– Dr Sneha Divekar
Part 1 – Importance of Sports Dentistry and its various components.
Development of Sports in India
India is home to a diverse population playing many different sports across the country. Cricket is the most popular sport. Football is popular in some of the Indian states. The country has won many Olympic gold medals in field hockey. Kabaddi, an indigenous sport is popular in rural India. Several games originated in India including chess, snooker and other regional games. India has won medals in badminton, kabaddi, hockey and many other sports and disciplines. India has also hosted several sporting events such as the Asian Games (1951 and 1982), Cricket World Cup (1987, 1996 and 2011), Hockey World Cup and the Commonwealth Games (2010).
Thus, today sport is emerging as an important component of socio-economic development of our country. The active participation in sports improves community health, productivity, reduces medical expenses, imbibes discipline in character & enhances social cohesion. The execution of a mega sporting event helps in developing infrastructure, generating employment, securing inflow of foreign capital and thus contributes significantly to the economic development of our country. Therefore, it can be said that the impact of sports on the society is multi-dimensional.
Concern over increasing Sports Injuries
The injuries that occur during participation in organized sports are of growing concern. Injuries during sport appear to be unavoidable and up to 30% to 40% of all accidents in children and adolescents occur during sports. The prevalence of sports injuries varies widely. Injuries in youth sports account for substantial morbidity and cost. Sports injuries result from acute trauma or repetitive stress associated with athletic activities.
Dental injuries are the most common type of oro-facial injury sustained during participation in sports, with the increased popularity of contact sports. Contact sports are defined as those sports in which players physically interact with each other, trying to prevent the opposing team or person from winning . There is seldom very high incidence of dental trauma compared with all accidents in contact sports varying from 2% to 33% . Dental and soft tissue injuries are commonly associated with some top Indian collision and contact sports such as football, hockey, boxing, cricket, soccer, bicycling, skating, gymnastics, basketball, volleyball, karate, kabaddi, etc. Incidence of sports related oral injury vary widely based on the sport played, level of competition, the participant’s age and sex.
Dental injuries are the most common type of orofacial injuries sustained during sports activities. Dental trauma in sports differ from other dental trauma, as it is possible to easily prevent it and there is also a possibility to dramatically reduce the occurrence level by the use of mouthguards that protect all dental and periodontal structures.
Physical and Psychological impact of Dento-facial injuries to Athletes
As dentists, we are all aware that the athlete can suffer dental injuries like crown/root fractures, luxations, avulsions; soft tissue injuries like bruises, lacerations, lip/face cut and facial fractures leading to deformity, loss of function, pain, etc. All this can have severe psycho-social impact on the athlete’s mind leading to depression, anxiety, and hostility. It can lead to loss of confidence, self-image and reduced self-esteem, especially in cases of professional athletes who are in the limelight due to matches and tournaments. So “returning back to the game” doesn’t just happen with healing of physical injuries, but the athletes need to move on from PTSD, that is, post-trauma stress disorder which is highly prevalent post facial and dental injuries.
Economic Considerations for Dento-facial Injuries
It is estimated that millions of rupees are spent every year in India on rehabilitation of dental and facial injuries. Dento-facial injuries can be an economic burden to the athlete’s parents and guardians as thousands or lakhs of rupees have to be spent in their treatment and rehabilitation. There is a lot of social stigma and less acceptance in India over facial disfigurement and thus it affects the entire life of the athlete. Even if few teeth are lost, the long term cost of replacement of those teeth can go in lakhs of rupees. Thus, the athlete’s family and coach should take the issues of potential dento-facial injuries very seriously and work towards their prevention and early management. For this, the dentist should be trained in various aspects of Sports Dentistry and take initiative in providing dental care for athletes and creating awareness about prevention and management of dento-facial injuries. That is why, it is necessary to introduce Sports Dentistry to dentists and athletes alike.
Introduction to Sports Dentistry
Sports dentistry is one of the most recent and upcoming field in dentistry. It mainly includes the prevention and management of sport-related orofacial injuries and associated oral diseases. The sports or team dentist assists athletes in the prevention, treatment, and diagnosis of oral injuries. The most significant aspect in preventing sports-related orofacial injuries is wearing basic protective devices such as properly-fitting helmets, face masks and/or mouth guards. Dental injuries are the most common type of orofacial injury sustained during participation in sports. Many athletes are not aware of the health implications of a traumatic injury to the mouth or of the potential for incurring severe head and orofacial injuries while playing. The dentist can play an imperative role in informing athletes, coaches and parents about the importance of preventing orofacial injuries in sports.
Origin and Definition of Sports Dentistry
Sports Dentistry had its origin in the 1980s as vigorous physical activities and sports athletics in men and women increased. Though there were health benefits, participating in such activities also placed athletes at risk for injury, including trauma to the teeth and mouth. According to the Academy of Sports Dentistry (USA), “Sports Dentistry is the branch of sports medicine that deals with the prevention and treatment of dental injuries and related oral diseases associated with sport and exercise ”.
Components of Sports Dentistry
Sports Dentistry has mainly 2 components:-
- Prevention of dento-facial injuries through sports safety measures
- Management of Dento-facial Injuries
Prevention of dento-facial injuries through sports safety measures
Prevention of oro-facial trauma during sports activities includes
- Teaching proper sports skills by the coach
- Maintaining good health of the athlete
- Purchase and maintenance of appropriate equipment
- Safe playing areas
- Wearing and utilizing of properly fitted equipment (mouthguards)
- Making the entire team of athlete, coach, parent, physician and other paramedics aware of the management of dento-facial injuries.
Management of Dento-facial Injuries
1.Emergency management of dento-facial injuries
As incidences of sports-related dento-facial injuries is very high, the athletic trainer (coach), team physician, dentist and other primary health care providers should be competent in initial assessment and management techniques for these injuries with the help of first aid treatment. After the initial treatment or once the body parameters are normal, further investigation of the dental injury is to be done. If the dentist is not available on the field, the patient/athlete has to be immediately taken to a dental clinic and get further treatment done soon.
2. Treatment and Long-term Management of Dento-facial Injuries
The severity of oro-facial injuries varies significantly, but in many cases the extent of these injuries are not apparent immediately to the primary health care provider or dentist. Many seemingly benign sports-related dental injuries evolve into conditions that produce permanent discomfort and deformity. That is why, once the patient becomes stable after the injury, a more thorough and specific evaluation of the oral injuries is undertaken. This evaluation and management technique enables the coach, team physician or the dentist to perform a thorough soft tissue and structural assessment while managing and repairing any necessary wound trauma. Long-term management of dento-facial injuries includes many specialities of dentistry like oral surgery, endodontics, operative dentistry, orthodontics, hospital dentistry and patient behaviour management. Your team sports dentist can co-ordinate with the rest of the dental specialists and medical specialists (like plastic surgeons, orthopaedics) for the same.
Other Components of Sports Dentistry
Referral to the proper medical personnel: Sports Dentistry also includes the need for recognition and referral guidelines to the proper medical personnel for non-dental related injuries which may occur during a dental/facial injury. These injuries may include cerebral concussion, head and neck injuries. Even though dentists may not treat these injuries, but as health professionals dentists should be able to recognize these entities and refer these patients to the proper medical personnel.
Recognition of Doping: In sports, use of performance enhancing drugs is commonly referred to by the term “doping”. Many sports organizations have banned the use of performance enhancing drugs and have very strict rules and consequences for people who are caught using them. The World Anti-Doping Agency (WADA) was established in 1999 to control and avoid the use of drugs in sports industry. The WADA provides a list of drugs which are prohibited to be used in sports by international athletes and also provides the list of drugs which are allowed to be used in the case of injuries. The sports dentist must be familiar with all these drugs and try and recognize any symptoms if he/she witnesses in their athlete patients. If the dentist doubts that the athlete is breaking anti-doping rules, they must inform the athlete’s physician, parents and if required, any anti-doping organization. The National Anti-Doping Agency (NADA) is the organization in India which monitors the use of unethical drugs in the sports industry.
Recognition of Substance/Drug Abuse: Smokeless tobacco can also be included and addressed under Sports Dentistry. Smokeless tobacco is often associated with certain sports, and the athletes should be educated on the dangerous properties and consequences of using smokeless tobacco. The dentist can identify athletes with substance/drug abuse as dental patients with substance use disorders have more tooth decay and periodontal disease than the general population, but are less likely to receive dental care, according to a review published online in the journal Addiction. Drug use affects oral health through direct physiological routes such as
- dry mouth,
- an increased urge for snacking,
- clenching and grinding of teeth and
- chemical erosion from applying cocaine to teeth and gums
- more tooth decay and periodontal disease than the general population
Dentists should screen their patients for substance use, notice any advanced dental or periodontal disease inconsistent with patient age and consider referral to medical doctors for management.
Health assessment of Athletes: Along with the team physician and coach, the dentist can also look into the matters of the overall health of the athlete. Research has proven that poor dental care can affect athlete’s overall health. It is now an established fact that if athlete doesn't take proper care of his/her teeth, they could face far more serious consequences than a simple toothache or some unsightly stains. Increased gum problems and high decay rate increases the chances of developing cardiac diseases, dementia, respiratory infections and diabetic complications. If the dentist comes across such potent dental problems, he/she should explain the consequences to the athlete, coach, parents, team physician and get dental/gum treatment done soon and keep a follow-up.
Recognition of Eating Disorders: It is not uncommon for dentists to recognize the symptoms of anorexia and bulimia through dental examination. Eating disorders are not as infrequent as one may think in female athletics. Woman's gymnastics, volleyball, and basketball are just a few sports where eating disorders have been documented in the medical/dental literature. Erosion patterns in the teeth, caused by gastric acids, often help dentists in the differential diagnosis of eating disorders. These patients need to be referred to the proper medical and psychological health professional.
Nutrition assessment of Athlete: Athletes need to have a high carbohydrate diet for optimum performance. However, these carbohydrates have to be carefully chosen to reduce the risk of dental decay or erosion. Thus, it is imperative that the dentist understands the dietary habits along with the oral hygiene habits and use/overuse of certain substances as it can lead to rise in dental problems for the athlete. The dentist needs to instruct the athlete regarding the usage of certain foods commonly seen in sports setups like sports drinks, carbonated beverages, use of chewing gums, etc.
Special needs Athlete: Behavioural issues, developmental disorders, cognitive disorders and systemic diseases may increase a child’s risk of developing oral diseases, according to an article published in the May/June 2010 issue of General Dentistry, the peer-reviewed clinical journal of the Academy of General Dentistry, USA. For a child with special health care needs, special diets, frequent use of medicine and lack of proper oral hygiene can make it challenging to maintain good oral health. That is why, in case of special needs athletes, it becomes all the more important to assess the dental health of the athlete and get dental treatment done to ensure hassle-free participation of the athlete in any kinds of games/competitions specially designed for them.
Currently, there is a very limited data regarding sports dentistry in India. There is no dental institute in India that has courses on Sports Dentistry. The Sports Authority of India does not have any policy on Sports Dentistry. Thus, like other countries, India too needs a systemic approach for how the dental profession can interact with the sports world, including opportunities for dentists in athletics. There is a great need for “Team Dentist” from high schools to professional teams. The dentists can assist athletes and incorporate knowledge into their private practices in three main ways, i.e. by conducting pre-season oral health screenings, fabricating custom-made mouthguards, and being available for emergency care. Dentists can educate the general public, parents/guardians, staffs of emergency department, coaches and athletes regarding health risks and benefits of mouth guards including the importance of emergency care for orofacial injuries. It is advisable for the sporting community to have sports dentistry centres all over the various cities across India identified for a quick approach when needed.
Part 2 – Next article: Role of a Sports Dentist and how to practice it as an alternate or dual career?