The 1990 report of the "Better Health Program" entitled, "Sports injuries in Australia, Causes, Costs and Prevention" estimated that sports injuries cost Australia (population 18 Million) about $1.4 billion per year and that between 30-50% of these injuries are preventable. Multiply these numbers for the United States (population 260 million). Participation in exercise and sport whether positive or negative, will always remain a major consideration in the health of a national population.

In sports, the challenge is to maximize the benefits of participation and to limit injuries. Sports dentistry has a major role to play in this area. Prevention and adequate preparation are the key elements in minimizing injuries that occur in sport. For sports dentistry the prevention of oral/ facial trauma during sporting activities can be helped by many facets. Included are teaching proper skills such as tackling technique, purchase and maintenance of appropriate equipment, safe playing areas and certainly the wearing and utilization of properly fitted protective equipment.

In some sports, injury prevention, through properly fitted mouthguards are considered essential. These are the contact sports of football, boxing, martial arts and hockey. Other sports, traditionally classified as non contact sports, basketball, baseball, bicycle riding, roller blading, soccer, wrestling, racquetball, surfing and skateboarding also require properly fitted mouthguards, as dental injuries unfortunately, are a negative aspect of participation in these sports.

The National Youth Sports Foundation for the Prevention of Athletic Injuries, reports several interesting statistics. Dental injuries are the most common type of oral facial injuries sustained during participation in sports. Victims of tooth avulsions who do not have the teeth properly preserved or replanted will face lifetime dental costs estimated from $10-15,000 per tooth, the inconvenience of hours spent in the dental chair and possibly other dental problems. (See "What to do when a tooth is knocked out" Section)

Treatment of oral/facial injuries, simple or complex, is to include not only treatment of injuries at the dental office, but also treatment at the site of injury, such as a basketball court or football or rugby field, where the dentist may not have the convenience of all the diagnostic tools available at their office. Knowledge and ability to do "on site" differential diagnosis is essential, withoutthe use of radiographs and dental operatories, to determine the future treatment and prognosis of the injury.

Preseason screenings and examinations are essential in preventing injuries. Examinations are to include health histories, at risk dentitions, diagnosis of caries, maxilla/mandibular relationships, orthodontics, loose teeth, dental habits, crown and bridge work, missing teeth, artificial teeth, and the possible need for extractions for orthodontic concerns or wisdom teeth. These extractions should be done months prior to playing competitive sports as to not interfere with their competition or weaken their jaws during competition. Determination of the need for a specific type and design of mouthguard is made at this time.

Mouthguard design and fabrication is extremely important. There are four types of mouthguards according to the dental literature. Stock, Boil and Bite, Vacuum Custom made, and Pressure Laminated Custom made. (See Mouthguard Section).

First of all, it is essential to educate the public that stock and boil and bite mouthguards bought at sporting good stores do not provide the optimum treatment expected by the athlete. These ill fitting mouthguards cannot deal with idiosyncrasies athletes and children may have. If everyone had the same dentition; were of the same gender; played the same sport under the same conditions; had the same experience and played the same position at the same level of competition, and were the same age and same size mouth, with the same number and shape of teeth, prescribing a standard mouthguard would be simple. This is the precise reason why mouthguards bought at sporting good stores, without the recommendation of a qualified dentist, should not be worn.

Idiosyncrasies are to be noted during mouthguard design and fabrication. These may include jaw relationships where mouthguards may have to be designed on the mandibular arch such as a Class III prognathic bite. Otherwise, where possible, mouthguards should be built on the maxillary (upper) arch.

Erupting teeth (ages 6-12) should be noted so the mouthguard can be designed to allow for eruption during the season. Boil and bite mouthguards do not allow for this eruption space.

For patients with braces, special designs for the mouthguards are essential to allow for orthodontic movement without compromising on injury prevention and fit. This can only be achieved through consultations with your dentist.(See mouthguard section for further information on types and designs for mouthguards.)

Sports Dentistry also includes the need for recognition and referral guidelines to the proper medical personnel for non dental related injuries which may occur during a dental/facial injury. These injuries may include cerebral concussion, head and neck injuries, and drug use. We are NOT suggesting that dentists treat these injuries, but as health professionals dentists should be able to recognize these entities and refer these patients to the proper medical personnel. For example, if a patient comes into the office for a broken or knocked out tooth, dentists must rule out the possibility of a head injury or concussion before treating the patient for the dental injury. If certain symptoms are present, such as persistent head aches or nausea, immediate referral to medical personnel is essential. (See concussion section).

Smokeless tobacco should also be included and addressed under Sports Dentistry. Smokeless tobacco is often associated with certain sports, and the public should be educated on the dangerous properties and consequences of using smokeless tobacco. (See Smokeless tobacco section.)

Is not uncommon for dentists to recognize the symptoms of anorexia and bulimia through dental examination. Eating disorders are not as infrequent as one may think in female athletics. Woman's gymnastics, volleyball, and basketball are just a few sports where eating disorders have been documented in the medical/dental literature. Erosion patterns in the teeth, caused by gastric acids, often help dentists in the differential diagnosis of eating disorders. These patients need to be referred to the proper medical and psychological health professional.