Dental trauma during sports practice is one of the most frequent injuries that are usually treated in the office, with many restorative options depending on the impact received, and whose management often generates many doubts on the part of parents, coaches, teachers and other figures related to sports at school age.
From a statistical point of view, there are usually two peaks of incidence where the frequency of suffering this type of injury shoots up notably. The first of these is recorded in children between 10 and 24 months, affecting baby teeth when they start activities such as crawling, or when they take their first steps independently.
This aspect will be discussed in more depth in another blog post. The second peak of incidence is usually registered around 9-10 years of age, the age at which sports practice begins much more energetically and competitively, where young athletes also lack information about prevention devices (sports splints, helmets, etc…).
At this early age, girls have a statistically lower rate of dental injuries caused by trauma because it has been shown that they tend to use these means of protection more often than boys. However, as the years go by, at later ages this casuistry tends to be equalized, with both sexes becoming equal.
Logically, a trauma is the result of a fortuitous action, sometimes difficult to predict and avoid, but nevertheless, from the point of view of sports dentistry, there are a series of predisposing factors, easily identifiable by the dentist in a routine check-up, such as dental malposition, having a very prominent jawbone, not being able to close the lips completely and without effort in a situation of rest.
An elongated facial profile normally associated with sportsmen and women who breathe mainly through their mouths instead of channelling air exclusively through their noses, and a host of other data which, identified in time, can help to plan immediate preventive treatment, or corrective treatment in periods of absence from sports competitions, in order to minimise the negative consequences of these misfortunes.
What happens when trauma occurs to a baby tooth?
In general, the approach depends a lot on the age of the patient and the type of dentition that is present at the time of the trauma. In other words, the treatment protocol varies depending on whether the affected tooth is a “baby tooth” (temporary) or a permanent tooth since the reaction of the supporting bone and the tooth’s supporting tissue is different in both cases.
When the sportsperson is younger and has not yet begun to change teeth, the teeth are smaller and this implies that the distribution of the forces originated by the impact are practically absorbed by the bone and the gum and the result is a displacement of the tooth within the arch.
Although it is not ruled out that it may be fractured, which also happens, the most frequent is that there are dislocations or changes in position produced by the fracture of the alveolar bone that protects the root of the tooth and that is why the tooth changes position forwards, laterally or inwards, as if it were sunk in the bone.
In these cases of displacement, no attempt is made to reposition the tooth in its original position, but the dentist must assess whether there is any type of affectation of the permanent tooth, which develops at the tip of the root of the temporary tooth, which could condition a deviation in its eruption.
When the temporary tooth receives an impact on its longitudinal axis and sinks completely until it “disappears” from the arch, the radiographic diagnosis is fundamental and in these cases it is decided to wait for its reeruption in a natural way. Obviously it will not erupt in the same original position since it is normal for it to do so in a way that is deviated by the trauma itself.
But it is necessary to perform a complete and thorough examination by the dentist to rule out other soft tissue injuries, such as lips or tongue, produced by “splinters” or small fragments of enamel that sometimes remain embedded within the lip itself, being necessary to remove them to promote proper healing of the same.
With the passage of time, the tooth may darken as a defensive mechanism to protect the pulp (“nerve”) and that is why periodic controls are essential to prevent this darkening from masking a pulp affectation that leads to an infection that compromises the germ of the permanent tooth or any of the adjacent teeth.
In this case, we inform the parents about what is normal and what is not, so that they can control the gum in the affected area exhaustively and almost daily to detect any redness or abnormal inflammation, and go immediately to the consultation.
What if the trauma affects a permanent tooth?
When the trauma has occurred to a permanent tooth, the treatment is conditioned to the degree of development of the root. Having said this, it should be noted that when a tooth erupts in the mouth, it does not mean that it is fully developed.
The growth of the tooth is produced from the crown, which is the first to form, until the formation of the root is complete during the period of dental eruption, and even with the tooth already completely positioned in the arch. This degree of formation is determined by a periapical X-ray in the dentist’s office.
In definitive teeth that are in the process of erupting, it is frequent to find dislocations or displacements with respect to the original position, but it is also not ruled out, in fact on many occasions, that a fracture or breakage of the tooth itself occurs, totally or partially, it being important to determine which tissues, hard and soft, are affected by this fracture (enamel, dentine and pulp) and if the fracture line is limited only to the crown, to what extent, or affects only the root, in what part of it.
It is also not uncommon to find combined injuries involving both the crown and the root. In some cases, the viability of the tooth may even be compromised, although all possible therapies should be tried to preserve the tooth in the arch, especially if it is a young or adolescent sportsman, although the prognosis is not very promising.
In these cases, rehabilitation by means of an implant, for example, is temporarily ruled out due to the bone development at the level of the jaws.
If the definitive tooth has therefore suffered a displacement within the arch (the case of when it comes out completely outside the alveolus deserves a separate explanatory post), both parents and coaches and teachers, depending on the area in which the incident has occurred, must be informed in order to react on the spot and/or go immediately to the consultation so that the dentist can try, by means of local anaesthesia, to proceed with the repositioning in the original position.
Although in cases of intrusion, where the result of the trauma is a tooth that is deeper into the bone and gum, this repositioning is deferred by orthodontics or surgery.
It is normal to wait for spontaneous reeruption and evaluate radiographically over time how the pulp tissue (“nerve”) is evolving in case complementary treatments such as devitalization (root canal) are necessary to avoid the development of an infection.
Or to evaluate some type of whitening in addition to the restorative treatment itself by means of the material of the “fillings”, or ceramic fragments to adapt to the high level of aesthetics that, above all in the anterior-superior sector, the patient demands, and which must be corrected to try to recover the colour and original shape so that the treated tooth passes totally unnoticed.