Dental problems in athletes.

Orofacial injuries and diseases occur in athletes, and they may not always have access to dentists. Therefore team physicians should be aware of the common injuries and initial management. Treatment of dental injuries will depend on whether the teeth are primary or permanent. The most common type of fracture is crown fracture, but there are other dental injuries that can lead to future complications if not treated promptly and monitored closely. Tooth avulsions need to be handled properly, and athletes should see a dentist as soon as possible. Despite the urgency of some injuries, other orofacial injuries or diseases, such as lacerations and caries, should not be overlooked. Proper education and use of mouth guards can assist athletes in reducing their risk of orofacial injuries.

Criação, desenvolvimento e aplicação de serious game educativo para prevenção em saúde bucal infantil - "Caí, perdi um dente... e daí? / The conception, development and application of an educational serious game called - "I Fell Down and Lost my Tooth, So?"

Jogos são uma ponte natural entre educação e diversão. Seu uso já provou ser eficaz em várias áreas do saber, pois fornece, junto da interatividade, novas formas de aplicação do conhecimento, através de desafios propostos ao usuário. Tal meio, amplamente utilizado na indústria do entretenimento, pode assumir papel social quando aplicado a áreas diversas, como a da saúde. Esta categoria de jogos, com propósitos específicos como treinamento, reabilitação e prevenção, denomina-se serious games. No entanto, os materiais disponíveis para a propagação de conceitos referentes à prevenção em saúde, destinados ao público infantil, ainda são escassos e com pouco nível de atratibilidade. Compostos geralmente por materiais impressos, são meios de difícil acesso a todas as camadas da população. No âmbito da Odontologia, tal área se mostra pouco explorada, oferecendo às crianças apenas orientações quanto à prevenção de doenças, importância da boa higiene bucal e das visitas regulares ao profissional dentista. Esta dissertação apresenta, portanto, a criação, desenvolvimento e aplicação de um serious games, chamado Caí, Perdi um Dente... E daí?, focado no assunto avulsão dentária de um dente permanente, situação comumente vivenciada por responsáveis, educadores e crianças em fase escolar, que necessita de procedimentos rápidos para que o dente perdido possa ser reimplantado, evitando a necessidade de próteses dentárias. A pesquisa se desenvolveu na aplicação e análise dos resultados referentes à comparação de tal material com outros, comumente utilizados (cartilha e desenho animado), mostrando a eficácia da interatividade, quando combinada à educação para a saúde. Este trabalho também ofereceu as prerrogativas para especificar os requisitos de projeto do design do jogo, observando as necessidades evidenciadas para identificar as funções que este deverá desempenhar. Visamos, com este estudo, estimular a pesquisa na área de educação e interatividade dirigidas à saúde...

Games are a natural bridge between education and entertainment. Its use has already proven efficient in many areas of knowledge, since it provides (along with interactivity) new forms to knowledge application, through issuing challenges to the user. These means, widely applied in entertainment industry, can play a social role when applied to other areas, such as healthcare. This category of games, with specific purposes such as training, rehabilitation and prevention, is generally classified into the category of serious games. However, the available materials for teaching concepts related to health prevention among children are still scarce and with currently low attractiveness. Composed usually of print material, they are means of difficult access to whole of the population. Since dentistry is a not well explored area by games, children are provided only with some guidance towards the prevention of diseases, the importance of good oral hygiene and regular appointments with the dentist. This dissertation thus presents the concept, the development and the application of a serious game called I Fell Down and Lost my Tooth, So?, focused on a permanent tooth avulsion, usually experienced by persons in charge, educators and children in learning stage, who need rapid procedures to promote tooth reimplantation, avoiding the need for dental prostheses. This work was developed with the application and analysis of results by comparision with other educational materials usually applied (as guidebook and animated cartoon), proving its higher efficiency in interactivity, combined with education towards healthcare. Also, prerogatives were offered to detail the game design requirements, to observing the needs to identify the functions it must perform. It was also aimed to stimulate further research concerning education and interactivity towards healthcare, providing new tools to aid professionals, as well as improvements in the overall life quality of all people.

Dental trauma, prevention and knowledge concerning dental first-aid among Polish amateur boxers.

OBJECTIVES: A significant increase in individuals participating in contact sports has been noticed. Boxing is one of the most traumatic of such sports. In spite of this, the level of awareness among young boxers as to prevention and dental first aid is very poor. The aim of this study was to evaluate the frequency of dental injuries during trainings and competitions, the habit of wearing mouthguards, and the general level of awareness regarding prevention and first aid after tooth avulsion. DESIGN: Cross-sectional survey. METHODS: Our research was based on questionnaires given to 338 amateur boxers in Poland (divided into age groups: schoolboys, juniors, youth and seniors). Chi-square tests were used for the comparison of groups of respondents and relevant variables. RESULTS: The survey showed that 35.9% of the participants had suffered some kind of dental trauma. A similar number of 36.5% had witnessed some kind of dental injury during training and 26.1% during tournaments. The survey showed that only 15.8% of all participants knew that immediate replantation was the best way of treating an avulsed tooth. Also, 93.7% of all those interviewed reported that they had worn mouth-formed mouthguards and only 5.7% custom-made mouthguards. Of all the survey's participants, 41.1% were definitely satisfied with their mouthguards. CONCLUSIONS: To improve knowledge regarding dental trauma in the boxing environment it is essential to emphasize the need for an extensive educational campaign. Preventive measures, especially in the form of good custom-made mouthguards, should be mandatory for all active individuals participating in contact sports.

Dental injuries in water polo, a survey of players in Switzerland.

Water polo is a sporting activity which has a medium risk of causing dental trauma. Owing to the high speed, close body contact, and the combination of throwing and swimming that is inherent to the sport, the general injury potential is high. Using a standardized questionnaire for a total of 415 water polo players from Switzerland, this study examines the frequency of dental and facial injuries in water polo, athletes' habits regarding the wearing of mouthguards, and the general level of knowledge about emergency procedures following dental trauma. The participating players came from 6 divisions: Swiss national leagues A and B, first and second leagues, as well as the women's, and junior's league. The data were evaluated according to division and gender. Of the 415 interviewees, 185 (44.6%) had witnessed a dental injury in water polo. Eighty-seven (21.0%) players reported having suffered a tooth injury when playing water polo. Tooth fracture was the most stated dental injury [86 (16.4%)]. A similar number of tooth injuries were experienced by both male [355 (21.1%)] and female [60 (20.0%)] players. The interviewees over the age of 50 showed a higher incidence of tooth injuries than younger players (>50 years = 41.7%). Slightly more than half of the interviewed players [228 (54.9%)] were aware of the possibility of replanting avulsed teeth. As few as 43 (10.4%) players were familiar with tooth rescue boxes. Only 32 (7.7%) water polo players wore a mouthguard; the most common reason for not wearing a mouthguard was that it was seen to be unnecessary [169 (40.7%)]. This survey highlights the potential for improvement in the level of knowledge about dental injury prevention in water polo. In addition to information and guidelines from the relevant sports' associations, and coaches, dentists could also play a role in the provision of this education.

Assessment of awareness amongst school teachers regarding prevention and emergency management of dentoalveolar traumatic injuries in school children in Pune City, before and 3 months after dental educational program.

Children have boundless energy, so, they are continuously engaged in some or the other physical activity. It is seen that when child reaches school age, accidents in the school environment in the form of falls, injuries due to contact sports, fights, abuse, etc. are very common and the main cause of traumatic dental injuries. Trauma may vary from minor enamel chipping or avulsion to extensive maxillofacial damage, more serious neck and brain injury, which may cause pain, disfigurement and mental agony, having immediate and long lasting effects. In such cases, a school teacher is in the right position to handle such an emergency and refer the child to the concerned dental surgeon or a pedodontist for further needful care. The main reason for delayed treatment of dental trauma is that people present at the site of injury are unaware of protocol of rapid and appropriate management leading to improper first aid treatment. The purpose of this study was to investigate the awareness of a group of school teachers from different schools about the prevention and emergency management of dental trauma in school children, by means of a questionnaire. Then educating them and reassessing their knowledge after a period of 3 months. Unfortunately, the public is unaware of the risks and does not have enough information about first aid emergency treatment or to avoid traumatic injuries.

A rubber-covered ceramic weapon reduces the incidence of dental trauma in recruits during combat basic training.

The effect of a rubber-covered ceramic weapon was assessed on the incidence of dental trauma during basic training, since soldiers are more at risk of impact from a personal weapon. Dental files of soldiers (n = 4,542), who completed 8 months of training during 2008, were analyzed for incidence and type of dental trauma from a personal weapon. A rubber-covered ceramic weapon (n = 2,972) or a conventional one (n = 1,570, control) was used. Dental trauma was 0.4% per 8 months (0.6% per year) from the ceramic weapon and 1.5% per 8 months (2.3% per year) from the conventional one (p<0.001). The most prevalent type of injury was a simple/noncomplicated crown fracture (82% in study group, 75% in control group). The ceramic weapon significantly reduced dental trauma by diminishing the impact while in direct contact with the teeth or by absorbing and/or distributing the impact force. In conclusion, when possible a rubber-covered ceramic weapon should be preferred for basic combat training.

First aid for dental trauma caused by sports activities: state of knowledge, treatment and prevention.

In view of the widespread lack of knowledge of first aid procedures in cases of dental trauma, this article describes the current state of knowledge and highlights the need for education of those likely to witness or be victims of dental trauma while practising sports. Dental and oral injuries, the commonest type of orofacial injuries, are often sustained by athletes playing contact sports; indeed, they represent the most frequent type of sporting injury. Studies of a large group of children and adults have shown that as many as 31% of all orofacial injuries are caused by sporting activities. Furthermore, current literature on the subject emphasizes that awareness of appropriate triage procedures following dental trauma is unsatisfactory. Delay in treatment is the single most influential factor affecting prognosis. What should we know and, more importantly, what should we do? Immediate replantation of an avulsed tooth is the best treatment option at the site of the accident. If replantation is impossible, milk is the preferred transport medium for the avulsed tooth. There is a general low level of awareness about the need for prompt triage of traumatic dental injuries sustained in sports, despite their relative frequency. When a cohort of Swiss basketball players was interviewed, only half were aware that an avulsed tooth could be replanted. Cheap, commercially available tooth storage devices containing an isotonic transport medium (so-called 'Save-a-Tooth boxes'), can maintain the viability of an avulsed tooth for up to 72 hours, prior to replantation. More readily available storage media such as milk, sterile saline or even saliva may be used, but knowledge of this information is rare among sports participants. For example, just 6.6% of the Swiss basketball players interviewed were aware of the 'Tooth Rescue box' products. Sporting organizations seem to offer very little information about sports-related risks or preventive strategies for orodental trauma. Having an attending dentist at sports events - amateur or professional - is clearly a luxury that is neither practical nor affordable. The solution must lie in extending the knowledge of management of orodental trauma beyond the dental profession. Educational posters, when displayed prominently in sports clubs, gym halls and dressing rooms of swimming pools, are a clear, accessible and low cost method of presenting the appropriate procedures to follow after orodental injury. When the potentially avoidable financial burden and discomfort of protracted restorative or cosmetic dentistry are taken into account, rarely can such significant morbidity be so easily prevented.

Knowledge of general dentists in the current guidelines for emergency treatment of avulsed teeth and dental trauma prevention.

A high prevalence of dental trauma exists and its effects on function and esthetics deserve the attention of general dentists. The aim of this study was to assess the level of general dental practitioners' (GDPs) knowledge about guidelines for dental avulsion and its prevention using a questionnaire. The 21-item questionnaire was distributed among 264 GDPs and the survey was realized between August-November 2006. The data obtained were statistically analyzed using descriptive analysis and Pearson's Chi-square test to determine associations between knowledge regarding emergency treatment and dentists from public or private dental schools and years of experience. The results showed that the participants exhibited appropriate knowledge concerning procedures in cases of tooth avulsion and its prevention. The number of correct answers was low in relation to recommended treatment at the site of injury. Storage medium, preparation of the alveolus and splint time for receiving the avulsed tooth received a high number of correct answers. One statistically significant association between years of experience and recommended treatment at the site of the injury in the case an avulsed tooth (chi(2) = 9.384, P = 0.009). In conclusion, this survey showed appropriate knowledge of dental avulsion management and its prevention among the surveyed dentists. The findings also showed that communication between dentists and the population is deficient, especially concerning practitioners of high risk and contact sports.

Dental trauma: restorative procedures using composite resin and mouthguards for prevention.

AIM: The aim of this article is to describe a step-by-step protocol for emergency care of a patient with a dentoalveolar injury in the anterior region of the mouth as well as the fabrication of a mouthguard to prevent future trauma. BACKGROUND: Dental trauma is one of the most serious oral health problems in active children and adolescents. Care of traumatized patients requires immediate initial emergency treatment followed by integrated procedures to restore damaged oral structures along with a subsequent trauma prevention strategy. Dentoalveolar injuries in the anterior region of the mouth are often characterized by tooth avulsion and coronal fracture. They are managed using procedures such as dental splinting, endodontic therapy with its unique characteristics, and restorative techniques to re-establish function and esthetics as well as protective mouthguards. REPORT: A 16-year-old male presented with avulsion of his maxillary central incisors as a result of a direct, unintentional impact with an opponent during a basketball game. The teeth had been stored in physiological serum immediately following the injury and the patient received immediate care. On clinical examination, the right central incisor was fractured at the incisal third of the crown but no bone fractures were found. The teeth were reimplanted and splinted. The fractured right central incisor was restored following endodontic treatment and a mouthguard was fabricated for the patient. SUMMARY: The dentist must be knowledgeable about the most efficient and suitable treatment for each traumatic scenario in order to provide appropriate care for dental injuries. Coordinated multi-disciplinary action is fundamental in the successful treatment of these injuries. The dental mouthguard is an effective device for protecting the teeth and supportive structures during physical activities and must be part of the protective equipment used by athletes. It is the responsibility of the dental professional to make parents, trainers, and athletic associations aware of the risks associated with physical activities without orofacial protection; this should encourage the proper use of all protective devices to prevent dentoalveolar injuries that compromise oral functions, esthetics, and increase the cost of healthcare.

Nível de informação sobre a conduta de urgência frente ao traumatismo / Level of information about the urgent procedurs in dental traumatism with avulsion

Avaliar o nível de informação de estudantes, comidade média de 12 anos, seus pais e professores, de escolas públicas e particulares, quanto à conduta de urgência frente ao traumatismo dental com avulsão. Método: A amostra foi constituída de 990 indivíduos, aos quais foi aplicado um questionário fechado, devidamente orientado, que, após análise e avaliação por dois endodontistas e uma patologista bucal, foram classificados em quatro níveis alto, razoável,baixo e muito baixo. Resultados: Do total de entrevistados,apenas 6,77 por cento apresentaram um alto nível de conhecimento;16,26 por cento apresentaram um nível razoável; 51,13 por cento um nível baixo, enquanto 23,84 por cento apresentaram um nível deconhecimento muito baixo. Não foi estabelecida uma correlação significativa entre escolas públicas e particulares.Conclusão: É baixo o nível de conhecimento sobre a condutade urgência frente ao traumatismo dental, tornando necessária a inclusão do tema nos programas de prevenção à saúde bucal.

Avulsions and intrusions: the controversial displacement injuries.

Avulsions and intrusions are the most complicated and controversial displacement injuries of permanent teeth. Clinical guidelines published by authorities such as the American Association of Endodontists, the Royal College of Surgeons of England and the International Association of Dental Traumatology are inconsistent. While a certain amount of inconsistency might be expected, some of these guidelines recommend treatments that are experimental or have not incorporated research information from the past 5 years, and in one case the guidelines incorrectly describe the nature of Hank's balanced salt solution. Recent laboratory studies support previous clinical outcome studies in emphasizing that only for teeth replanted within 5 minutes of avulsion is there a chance of regeneration of the periodontal ligament and normal function. Teeth replanted beyond 5 minutes will take another path, that of repair followed by root resorption, ankylosis and eventual extraction. Dentists should explain these outcomes at the time of the replantation decision. Severe intrusions also have predictable outcomes. Teeth intruded beyond 6 mm cannot regenerate a functional periodontal ligament and so are prone to root resorption and eventual extraction as well. In this situation the decision is one of immediate extraction or repositioning, with the understanding that it is inevitable that the tooth will eventually be extracted. Authoritative clinical guidelines available on the Internet provide the clinician with useful outlines for treatment. However, individual inconsistencies stimulate academic controversies and, in some cases, clinical misdirection.

Viabilidade das células mononucleares de sangue periférico humano em diferentes meios de estocagem de dentes avulsionados / Human peripheral blood mononuclear cells viability in differents storage media for avulsed teeth

Neste estudo comparou-se a viabilidade de células mononucleares humanas mantidas durante 24 horas, a 20ºC, em diferentes meios de estocagem para dentes avulsionados: água destilada, leite pasteurizado tipo C, leite ultrapasteurizado integral, saliva, solução fisiológica e meio de cultura celular McCoy. Nos tempos 0, 30min, 1h, 3h, 6h, 10h e 24h foram coletadas amostras e analisadas pelo método de exclusão com azul de Tripan. Também foi medido o pH de cada meio de estocagem. Os testes indicaram que todos os meios tiveram melhor desempenho que a água (p<0,05). A partir de 3h, os dois tipos de leite e o McCoy mostraram viabilidade estatisticamente melhor (p<0,05) que a saliva e a solução fisiológica. Não houve diferença entre os leites, não sendo possível realizar a leitura de 24h devido ao depósito de material biológico. Os leites, saliva e McCoy apresentaram pH compatível com a proliferação celular. Os resultados sugerem que o meio de cultura McCoy e o leite são efetivos para estocagem de dentes avulsionados por possibilitarem a manutenção da viabilidade celular

Lingual displacement of an entire lower third molar. Report of a case with suggestions for prevention and management.

Perfect knowledge of regional anatomy is the main factor in the prevention of tooth displacement during lower third molar extraction. Some technical expedients should be used to avoid the occurrence of this accident and to manage it if it anyway happens. The patient was seen just 2 days after his left lower third molar was lingually displaced during surgical extraction. Two mucoperiosteal flaps were made under general anaesthesia, one on each side of the mandible, to obtain good exposure of the previous bone access and to retrieve the tooth. No further complications occurred. Lower third molar extraction becomes complicated if tooth displacement happens. Predisposing factors of this accident are analyzed and the rules to minimize the risk of its occurrence and to simplify the retrieval of the displaced tooth are discussed.

Displacement of a mobile tooth during impression procedure: effect of impression tray design.

When fabricating prostheses in a partially edentulous arch with some mobile teeth, it is important to minimize tooth displacement during the impression procedure. The present study examined the effect of custom tray designs on the displacement of a mobile central incisor in a mandibular simulation model with six anterior teeth. Twelve custom trays were designed according to the different spaces and perforated holes in the region of the remaining teeth. As a result, the degree of displacement of the mobile tooth could be reduced according to the size of spaces and the location of perforated holes in the custom tray.

Tooth avulsions resulting from basketball net entanglement.

The authors conducted a survey of dentists reporting tooth avulsions from basketball net accidents. Although the number of people injured was small, the dental injuries were serious. In many cases, multiple teeth were avulsed as a result of the maxillary anterior teeth becoming entangled in the basketball net while the patients were attempting to slamdunk a basketball either on a lowered backboard or from a raised take-off area. The authors present recommendations for preventing tooth avulsions resulting from basketball net entanglement.

An in vitro study of the efficacy of mouthguard protection for dentoalveolar injuries in deciduous and mixed dentitions.

Sports-related dental trauma remains a risk for children and adolescents. Although mouthguards provide protection, up to 25% of dentoalveolar injuries can occur with a mouthguard in place. This study examined the effect of mouthguard protection in an in vitro model. A total of 97 sheep mandibular segments with incisors at four developmental stages (early deciduous, ED, n = 37; middle deciduous, MD, n = 20; late deciduous, LD, n = 18; mixed dentition, PD, n = 22) was used. Customised pressure formed mouthguards (MG) provided protection from trauma produced by a servohydraulic materials testing machine to test incisors. Injuries were examined clinically, radiographically and by dissection. Mean forces required to produce dentoalveolar injury were significantly greater in test (with MG) teeth than control (no MG) teeth. Mean forces to produce injury in test teeth decreased with resorbing root lengths. Deciduous incisors differed in injury type: subluxations and horizontal root fractures predominated in test teeth; lateral luxations and horizontal root fractures in control teeth. Predominant injuries in test and control permanent incisors were enamel infractions and subluxations. The magnitude of lateral luxation measurements of individual teeth was reduced significantly by mouthguard protection in both deciduous and permanent dentitions. The mouthguard tended to increase the mobility of the teeth it encompassed and, in some instances, promoted dentoalveolar injury of adjacent teeth.