Overview

Sports are a fantastic way for children to stay active and have fun. But with all that action comes the potential for unexpected bumps and bruises. One area often overlooked? Their teeth! Various studies investigating sports-related dental injuries have consistently found that individuals across different age groups, genders, and proficiency levels face the potential of sustaining dental injuries during participation in sports. This risk extends to organized and informal recreational and competitive sports activities. Although collision and contact sports like boxing, rugby, and soccer carry inherent risks of injury, dental injuries are also common in activities with limited contact or non-contact sports such as gymnastics, racquetball, bicycling, and skating.

Prevalence of dental trauma in sports

The traumatic forces not only impact the structure of the teeth (enamel, dentin, cementum, pulp) but also have the potential to damage the tooth, and supporting periodontal tissues, including bone and surrounding soft tissues. Among individuals with a history of oral injuries, 92% presented with dental trauma.¹ Sporting-related trauma contributes to a significant portion, up to one-third, of all orofacial injuries. Within this category, traumatic dental injuries (TDI) make up 50.1% of cases.

In most studies, boys experience dental traumas more frequently than girls. Research indicates that dental traumas occur during childhood and adolescence, with up to 90% of all injuries occurring before 19.¹ The most affected teeth are the maxillary incisors, constituting 80% of all TDI cases. Sports-related dental injuries can result in single or multiple tooth injuries, especially among teenagers.

 The absence of suitable protective equipment and its improper use are two of the main causes of sports-related oral injuries. Additionally, some anatomical and developmental variables may increase the risk of oral injury in paediatric patients. In contrast adults, children, and adolescents frequently have more developed facial bones, weaker enamel, and larger pulp chambers.

Causes of dental trauma in sports

Dental traumas are typically caused by collisions that generate high-energy forces leading to injury. These collisions can result from objects used in sports, such as balls or sticks, or contact with another athlete's body part or an animal, such as horse hoofs. The extent of dental injury depends on the force's intensity and the object involved. Certain dental malocclusions, such as increased overjet with protrusion of upper incisors, insufficient lip closure, short upper lips, and being a mouth breather, wearing oral piercings are significant predisposing factors.^1,2 

Types of injuries to teeth in sports

The different types of injuries in baby teeth and adult teeth during sports are enamel infraction (crack without loss of tooth structure), crown fracture with loss of tooth structure (with or without pulp exposure), root fracture, crown/root fracture (with or without pulp exposure), concussion (injury to the tooth-supporting structures without abnormal loosening or displacement of the tooth), a subluxation (injury to the tooth-supporting structures with abnormal loosening but no tooth displacement), luxation (partial dislodgement of tooth in apical, incisal or lateral direction inside the socket) and avulsion (tooth knocked out from the socket).¹ The trauma can also cause damage to the underlying unerupted permanent teeth in children resulting in impaction or discolouration of teeth.

Prevention of dental trauma in sports

Prevention gains prominence when considering the aesthetic, functional, psychological, and economic impacts of traumatic dental injuries in children.

Routine dental checkups

Dental practitioners can collaborate with sports medicine experts to perform pre-participation dental screenings for young athletes. These screenings assess oral health before sporting activities, identifying any existing dental conditions that could elevate the risk of dental injuries, and addressing any necessary treatments.

A Bayesian probabilistic model has been developed to predict the likelihood of sports-related traumatic dental injuries in children and adolescents. This model identifies and prioritises 14 causal factors across various categories:

• Demographic information: child's age, dental malocclusion, athlete's gender, history of previous dental injury.
• Use of protective equipment: helmets, facemasks, mouth guards.
• Contact versus non-contact sport: velocity of the sport, intensity of the sport.
• Child’s participation: activity level, exposure time, focus of attention.
• Rating of activity: level of coaching, level of sport 

The information from this predictive index has been integrated into a computer-based program, allowing dentists to conduct real-time risk assessments of their patient-athletes. This clinical tool aids in the early identification of high-risk individuals and provides recommendations for appropriate protective equipment.³

Protective measures

Mouthguards

Mouthguards safeguard teeth from injuries such as avulsion, luxation, crown, or root fractures. The overall injury decline while using mouthguards was between 1.6- and 1.9-fold. Effective mouthguards must be comfortable, tear-resistant, odourless, tasteless, and not bulky but with sufficient thickness. They should be made of easily cleanable, disinfectable, resilient material, ensuring proper retention for optimal occlusal alignment and maximum protection.

 Additionally, they should absorb and redirect impact energy, cover the upper teeth, protect soft tissues, eliminate occlusal interferences, and not interfere with speaking and mouth breathing. By obtaining a complete dental history, knowing the sport, and conducting a thorough oral examination, dental professionals can determine the ideal mouthguard fit for a patient.^{4, 5, 6}

Types of mouthguards

1. Stock or ready-made mouthguards
   They are the most affordable, readily available mouthguards and generally the least protective. While they can be used straight out of the package, they often lack optimal retention. They feel bulky due to limited size options (small, medium, and large). Additionally, to prevent the mouthguard from shifting, athletes must keep their mouths closed and bite on it, potentially hindering their ability to breathe comfortably⁶
2. Boil-and-bite mouthguards: These are the most prevalent types of mouthguards available over the counter. The mouthguards are typically immersed in boiling water and then shaped in the mouth using finger, tongue, and biting pressure, allowing for a more customised fit. However, they may not cover the posterior teeth fully, potentially reducing their protective capabilities. Reducing the thickness can consequently reduce the level of protection provided. Variants of formed mouthguards include the shell liner type, which features a polyvinyl chloride outer shell and an inner lining made of plasticized acrylic gel or silicone rubber. These shell liners tend to be bulkier⁶
3. Custom-made mouthguard: Following a thorough dental examination and mouth impression, dentists craft custom mouthguards using various techniques such as vacuum forming, pressure lamination, and combined vacuum-pressure methods. A single-layer thermoplastic material makes a mouthguard over the child’s mouth cast. They are expensive but offer superior retention and comfort, minimise interference with speech and breathing, and are highly adaptable to orthodontic appliances⁶

Maintenance of mouthguards

Proper care of mouthguards involves cleaning them with cool water, mouth rinse, or toothpaste, and storing them in a durable container for air circulation. Regular washing helps prevent the buildup of saliva, bacteria, and debris. To maintain their shape avoid exposing mouthguards to high temperatures and direct sunlight. Athletes should refrain from chewing or cutting their mouthguards and schedule checkups as necessary.

Helmets and faceguards

When worn correctly, helmets and face masks offer protection and reduce traumatic injuries. Faceguards come in prefabricated or custom-made designs, typically made of metal, composite materials, or clear polycarbonate plastic. They are commonly attached to helmets or head straps. Additionally, full-face shields significantly decrease the risk of dentofacial injuries.⁶

Education about dental safety

Parents, coaches, and healthcare professionals can join forces to enhance the safety of sports. They should acknowledge the challenges and understand the measures paediatric dentists take to safeguard their dental well-being. Emphasising the significance of oral health and the risks of dental injuries is crucial. Parents should be educated about how non-nutritive sucking habits can affect the positioning of front teeth, leading to issues such as protrusion or an open bite, which increase the risk of traumatic dental injuries.⁵ Sports-specific advice tailored to understanding the unique risks associated with each sport is essential.⁴

Routine maintenance and inspection of sports facilities and equipment help mitigate risks that may cause dental damage. Safety measures such as stair gates, window guards, mobility aids, removal of loose flooring, and stabilisation equipment should be utilised to minimise risks.⁵ Supervision and instruction in sports safety procedures and practices are important in preventing collisions and incidents resulting in oral injuries.⁴ Coaches and trainers should prioritise teaching children proper technique, fair play, and injury prevention methods. Collaborating with governing bodies and sports organisations to enforce safety regulations and implement prevention programs can help reduce sports-related dental injuries.

Preparation for emergencies

Training caregivers in emergency management of dental injuries is highly important. Parents should discuss preventive measures with their family dentist or a paediatric dentist experienced in dental trauma, who should also be available for immediate care in case of an injury. Early diagnosis and treatment significantly enhance the chances of effective therapy and tooth preservation. An interdisciplinary approach facilitates prompt evaluation, accurate diagnosis, and appropriate referral to relevant specialists in sports-related dental injuries.⁴

Summary 

To prevent dental injuries to children, coordinating care and providing continuous support involves including parents, coaches, and medical experts. It's important to stress the importance of wearing protective gear like mouthguards, and maintaining regular dental checkups to address any existing dental issues that may increase susceptibility to injury. Ensuring the proper maintenance and safety of playing fields, courts, and equipment is vital to reduce the likelihood of accidents and falls that could lead to dental injuries. By providing proactive dental care, education, and preventive measures, we can ensure that participation in sports remains a positive and enriching experience, minimising the impact of sports-related dental injuries on oral health and the overall well-being of children.

FAQs

Are sports-related teeth injuries a major concern for children?

Sports-related dental injuries, such as tooth fracture, luxation, and avulsion, are a major concern among children because they directly impair oral function, cause discomfort, and affect their confidence.

Which sports have the highest prevalence of dental injuries?

Although collision and contact sports like boxing, rugby, and soccer carry inherent risks of injury, dental injuries are also common in activities with limited contact or non-contact sports such as gymnastics, racquetball, bicycling, and skating.

Can sports-related traumatic dental injuries be prevented in children?

Sports-related dental injuries can be prevented by taking necessary preventive measures. The injury to teeth can be prevented by wearing mouthguards, helmets, and face shields.

How can caregivers help children to avoid injuries?

Parents should take their children for routine dental checkups and encourage children to wear protective gear during sports. Supervision and instruction in sports safety procedures play a critical role in preventing collisions and incidents resulting in oral injuries. Routine maintenance and inspection of sports facilities and equipment help mitigate risks that may cause dental damage.