Dental trauma in sports – awareness and prevention

• Fast moving sports would appear to predispose to injury as a result of collisions.
• The same is ‘time of those sports’ that use projectiles balls, pucks or some form of sticks. Bats, hockey sticks and similar sports equipment are associated frequently with soft tissue lacerations and contusions as well as certain displaced fractures.
• Other factors like the conditions of the playing fields and the fit of the safety equipment affect the amount of risk to which the athlete is exposed.

HOST FACTORS

The host or the injured individual can be described not only by age and sex, but also developmental level, from toddlers learning to run or throw a ball; to school aged children learning to swim and play various games; to adolescents playing contact sports; to older individuals whose diminished eyesight and slowed reflexes make them susceptible to injury.

Age and growth: There is difference in the risk of sports injury with age.

• With the increasing age of children, changes in co-ordination, conditioning, training and playing skills are observed. The developing child needs to adjust learned skills rapidly to the changing dimensions of his or her body. Their inability to adjust to new body proportions and make necessary skill adjustments may result in increased vulnerability and risk of injury during this age.
• After completion of puberty/ growth phase, the athlete is at his/her prime level of playing any sport and can have very good co-ordination, training and playing skills.
• However, the diminution of these same factors with advancing age can increase chances of injury. Degenerative changes in the bone, ligaments and other connective tissues may also be important factors that increase risk of dento-facial injury in older players.

Gender: Gender is a potential risk factor as there is an apparent tendency for men and boys to select more aggressive or contact sports. Many studies have concluded that boys seem more prone to dento-facial injuries than girls.

According to National Youth Safety Sports Foundation (NYSSF) 1994 survey, the ratio of injuries in boys to girls is 3:1.

However, some authors suggest that girls are at higher risk than boys when exposure rates are taken into account.

Perception of the parents also differs toward son/daughter injury risk, as shown by their tendency to require their sons to wear mouthguards but not their daughters. This will hold truer in India where participation of girls in various sports and support given to them by their parents has been increasing only in the last decade.

However, attitudes are slowly changing and the obvious importance that the female athlete’s family has in maintaining the structural integrity of her face will motivate them to take more preventive steps and get mouthguards fabricated in the future. This will dramatically decrease chances of dento-facial injuries for female athletes as well.

Physical and Mental Fitness: An increased body size can increase chances of injury for the athlete; this can be due to higher center of gravity and stress on joints due to additional weight.

• A number of research studies have documented that excessive height and weight predispose athletes to injury.
• Since physical fitness of the athlete can lessen the onset of symptoms of fatigue, it can be assumed that aerobic fitness can predict some prevention of sports injuries.
• This suggests that unfit athletes would be more prone to injury as their stamina and concentration both can get affected. Strength acquired by the athlete through proper conditioning can reduce the potential for injuries. On the other hand, localized weaknesses, muscle imbalances or tightness appear to predispose an individual to sports injury.

For many athletes, inherent personality factors and mental health fitness may play a role in the prediction of sports-related injuries. Children with emotionally stressful states, as investigated by differences in urinary catecholamines, pose a greater risk of dento-facial injury.

Skilled Coaching and history of previous injury: A lack of skilled coaching can increase risk potential for the athlete. Without proper instruction and guidance in physical fitness and sporting skills, the athlete is less able to respond in game situations, thereby increasing injury risk. In fact, it is proven that athletes are influenced by their coaches more than their parents, other athletes or officials.

Some studies have found out that one of the most important risk factor for dento-facial injuries in sports was having a previous injury, which affects the psychological or psychosocial mind-frame of the athlete. Especially those athletes who have undergone a considerable amount of dento-facial trauma due to a sports injury, it is very important to boost the confidence and remove any fears of injury from the athlete’s mind.

Orthodontic status and other dental issues: The relationship of the upper jaw to the lower jaw affects the vulnerability to injury.

Many studies have shown that orthodontic status plays a significant role in risk of trauma to the upper front teeth, for example, risk of injury increases in:

• Proclined maxilla (upper jaw placed more in the front in relation to the lower jaw with many times upper front teeth projecting out),
• a short upper lip or incompetent lips and
• mouth breathers.

Athletes with severe dental problems are at increased risk of injury as discomfort in the mouth or teeth can hamper the confidence and concentration of the athlete while playing.

ENVIRONMENTAL FACTORS

In some of the unforeseen circumstances, sometimes the nature factors such as

• condition of light (e.g. dull light),
• disturbed air conditions
• modified humidity conditions
• rains

may cause disturbed physical conditions.

Sports injuries occur when the elements of host, agent and environment interact together at a precise time. For some injury types, these elements are quite predictable.

Depending upon the risk factors given above, a predictive index can be developed that determines the likelihood of sports-related dento-facial injuries in various age groups of athletes playing different types of sports. This predictive index will help the coach, team physician and dentist to understand the risk of injury for a particular athlete playing a particular sport and help in taking preventive measures.

Conclusion

To conclude, awareness creation will bear fruit if there are proper mandates and policies in place. While mandates may be appropriate for some sports, education and the use of marketing and social media will likely be more effective in achieving the desired outcome. By focusing on creating a culture among parents, students, coaches and the general public that mouthguard use is part of participating in sports, the use of orofacial protective devices will increase and hopefully become the norm rather than the exception.

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