Sparing the Impact, Saving the Smile
Posted by Dr. Alan Pressman (dr.p.dmd) on Oct 01 2010
Blog >> 2010

 The day before visiting my office, a 25-year-old girl was hit in the face with a softball. Her face was swollen. The tooth was fractured vertically and had to be extracted. Using an implant and a crown, I was able to restore the affected area.

Each year, more than 5 million teeth are knocked out in the United States as a result of sports injuries. Three-quarters of all orofacial injuries occur when athletes are not wearing mouthguards. 
The American Dental Association recommends that mouthguards be worn for many popular sports, including baseball, basketball, biking, football, hockey, racquetball, soccer, and skiing. 
The risk of jaw fracture is the same while playing baseball or soccer as it is for football. Playing basketball without a custom mouthguard increases a player's chance of orofacial injury seven times compared with someone who plays with a mouthguard.
Trauma to the front teeth and the front of the mouth is most common. Unsurprisingly, children with unprotected forward-protruding front teeth are at an increased risk. 
Anyone receiving a blow to the mouth should visit the dentist as soon as possible, even if the tooth is not lost immediately. The nerve of the tooth may be involved, or the tooth might be fractured. Tooth fractures can range from minor (e.g., chipping of the tooth’s outer layer or enamel) or severe (e.g., vertical, diagonal or horizontal fractures of the root, which cannot be seen as they are below the gumline).
A simple blow to a primary tooth (a child’s baby tooth) may discolor it. Seventy-five percent of these teeth survive and return to normal color. 
Trauma to secondary (or permanent) teeth requires different treatment. Re-implantation or returning the tooth to the socket is vital--the faster the better. Parents can try these steps first: 
 
(1) Gently wash the tooth in water
(2) Do not disturb the tissue around the tooth, but ice the area to reduce swelling 
(3) Place the missing tooth into its correct position
 
If you can't re-implant it, put it in cold milk and rush it (and the child!) to a dentist. The likelihood of the tooth’s survival is much higher if it is repositioned into the mouth within 1 hour.
Discoloration means nerve damage and the tooth is non-vital. It doesn't mean the tooth is lost, but it needs attention. Always place ice on the area to keep the swelling down, and head to the dentist’s office as soon as possible. 
Here are a few items a coach should keep on hand in case of a dental emergency on the field. Gloves, a pen light, tongue depressor, wax (which can be used to cover orthodontic wires that loosened and serve as a makeshift filling), temporary material, sterile gauze, a sterile saline solution, and a spare commercial mouthguard. (all items can be found in most drugstores). 
Spending a couple of dollars on a guard today, could save thousands tomorrow. Many of the inexpensive, ill-fitting guards available over the counter even come with a warranty. Though not best, these mouthguards are better than none.
Remember, Andy Roddick hits a serve at 150 mph. Billy Wagner's fastest pitch was 107 mph and the average line drive flies at 115 mph. A racquetball goes between 150 and 180 mph. It doesn’t take speeds like this: a much slower projectile can cause a great deal of damage. Be smart: all athletes—you and your kids—should wear a mouthguard.

Last changed: Oct 01 2010 at 5:52 PM

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