Traumatic dental injuries (TDIs) are highly prevalent, particularly in sports activities. Many cases of dental trauma are preventable through appropriate measures, which include both primary and secondary prevention. Primary prevention focuses on avoiding the development of dental pathology, while secondary prevention involves the early diagnosis and treatment of dental issues before they lead to significant morbidity.
The role of dental professionals, including denturists, extends beyond treating dental diseases; it also includes educating patients and other healthcare professionals about preventing dental injuries. This article will cover dental sports medicine prevention methods and more.
Global Impact and Cost of Traumatic Dental Injuries
Traumatic dental injuries account for a substantial proportion of bodily injuries. Research indicates that over one billion people globally have experienced a TDI, with an estimated rate of 2.82 incidents per 100 people annually. In 2016, this translated to approximately 900 million people having at least one TDI, including around 180 million children with TDIs affecting their primary teeth. This prevalence suggests that TDI should be ranked as one of the world’s most frequent acute or chronic conditions.
The cost burden of managing TDIs is significant, estimated between $2,000,000 and $5,000,000 per one million inhabitants, and their management is more time-consuming compared to other bodily injuries.
The Role of Sports Dentistry and Denture Dental Care
Sports dentistry encompasses the prevention, diagnosis, and treatment of orofacial trauma related to sports. It includes dental screening, pre-season assessments, injury prevention, and the impact of nutrition on athletic performance. Over the past decade, sports dentistry has evolved from focusing solely on injury treatment to supporting overall athlete health.
The World Dental Federation (FDI) and other organizations have developed guidelines and toolkits for sports dentistry, emphasizing the need for continuous education and preventive measures.
Additionally, other dental professionals, such as denturists, are involved in sports related dental injuries due to their specialized role in reconstruction. It’s therefore vital that denture dentists have a thorough understanding of sports related oral diseases and injuries.
Classification of Traumatic Dental Trauma
Traumatic dental injuries can be categorized into three main types. Sports medicine physicians, sports dentists, and denturists should all be familiar with the following for the betterment of a patient’s oral and general health.
- Soft Tissue Injuries: These include abrasions, contusions, or lacerations affecting the lips, oral mucosa, gingiva, and frenulum.
- Hard Tissue Injuries:
- Enamel Fractures: Limited to enamel only.
- Enamel-Dentin Fractures: Affect enamel and dentin without exposing the pulp.
- Complicated Crown Fractures: Involve enamel, dentin, and expose the pulp.
- Crown-Root Fractures: Affect enamel, dentin, and root, with possible pulp exposure.
- Root Fractures: Affect dentin, cementum, and pulp, classified as vertical or horizontal.
- Alveolar Fractures: Involve the alveolar bone and may extend to adjacent bone.
- Periodontal Injuries:
- Concussion: Tooth is tender, with normal mobility and no gingival bleeding.
- Subluxation: Tender tooth with increased mobility but no displacement.
- Extrusive Luxation: Partial displacement of the tooth out of its socket.
- Lateral Luxation: Displacement of the tooth in a palatal/lingual or labial direction.
- Intrusive Luxation: Apical displacement of the tooth, usually through the labial bone plate.
- Avulsion: Complete loss of the tooth from the socket.
Prevention Strategies
Prevention of traumatic dental injuries can be categorized into four levels.
| Primary Prevention | Avoidance of pathology development |
| Secondary Prevention | Early diagnosing and treatment of the pathology before significant morbidity occurs |
| Tertiary Prevention | Reduction of adverse effects and complications of pre-established disease and restoration of function |
| Quaternary Prevention | Avoidance of the consequences of overtreatment and overmedication for the specific condition |
*Prevention Levels | Sports dentistry – Education and Prevention: Play it right! | Continuing Education Course on dentalcare.com. www.dentalcare.com/en-us/ce-courses/ce679/prevention-levels
Dental professionals must act to benefit the community by educating on screening, prevention, and treatment of traumatic dental injuries. As the profession shifts from treating existing caries to managing risk factors for dental trauma, identifying and managing high-risk individuals becomes crucial.
A sports dentist and denturist must be proactive to effectively protect athletes’ oral health.
Mouthguards and Face Shields
- Mouthguards: Proven to reduce the probability and severity of orofacial injuries. Different types include:
- Stock Mouthguards: Over-the-counter devices with no retentive features, less effective in protection.
- Mouth-Formed (Boil-and-Bite) Mouthguards: Thermoplastic materials adapted to individual dentition, offering improved fit but potentially less stability.
- Custom Mouthguards: Fabricated on a stone model for a precise fit, providing optimal protection and stability, especially beneficial for patients with fixed orthodontic appliances.
- Face Shields: Recommended to prevent injuries to the face and mouth during sports events. They reduce injuries to the teeth, mouth, eyes, nose, and facial bones. Studies show that face shields decrease the incidence of upper facial injuries and are often used in conjunction with mouthguards for additional protection. They come in various formats, including those attached to helmets for specific sports or worn independently.
Implementing comprehensive preventive measures and utilizing protective equipment will decrease the risk and impact of traumatic dental sports injuries.
Traumatic Brain Injuries and Concussions in Sports
Recent media coverage has heightened awareness of traumatic brain injuries (TBIs) in sports, particularly following high-profile cases involving professional, elite athletes.
However, contact sports of all levels can result in severe dental injuries and dental trauma. The following sections will specifically cover the risk of brain and TMJ injuries during sports impacts and how the use of appliances that lock the lower jaw in position can reduce injury.
Categories of Brain Injury
Brain injuries from sports trauma can be categorized into two main types:
- Diffuse Brain Injury: This includes concussions, where the brain suffers widespread injury due to shaking or rotational forces. These injuries result in stretching and damage to nerve fibers, leading to temporary or permanent loss of function. Diffuse injuries are not visible on CT or MRI scans and are diagnosed through neuropsychological tests.
- Focal Brain Injury: This type involves localized damage from direct trauma, such as contusions, hematomas, or hemorrhage. Focal injuries can be seen on CT or MRI and result from localized cellular damage and the compression of brain tissue. These injuries may require surgical intervention and can be severe or even fatal.
Traumatic brain injuries lead to metabolic dysfunction in the brain, decreased regulation of blood flow, and an inability to restore physiological balance.
Neurons may die from lack of oxygen, glucose, or due to mechanical disruption. The severity of brain injury depends on the injury’s nature and the brain’s recovery environment.
Mechanisms of Energy Transfer in Brain Injury
Brain injury can occur through:
- Direct Transfer of Energy: This results from impacts to the head, causing skull fractures or focal injuries. Differential acceleration can cause the brain to collide with the inner skull, leading to contusions or hematomas. Modern helmets have been effective in reducing skull fractures and focal injuries but may not fully protect against impacts to the jaw.
- Indirect Transfer of Energy: Sudden head movements from collisions or falls generate rotational forces that cause diffuse brain injuries. These injuries result from the brain’s shearing against the skull’s irregular surface and are common in high-speed contact sports.
- Lower Jaw Impacts: Blows to the lower jaw can transmit significant forces to the temporomandibular joint (TMJ) and the skull base, causing both diffuse and focal brain injuries. Lower jaw impacts can occur even with helmets and face shields, leading to significant energy transfer and increased risk of TBIs.
Understanding Lower Jaw Impacts
The lower jaw connects with the skull at the TMJ, making it susceptible to significant impacts. Blows to the chin, a common target in boxing, produce considerable forces due to the jaw’s mobility.
Athletes wearing face shields and helmets are still at risk, as impacts can transfer substantial energy to the jaw, TMJ, and skull base.
Jaw joint protectors are a new device that can make a significant difference. They’re designed to protect teeth, oral tissues, jaw joints, and brain from lower jaw impacts.
Design Requirements for Minimizing Concussion Risk
An effective intraoral appliance for reducing concussion risk should:
- Prevent posterior and superior displacement of the lower jaw during impact, typically achieved by a dual-arch design.
- Exhibit rigidity and resistance to deformation during impact and clenching.
- Fit properly to ensure comfort and retention.
- Allow adequate breathing by incorporating an airway space.
Stay Informed and Prepared With Stomadent Dental Laboratory
Complete dental care requires working knowledge of the best prevention practices and an understanding of the biggest risks facing youth and professional athletes.
At Stomadent Dental Laboratory, denturists also receive access to a premier full service dental lab, including the latest 3Shape, 3D scanners, CAD/CAM Systems and more. Ensure your patients get the best with Stomadent.
Related Posts
