players are wearing properly fitted mouthguards. Prior to the use of mouthguards, injuries to the orofacial areas occurred over 50% of the time. The NFHS recommends mouthguards for any sports where there is a potential for orofacial injury from body contact. It is clear that the need for studies, education, and regulations for mouthguard implementation is a major concern in the dental field.
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 greater chance of receiving an orofacial injury every season of play. It is estimated that mouthguards prevent between 100,000 and 200,000 oral injuries per year in professional football alone. The American Academy of Pediatric Dentistry and the American Dental Association recommend a mouthguard for all children and youth participating in any organized sports activities.
Following is a list of types of injuries an athlete may sustain that are of particular concern to the dental professional.
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 fractures or other significant underlying injury. These usually occur over a bony prominence of the facial skeleton such as the brow, cheek, and chin. Lip lacerations are also common.
Fractures of the facial bones present an even more complex problem. One of the most frequent sites of bony injury is the zygoma (cheekbone). Fractures of the zygoma, occurring as a result of direct blunt trauma from a fall, elbow, or fist, account for approximately 10% of the maxillofacial fractures seen in sports injuries. Like the zygoma, the prominent shape and projection of the mandible cause it to be frequently traumatized. Approximately 10% of maxillofacial fractures resulting 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. 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.
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 tissue is 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.
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 re-eruption. Mature root development will require repositioning and splinting or orthodontic extrusion.
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. 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. Treatment is determined by the level of injury.
Certainly one of the most dramatic sports-related dental injuries is the complete avulsion of a tooth. According to recent studies by the American Academy of Pediatric Dentistry, 0.5-3% of 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 it is 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. See the American Academy of Pediatric Dentistry website relating to avulsed teeth recommendations for dental professionals.