Dr. Poorva Gharpure, Smile Care, Nashik

In the recent times, preventive dentistry has emerged as the main focus of dentistry. Awareness among sportsmen and various international sport organizations has recognized the need of dentistry in sports. Prevention of such injuries can be achieved through proper patient education, diagnosis, treatment of existing dental problems & designing custom made mouthguards.

Types of orofacial injuries commonly observed in athletes include injuries to the dentition, namely, fractured or knocked out teeth, loosened teeth or teeth forced out of position. Injuries resulting in dislocation or fracture of jaws may be incurred due to direct impact on jaws.

Contact sports like football, boxing, martial arts, hockey and non contact sports like basketball, baseball, bicycle riding, soccer, wrestling, racquetball, surfing and skateboarding should be supplemented with protective appliances like mouthguards.

Preventive solutions for orofacial injuries can be enlisted as :

1. Regular check up for any undiagnosed problem that might cause an unexpected problem during athletic event.
2. Completion of any ongoing dental treatment.
3. Use of mouthguard under professional dental guidance.

Mouthguards :

Mouthguards are readymade or custom made devices fabricated in a way to provide maximum coverage over all teeth. Usually they are adapted over maxillary teeth unless indicated on mandibular teeth. Material used for mouthguard must have shock absorbing properties. According to various international organizations for sports dentistry, material of choice for custom made mouthguards is ethylene vinyl acetate.

Types of athletic mouthguards :

1. Stock : Has no individual fitting and is least desirable; available at local sports stores.
2. Boil & bite : individual fitting attempted by boiling material and adapting to individual teeth and is less desirable; available at local sports stores. Uneven distribution of material does not allow proper fit and protection.
3. Custom made : The most preferred type. Fabricated under proper guidance of a dentist, they are either made in dental clinic or sent by the dentist to the dental lab for custom fabrication with proper guidelines. The advantage of a custom made mouthguard is its fit, adapatability to individual speech requirements, customized occlusion and no interference in breathing.

Custom made mouthguards : They are designed according to the sport played, age of athlete and history of any previous trauma. Eg: Boxing and martial arts need mouthguards to be made keeping in mind maximum exchange of oxygen and adequate airway maintenance in unexpected events like nasal obstruction due to blow on nose. Custom made mouthguards are further classified according to the method of fabrication as :

1. vaccum custom made by vaccum machines
2. pressure laminated custom made by pressure machines.

Features of mouthguard :

1. shock absorbing concussive forces to lower jaw.
2. protection against neck injury.
3. distributing force of blow all over surrounding teeth and gums.
4. adequate material thickness, maximum occlusal coverage.

A snugly fit customized mouthguard when in place causes forward and downward movement of movement of the jaw, opening the space between the glenoid fossa and condylar head. Any impact to the lower jaw reduces the possibility of direct impact of head of condyle to the glenoid fossa, thereby decreasing impact and forces to the entire temporal region.

Maintenance for mouthguards :

1. Store in hard, perforated case.
2. Replace when signs of wearing out are evident.
3. Keep clean using toothbrush and water.
4. Never keep in warm place or in hot water.

As a helmet will not hamper the ability to drive a bike, likewise athletes should understand that oral protection by way of properly fitted mouthguards will not hamper their ability to perform. “Prevention is better than cure”, says an old adage. This holds true for orofacial injuries in sport events. Damage due to lack of proper measures may lead to a range of minor to major events having a long lasting impact on patient’s oral as well as general health. We at Smile Care share the responsibility of limiting orofacial injuries for those sportspersons/athletes, maximizing their potentials to excel as professionals.