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Sports injury prevention and trauma. (Part XIII).

Traumatic injuries to the teeth are among the most common and disturbing injuries to occur in children and adults with developmental disabilities. Although a significant number of injuries in both children and adults with developmental disabilities result from ambulatory and seizure disorders, these injuries can take place during some forms of sporting activity. It is important to understand that not all injuries will occur in formal sports. Children will often injure themselves during a friendly hockey game on a local street or while shooting hoops. Injuries can range from a small crack in the tooth enamel to complete avulsion (pulling out) of the tooth from the mouth. This article will deal with prevention of injuries during sporting activities, first-aid treatment that can be administered to the person before visiting a dentist and some of the recent techniques used to restore broken teeth.

Prevention of injuries to the teeth

Injuries to the teeth will happen most often when children are playing in either an organized sporting activity or during casual play with their friends. During casual play it is very difficult to prevent injuries as contact generally occurs randomly. Usually the child will fall and hit his/her face, lacerating tissues and often damaging a tooth or teeth. You can only advise your child to be careful when playing; should an injury occur, seek treatment immediately, especially if a tooth has been knocked out of the mouth. Children with very protruding teeth, such as those often seen in individuals with Cerebral palsy, are more prone to injuring their teeth after experiencing a blow to the face and teeth. When possible, the child should have orthodontic treatment to straighten and align the teeth. If the child or adult has an ambulatory or seizure disorder and is prone to falling, the use of a face protector should be considered. Fortunately, the majority of these disorders are controlled with medications, reducing the incidence of injury to the face and teeth.

Organized sporting activities

Any child or adult who is engaged in organized sporting activities which may result in contact with another athlete during the activity should wear a mouth guard to prevent injuries to the teeth and supporting soft tissues.

Mouth guards

Mouth guards are thin, flexible u-shaped pieces of plastic that are worn over the upper teeth when playing any contact activity, such as floor hockey, basketball, soccer, rugby, football, karate, tai-kwando, judo and boxing. Research has shown that these mouth guards act as shock absorbers when the person suffers a blow to the jaws. The primary function is to prevent injury to the teeth, temporomandibular joints and soft tissues; even more important, it has been demonstrated that concussion injuries to the brain can be prevented by wearing a mouth guard. All parents should insist that any child who is involved in a contact sport be fitted with a mouth guard.

Mouth guards can be either custom-fitted by your dentist or purchased off the shelf at the local sports or drug store. To have a custom guard made, the child visits the dentist, who will take a mold of the upper jaw. This mold is sent to a dental laboratory where the mouth guard is vacuum-formed to the mold. The completed mouth guard is then placed over the teeth and because it fits very well, is very comfortable. High-quality off-the-shelf mouth guards that also function very well--the "boil and bite" variety--are available. The mouth guard is placed in boiling water to soften the plastic, then placed over the teeth of the person, who is instructed to bite down gently and suck in on the mouth guard. This adapts the guard to the teeth. The guard is then removed from the mouth and placed in cold water to set the plastic. While this type of mouth guard is not ideal, those of higher quality are acceptable alternatives to the custom-fabricated guard. The important thing is that the person must wear the mouth guard. Consult your dentist, who will advise you on the best type of mouth guard for your child. The dentist can custom design a guard depending on the type and nature of the sporting activity.

Treatment of injuries to the teeth

Any time a person has suffered an injury to the face and teeth, it is very important to determine if s/he has lost consciousness. If this is so, even if everything appears perfectly normal, take the person immediately to the local emergency room for examination. Remember that you might not see the injured person until some time after the accident. Once it has been determined that the person did not lose consciousness, any injury to the soft tissues of the face and teeth can be dealt with.

The Avulsed Tooth

The most severe injury to the teeth is the avulsion, occurring when the tooth has been knocked out of the mouth. If a primary (baby) tooth is accidentally avulsed, do not put it back in the mouth. The correct treatment is not to attempt to replant it, but to seek immediate dental attention and address the injury. If a permanenttooth is lost, time is of the essence in treating this type of injury. The longer the tooth is out of the tooth socket, the less chance it will have to be treated successfully. The best treatment is to replace the tooth in the socket immediately and visit the dentist for further treatment that might involve stabilization. If the tooth has fallen in dirt, it should be washed off--holding the tooth by the crown only--and then replaced in the socket. Again, go straight to the dentist. Do not be concerned if you put the tooth in the wrong way; the best place to store the tooth is in its own socket, root side first. If you are uncomfortable placing the tooth back in the socket, place it in a glass of ice cold milk. If the person is high functioning you can place the tooth under the tongue or in the cheek pouch; saliva is an excellent storage medium. You must instruct the injured person to be very careful not to swallow the tooth. Proceed to the dentist or emergency room, where the tooth will be placed in a special preserving solution until the person can be treated.

Do not wrap the tooth in a dry handkerchief or piece of plastic; it is very important that the tooth remain moist during its trip to the emergency room or dentist. If you are in a facility which has a special "tooth saver container" for avulsed teeth, place the tooth in the container and go to the dentist immediately. Time is critical. The biggest problem with a tooth that has been avulsed is that the tissues on the root surface become dehydrated, greatly reducing the chance of successfully replanting the tooth.

Repairing broken teeth

For teeth that have been chipped, try to locate the broken piece, place it in water and take it with you to the dentist. The piece can sometimes be bonded onto the tooth, restoring its aesthetic appearance. If you cannot find the piece, the dentist will be able to repair the tooth almost to its original color and shape using current bonding techniques. If the piece is lost and the person has a lip laceration, an x-ray may be necessary to ensure that the piece is not embedded in soft tissue.


The dentist will clean the broken tooth surface very well with a mild acid, which prepares the tooth surface for bonding. The dentist will then apply a bonding agent to the tooth and cure it with a special curing light. Now the tooth can be built up with very lifelike materials, duplicating the shape and color of the original tooth. In most cases it is almost impossible to distinguish between the natural tooth and bonded repair. The repairs can often be made without the use of a local anesthetic, as the tooth does not have to be drilled at all, and the procedure is almost painless. However, if the nerve (pulp) of the tooth is involved, the dentist may have to use local anesthetic before treatment. Today "nerve treatments" (root canals) can be completed very rapidly thanks to advanced technology and materials. In a young child who has damaged a tooth and exposed a nerve, the treatment will normally take one or two visits. Following the nerve treatment, the dentist will restore the tooth to its normal function and appearance.

Sometimes a tooth may darken or discolor following trauma. If the tooth is a primary (baby) one, treatment is determined by the age of the patient and the development of the dentition, as this tooth will eventually be replaced by its permanent successor. A permanent tooth can be bleached, or even veneered, using bonding to restore its original color. If the tooth is very dark a porcelain crown or cap may be needed.


Today a person who has avulsed a tooth which cannot be replanted, or sustained a severe injury rendering the tooth (or teeth) non-restorable, can have it replaced with an implant. An implant can be likened to an artificial root that is imbedded in the bone, then covered with a crown to replace the tooth that was lost. Unfortunately, this treatment is only suitable for persons 18 years of age and older, because the jawbones have to complete their growth before an implant can be placed successfully. This treatment is especially useful for someone who has lost a single front tooth, as this treatment avoids cutting the adjacent teeth down to place a bridge. Bridges are an alternative method of replacing lost teeth. The teeth on either side of the lost tooth are reshaped by the dentist so that crowns can be placed on the teeth. The two crowns are joined by a false tooth and the whole bridge is cemented onto the prepared teeth. This type of restoration is very good as long as the patient has very good oral hygiene. Other important considerations about implants are significant cost and the high level of patient cooperation required for the procedure.

The use of dentures to replace teeth in a person with developmental disabilities must be carefully evaluated, especially in those individuals with seizure disorders, as dentures can be displaced during a seizure episode. Your dentist will be able to evaluate the best replacement method for the individual.

If the tooth remains in the socket but has been knocked out of alignment, you can try to reposition it if the child or adult will allow you to do so. The best time is immediately after the accident, as the person will be a little shocked and will still allow you to touch the teeth. Again, visit your dentist as soon as possible. If your dentist is not available, take the person to the local emergency room. Unfortunately, emergency rooms are notorious for keeping patients waiting if an injury is not life-threatening, and sometimes this wait can compromise the success of treatment.

Remember, once the teeth have been repaired it is important to visit the dentist for regular follow-up visits to check that the teeth are functioning properly and healing well. It is not uncommon for the nerves--not only in the injured teeth but in the adjacent teeth--to deteriorate following trauma, so follow-up is very important. If the initial repair was made at an emergency facility or while away from the area, please be sure to tell your dentist that the person has had a traumatic injury to the teeth. The dentist will then take x-rays as necessary to monitor the traumatized teeth over time.

Manfred Friedman, DDS, is an Assistant Professor in the division of operative dentistry and endodontics at the School of Dentistry, University of Western Ontario, London, Canada. He is also the Director of Dentistry at the South-western Regional Center and has a private practice limited to endodontics in London.
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Author:Friedman, Manfred
Publication:The Exceptional Parent
Geographic Code:1USA
Date:Jul 1, 2002
Previous Article:The double whammy: Tourette syndrome and associated disorders as they impact families. (research reflections).
Next Article:Informing empowering and keeping parents involved. (Special report: Part II: the decision and the battle).

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