Fifteen year old Brad was an avid soccer player. During one of his practice games, his opponent's shoulder struck Brad's mouth with considerable force. Brad immediately held his mouth and fell to the ground bleeding. When his team's physician examined him, Brad had cut his lip and broken his two front teeth in half.
This, unfortunately, is not an uncommon scenario. Outdoor sports and recreational activities can be an integral part of childhood, youth and adult life. And injuries, especially those related to teeth, mouth and face, also called oro-facial injuries, are part of sports. Oro-facial injuries can also be caused by auto-accidents, ill-habits and falls or domestic accidents. To keep this article brief, we will deal mostly with dentistry related oro-facial injuries.
Contact sports such as basketball, football, martial arts, boxing and hockey (ice, field and street hockey); and, non contact sports such as baseball, bicycle riding, roller blading, soccer, wrestling, racquetball, surfing and skateboarding, may lead to oro-facial injuries. In the case of sports injuries, it is imperative for athletes, parents, coaches, trainers and care providers to follow certain protocol, until the injured person can be seen by a qualified physician or dentist. It can be beneficial to know basic CPR (cardio pulmonary resuscitation) skills and deliver the same if needed, until Emergency Services arrive at the scene. Compromised airway, head injuries and suspected loss of consciousness should always be assessed further by a trained physician.
Dentistry related oro-facial injuries can be broadly categorized into soft tissue injuries, jaw injuries and teeth related injuries. The treatment varies according to the severity of the injury.
Soft Tissue injuries are injuries such as bruises, cuts and lacerations related to the lips, gums, cheeks and tongue. The wound should always be cleaned well to remove any pieces of broken teeth, debris and dirt. If the wound is large, stitches or sutures maybe required. A tetanus toxoid shot and antibiotics maybe needed to prevent any life-threatening complications.
Jaw injuries involve jaw dislocations and simple or complicated fractures of the upper and lower jaws. This requires the skills of trained oral and maxillofacial surgeons.
Teeth related or dental injuries are injuries of the teeth that may range anywhere from a simple chip to complex fracture of the tooth or even avulsion (where the tooth is completely removed from it's socket).
Sometimes, preserving an avulsed tooth might prove beneficial. It is advised to pick up the avulsed tooth only by the enamel area (crown portion) of the tooth while avoiding touching the root portion of the tooth. One should immediately and gently rinse off any debris and dirt from the avulsed tooth with clean water or milk. Trying to put a baby tooth back into the socket might injure the underlying permanent tooth bud and should be avoided. If a permanent or adult tooth cannot be placed back into the socket within 5 minutes of the injury, preserve it in the saliva of the injured person's cheek (if they are conscious, old enough and not in the danger of swallowing the tooth) or in a bag of milk or saline, and see a dentist immediately.
Sometimes, it may be possible for the dentist to place the fully formed avulsed tooth back into the socket depending on the extent of the injury and if the tooth is salvageable. This is called re-implantation. Your dentist might recommend further treatment of the re-implanted tooth depending on the diagnosis.
If it is a simple very small tooth chip, the dentist may smooth the tooth to remove sharp edges that irritate the soft tissues, or bond the tooth or advise a crown if the chip is larger. If the fracture is complicated and involves the dental pulp or nerve, the tooth may require a root canal and a crown. The injured tooth may sometimes not require a root canal immediately but may do so in months or years after the injury, due to the delayed reaction of the dental pulp to the injury.
If the root of the tooth has experienced a diagonal, vertical or horizontal fracture, making the tooth unrepairable or very mobile, the tooth may need to be removed or extracted. In this case and in the case of complete avulsion where the tooth cannot be re-implanted, implant(s) or denture may be considered as replacement after healing is complete. If the teeth are moving or displaced from their original position after the injury, your dentist might advise a procedure called splinting. This may require bonding the moving tooth or teeth to adjacent immobile teeth in the mouth in order to stop the mobility and stabilize the teeth.
Oro-facial injuries can have significant negative functional, esthetic and psychological effects on children and adults alike. Although most of these injuries may not be always life-threatening, they can be debilitating and costly during a person's lifetime. Hence, prevention is always better than cure.
In case of toddlers and younger children, since most injuries are related to house hold furniture, it would be better to avoid furniture with sharp edges or having glassware extensively around the house. “Child proofing” your house and vigilant supervision may go a long way to preventing common injuries.
Custom fitted mouth guards and properly fitted personal protective equipment, such as face guards and helmets, are extremely important in prevention of outdoor recreational and sports related dental oro-facial injuries. Since all people do not have the same alignment and form of teeth, it is important to have your dentist make you a custom fitted mouth guard that may effectively protect your teeth. It is advisable to wear the protective equipment not only during the games, but during practice as well.
Ill habits related to sports and recreational activities can also cause damaging effects to the dental and overall health of an individual. The use of smokeless or chewing tobacco can cause severe injury to the gums, lead to gum disease and also cause tooth decay in the long run. Athletes should be encouraged to avoid this dangerous habit. It is recommended to follow a nutritious diet and avoid all sports drinks and food that contain various sugars, to prevent tooth decay.
Follow a healthy lifestyle, brush and floss to keep immaculate oral hygiene, and see your dentist for regular dental check-ups. Always take excellent care of your pearly whites and they will keep you smiling for life!