Dental Trauma

Dental trauma is common, with one third of all dental injuries in the United States occurring with sports activities (Honsik, 2004). Mouth guards are recommended by the American Dental Association for participation in all collision and contact sports as well as weightlifting, skydiving, skateboarding, gymnastics, racquetball, squash, and skiing. Dental injury is especially common in sports combining collision and a hard ball or puck, such as ice hockey or field hockey. A study of college basketball found a significant decrease in tooth injuries in participants using custom-fitted mouth guards; however, there was no decrease in oral soft tissue injury or concussion (Labella et al., 2002). Sports physicians and dental professionals agree that although off-the-shelf molded mouthpieces are less expensive and more readily available, they do not protect teeth as effectively as a custom mouthpiece (Honsik, 2004).

Teeth rest in a bony socket, each with a neurovascular root connected to the socket by a periodontal ligament. Above the gum the tooth consists of three layers: dentin, pulp, and superficial enamel. Injuries involve fracture of the tooth or some degree of luxation. Fractures range from an enamel chip to those involving the deeper components. Luxation can result in a normally positioned loose tooth or a displaced tooth still positioned in the socket. Injury can also result in complete tooth avulsion.

After injury, tooth fragments or avulsed teeth should always be recovered, if possible, and transported to a dentist in saline-soaked gauze. Fractures involving only enamel and dentin can be managed by dental evaluation within 48 hours. Pulp involvement (visible pink or blood in center of the tooth) mandates urgent dental referral, and medical-grade cyanoacrylate (Super Glue) can be placed on the tooth acutely for pain and to prevent infection. Luxation without impaction can be reduced if jaw fracture is not suspected, and return to play with a custom mouth guard can be considered, depending on successful reduction, level of pain, and level of competition. If the tooth is easily repositioned, dental consultation can be delayed 24 hours. Players with impacted luxation or teeth that cannot be repositioned should not return to play, and dental consultation sought immediately. Avulsed teeth should be rinsed with sterile saline and replaced, if possible, taking care not to handle or damage the root, followed by immediate dental consultation (Honsik, 2004).

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