In an age of active lifestyles, including sporting activities at both the youth and adult level, it is no surprise that athletic injuries to the orofacial region and the dentition are on the rise.
Douglas L. Lambert, DDS, FACD, FASDA, FASD, ADAB, led a course at CDA Presents The Art and Science of Dentistry in San Francisco Aug. 17 that focused on the subject of sports-related injuries, classifications, contemporary management and prevention.
Knowledge of sports dentistry in any practice is important, Lambert said.
“Anything we as dental professionals can learn, embrace and pass on to trainers, coaches or athletic directors is a big help to those folks,” Lambert said.
Unique and timely techniques for diagnosing, treating and restoring oral health accidents are vital for successful long-term results, whether the patient has had a sports-related injury or fallen down a flight of stairs. And dentists have a lot of options when it comes to restorative options for the sports-related dental injury.
“It can even be somewhat daunting,” Lambert said, “figuring out what you’re going to use. And specifically when you’re talking about an athlete, there’s going to be some parameters that you’re going to want to look at as to how you will deal with the athlete now, and how you may treat them in the future.”
After reviewing a few sports-related dental trauma cases from his practice and explaining the accompanying treatment plan and restorative technique used, Lambert moved on to discuss the various dental-based injuries, including luxations, crown fractures, crown/root fractures, root fractures, alveolar bone fractures and, as Lambert said, “the biggest of them all — avulsions.” Lambert said that in his almost 30 years in practice, he’s seen just five avulsions, but added that when they do come up, time is of the essence.
“Avulsions are the true dental emergency. And when it comes to these injuries, the single most important factor is speed,” Lambert said.
For the best results, the tooth should be replanted within 20 minutes with, ideally, a clean and undamaged root surface. To reduce the risk of avulsion, or any sports-related dental injury, altogether, Lambert suggests encouraging patients to wear a mouth guard.
“Evaluate the various types of mouth guards available and help the athlete choose the appropriate one,” Lambert said.
Various mouth guard types include stock, mouth-formed and custom-fitted. Stock mouth guards are commercially produced and are taken right from the box and into the mouth. Mouth-formed, sometimes referred to as “boil and bite,” are generally made of acrylic gel or thermoplastic materials designed to be softened in boiling water then molded to the teeth using finger and tongue pressure. Designed to cover all the teeth, custom-fitted mouth guards are vacuum-formed and heat/pressure laminated, offering the most effective protection.
Lambert said it’s typically a sport people don’t consider all that dangerous that requires the most protection.
“Between baseball, softball, basketball and sometimes soccer, some of the most traumatic injuries I’ve seen have come in from those sports. Why is that? Because most of those sports don’t have mandated mouth guards. Think about it. Football, hockey, men’s lacrosse — sports that require a helmet, a cage and a mouth guard — you don’t see those kinds of injuries to the orofacial area that you do in the nonprotected sports.”
Orofacial injuries are much lower in football, Lambert said, because face masks and mouth guards are mandated.
Lambert covered a number of specific mouth guard and splinting armamentarium suggestions and attendees left with a list of restorative armamentarium as well. Also included in Lambert’s course handout was a “recipe for success” for anterior and fiber-reinforced direct composite bridge techniques.
His goal was for every attendee to take away something practical.
“I hope that everyone here can find one or two little nuggets that will help modify or improve what they do when they go back to their practices,” said Lambert. “I’m not necessarily out to reinvent the wheel for them, it’s more to modify and improve upon what they’re already doing successfully.”
For more information about CDA Presents lectures, visit cdapresents.com. For members planning to attend CDA Presents in Anaheim May 15-17, registration will open in December at cdapresents.com.