Taking the hit out of sports injuries.

The crack of the bat and the words "play ball." Does this bring any images good or bad into your mind? Remember the patient who came into the office with chipped or fractured teeth #8 and #9 due to being hit in the mouth by a bat or a baseball? How about the poor fellow, who was playing tag football outside with his dad, and was accidentally elbowed and needed an emergency dental or ER visit? At our office we shudder when we see an emergency put into the schedule with an injured child. We had always spoken to parents and school classes about being careful when playing sports and wearing proper protection, but about five years ago we decided to aggressively do something about it.

It has been estimated by the National Youth Sports Foundation that over five million teeth are lost annually in sports-related accidents, with over 300,000 orofacial injuries occurring yearly. (1) According to the American Dental Association and the National Athletic Trainers Association's newsletter, NATA News, athletes who do not wear mouth protection face a seven times greater chance of suffering an orofacial injury than those who use such protection. (2) Baseball and softball are the most popular organized sports with an estimated involvement of 25 percent of U.S. children. Protective headgear was used regularly during organized games by about 35 percent of these children. Unfortunately, mouthguards were used by only seven percent of these athletes. (3)

What could our office, and dental offices around the country, do to reduce the number of dental-related sports injuries per year? Our doctor did some investigating about making a quality sportsguard available to all of our patients, which we could fabricate in office. We wanted to be sure that the mouthguard we recommended would be superior to all others, would hold up under wear, would protect the athlete as no other mouthguard could do, and come highly rated and recommended by other users.

We found that stock mouthguards may not provide a good fit and comfort to the wearer because they are not intended to conform to the individual's mouth. The boil and bite mouthguard is the most common one sold and is shaped by heating the material in boiling water, then forming it in the mouth. Unfortunately, this provided almost no protection, and became misshapen after only a few wearings. According to our research, the only mouthguards that provide custom-made protection for the users are the vacuum-formed or the pressure-laminated.

Since our research indicated that the vacuum-formed mouthguards only retained their shape for about three to four weeks after delivery, our office invested in a Drufomat (photo above). This machine enables us to make pressure-laminated mouthguards of all types. We can fabricate 3mm, 5mm or greater sportsguards of all colors, and can make a mouthguard suited for hockey players, which has a hard anterior for extra protection. These mouthguards are superior to boil and bite, vacuum-formed, or anything else on the market. They are designed to fit snugly, holding the soft tissue of the lips away from the teeth, which helps to prevent lacerations and bruising. They also help to prevent concussions by cushioning most blows that occur to the mouth due to their support of the mandible. They provide more than adequate protection to the teeth, but more importantly they significantly reduce the possibility of concussions that can result in irreversible brain injuries. We also recommend them to the patient who has come in with an injury who was not wearing any mouthguard, to prevent further damage.

We make these mouthguards as a free service to all of our patients, young or old, who play sports. We do this for the sole reason that they protect their mouths, which, in turn, protect their health. We have also, for the last four years, made sportsguards for the lacrosse and hockey teams at our local Elizabethtown College, and have made them for the Hershey Bears Minor League Hockey team. In addition we make them each year for the Central Penn Piranha Football team, which is a semiprofessional football team in Pennsylvania. The players love the mouth guards, because they can speak clearly while wearing them, they don't fall out of their mouths when they wear them, and they are very comfortable.

When we deliver them, we heat up the occlusal surface and have the athlete bite down so that the teeth have their normal relationship when they bite. Then if they are hit accidently and quickly, they will occlude in the proper position. We also provide pertinent information about proper home care, which is very important to the success of the mouthguard.

We have dedicated ourselves as an office aiming to educate parents, teachers, coaches and students about the dangers of facial and head injuries and how they can protect themselves by wearing the proper protection. With a practice of 2,000 patients or more, there could be at least 200 athletes whom dental personnel could be teaching about the benefits that wearing sportsguards could provide. Our dentist has also spoken to athletic organizations about the benefits of wearing a custom-made sportsguard for protection.

Providing sportsguards has given us the distinction in the community of being a warm and caring office, concerned about the community and the people in it, especially our young athletes, the stars of the future. It has set us apart in our own way; I have had local dentists calling us to find out where they can buy a mouthguard similar to the ones that we make for their children. This has the potential for being a great market niche, or could be a profit center for a dental practice, although we have decided to make it a "caring" center instead.

We, as dental professionals need to take a more active role in helping to prevent dental-related accidents by educating the parents, coaches and athletes alike on the importance of wearing a mouthguard whenever an injury to the face or head could occur.

Whether we are promoting having a vacuum-formed or a pressure-laminated mouthguard made, fabricated in office or sent to a lab, it is important that we care enough to give the very best that we can give, a custom-made sportsguard, made only for the patient.

The Importance of Mouthguards

I always stress the importance of the patient wearing the mouthguard even when not playing sports. Many accidents happen when a child is riding a bike (we stress helmets also) or even playing tag football with family in the front yard. We always have the player (if over 18) read and sign an informed consent, because it is a necessary precaution for our office but also because it stresses the importance of "wearing" the sportsguard and never transferring it to anyone else to wear. It also reiterates the importance of having another one made at least once a year. When they have the mouthguard delivered, I tell them how to keep it clean (brush with your toothpaste and toothbrush, put upside down in the case and leave the lid open until it dries). Never rinse the mouthguard in very warm or hot water because it may distort it, then it won't fit. A copy of our informed consent form appears below.

SPORTS MOUTHGUARD

I hereby consent for--to have a custom-made mouthguard made by Knowlton Dental Associates. I have been informed that the mouthguard needs to be examined periodically and is good for only one season. If my son/daughter is wearing braces the mouthguard may need to be replaced every three months or as directed by the Orthodontist. The mouthguard is made specifically for my son/daughter and is not transferable. It is to be used solely for helping protect teeth and surrounding tissues during athletic activities, events, and practices and to help prevent concussions and reduce the probability of head and neck injuries. The mouthguard is not to be cut or altered in any way as this reduces the protective properties of the mouthguard. The mouthguard should be cleansed with toothpaste and cold water only and stored in a cool area, otherwise distortions occur. I understand that this mouthguard is not a guarantee that injury will not occur.

PATIENT --

DATE --

References

(1.) American Dental Association, Council on Dental Materials. Mouth protectors and sports team dentists. JADA 1984; 109:84-7

(2.) National Athletic Trainers Association. NATA News, 1995; October.

(3.) American Dental Association, JADA 1996; April.

Cindy Smith, CDA, EFDA, is Clinical Director for Know/ton Dental Associates, Elizabethtown, Pa., where she has been employed for 20 years. She conducts all expanded duty functions for the office and is in charge of marketing, practice newsletter, web site and advertising. Ms. Smith has been a licensed EFDA for 10 years and is a member of the ADAA. She holds a certificate in Human Resource Management from Penn State and is working toward a degree in Healthcare Management.