1. Dental and oral trauma in sports
A. Khayampour, DDS, MSc, OMFS

2. Oral tissue trauma %50 of facial trauma occurs in mouth and teeth
Low Speed
elbows & fists
soft tissue lacerations & contusions
High Speed
balls, pucks, sticks
Bone / tooth fractures

3. Intraoral laceration Treated much like skin lacerations
Irrigation with saline, reapproximation with absorbable sutures
Avoid secondary healing, esp. in tongue

4. Lip laceration Compression of lip on teeth
Look for associated dental and other hard tissue injury

5. Lip laceration

6. Lip laceration Mucosal only lacerations heal well without sutures
Deep or through & through lacerations require layered repair
Vermillion border: approximate border FIRST, then repair remainder

7. Tongue laceration Irrigate, remove foreign bodies
Repair muscle with resorbable; if deeper than 5mm
Repair mucosa if still necessary, resorbable is fine
Check for hematoma and sweeling: consider corticosteroids

8. Gingival trauma Consider suturing free gingiva
Attached gingiva does not need suturing; consider secondary healing

9. Dental trauma Infraction Enamel fracture
Enamel- dentin fracture( uncomplicated crown fracture)
Enamel- dentin- pulp fracture( complicated crown fracture)
Crown- root fracture without pulp exposure
Crown root fracture with pulp exposure
Root fracture

10. Periodontal trauma Alveolar fracture Concussion Subluxation
Extrusive luxation
Lateral luxation
Intrusive luxation
avulsion

11. infraction Enamel cracks Usually asymptomatic
In case of marked infraction etching and sealing is required

12. Uncomplicated crown fracture
Loss of tooth structure without involving pulp
Glass ionomer for emergency treatment, composite resin for definitive cure

13. Complicated crown fracture
Loss of tooth fracture with pulp exposure
Pulp capping/ partial pulpotomy/ RCT

14. Crown-root fracture without pulp exposure
Loss of tooth structure: enamel, dentin and cementum

15. Crown- root fracture with pulp exposure
Consider RCT and check for fracture line under the gingiva

16. concussion
An injury to tooth supporting structures without mobility or displacement but with pain in percussion
Soft diet, monitor for 1 year

17. subluxation
Increased mobility without displacement, gingival sulcus bleeding
No treatment, if mobility is too much
Consider splinting for 2 weeks

18. extrusion Partial displacement of tooth out of it’s socket
Repositioning and 2 weeks splinting

19. Lateral luxation Tooth displacement other than axially
Usually with labial or lingual bone fracture
Repositioning and 4 weeks splinting

20. intrusion Displacement of the tooth into alveolar bone
Treatment is determined by intrusion severity and open/ close apex of the tooth
Surgical repositioning is used in more than 7 mm intrusion in close apex, otherwise spontaneous or orthodonthic repositioning is used

21. avulsion Complete displacement of tooth out of it’s socket Treatment:
Find the tooth and pick it up by the crown
Wash the tooth for 10 seconds and replace it
If immediate replacement is not possible store the tooth in milk, hanks storage medium or saline
It can be stored in mouth or saliva

22. avulsion
Splinting is used for up to 2 weeks if closed apex and extraoral time is less than 60 minutes
Antibiotic therapy is needed for days with doxycycline
RCT is performed days after initializing of splint
If extraoral time is more than 60 minutes perform RCT prior to tooth replacement and remove PDL with gauze and splinting is used for up to 4 weeks

23. avulsion In open apex defer RCT until signs of necrosis are seen.
Tetracycline is contraindicated in less than 12 years of age and instead amoxicillin or penicillin are used.
Splinting is used for 1- 2 weeks in open apex

24. avulsion
A very important note is the storage medium for avulsed tooth:
Milk, saliva, hanks solution, green tea are considered suitable
Never use water or saline. Some literature suggest saliva is not a good medium because of microbial contamination.
Remember the 60 minutes extraoral golden time.

25. Primary teeth Primary avulsed teeth should not be reinserted.
Intruded primary teeth are allowed to re erupt
In primary dentition every effort is made to preserve the permanent teeth, even with primary teeth sacrificing.

26. Prevention of oral injuries

27. Mouth guards
Mouth guard use is mandatory for football, ice hockey, lacrosse, field hockey, and boxing.
Several states have passed regulations mandating mouth guards for soccer, basketball, and wrestling

28. Mouth guards
1. Mouth guards help to protect the teeth and soft tissues of
the mouth from injury.
2. The better the fit, the more protection offered.
3. Mouth guard use may reduce the risk or severity of a concussion.

29. Types of mouth guards There are 3 types of mouth guards: 1. Stock.
2. Mouth-formed, or “boil-and-bite.”
3. Custom fit.

30. Stock mouth guards
These pre-formed, over-the-counter, ready-to-wear mouth guards are generally the least comfortable and, therefore, the least likely to be worn.
Because of poor fit, they also offer the least protection and require constant biting down to stay in place.

31. Boil and bite mouth guards
Made of thermoplastic material that conforms to the shape of the teeth after being placed in hot water, these mouth guards are commercially available and the most common type used by athletes.
They vary in fit, comfort, and protection.

32. Custom fit mouth guards
This type of mouth guard must be made by a dentist for the individual.
It is the most expensive, but also offers the most protection and comfort.
Custom mouth guards are preferred by dentists and usually preferred by athletes because of their increased comfort, wear-ability, and retention, as well as ease of speaking when worn.
This type of mouth guard is particularly important for adolescents with orthodontic appliances.

33. Recommendations
The American Academy of Pediatric Dentistry (AAPD) recommends properly fitted mouth guards for all children participating in organized and unorganized contact and collision sports.
The AAPD supports mandated for use of athletic mouthguards in any sporting activity containing a risk of orofacial injury.

34. Thanks…