Preventing Damage to Oral Health While Playing Sports

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Sports play an important part in maintaining our overall health and wellbeing. Unfortunately, risk of injury comes as part of the package to the benefits of physical activity. While it may not be often that we consider the benefits of exercise to our teeth, the risks to our mouth are significant when participating in athletic and sporting activities.

The challenge is to maximize the benefits of exercise and minimize injuries and damage to your mouth.

The face and mouth is one of the most vulnerable areas of our body and is usually the least protected area.

Around a third of all sports injuries involve the face. The field of sports dentistry involves the prevention and treatment of oro-facial sports injuries and related oral diseases. It also has a role in promoting the best practice in minimizing the risk of oro-facial injuries, usually with devices like mouth guards.

Fluid replacement and dehydration also play a significant risk in the oral health of athletes. Studies have found that conditions like tooth decay and enamel erosion can occur in those who exercise more due to impaired saliva flow that plays a protective role with teeth.

Let’s take a look at the risks that may be encountered during sport.

Sporting Injuries

  1. Soft Tissue Injuries: The most common form of injury. Injuries include abrasions, contusions (it is caused when blood vessels are damaged or broken) and laceration (or cut). Lip lacerations are also common.
  1. Fractures: The zygomatic bone (cheek bone), as well the mandible  (jaw bone) are common sites of fracture. A condular fracture of the jaw bone happens around the area where the mandible joins the skull. In young children, this can lead to permanent deformities later in life.
  2. Tooth intrusion: This is a serious injury and happens when a strong force pushes the tooth either upwards or downwards into the tooth socket. Don’t try to move the tooth by your own as it worsens the condition. Apply ice if you have any discomfort and consult a dentist immediately.
  1. Tooth extrusion: These cases occur when the tooth is displaced partially out of the socket. In these cases, of displacement injury, there can be significant long-term consequences and damage including loss of the tooth. Do not try to move the tooth by your own. Apply ice if you have any mouth discomfort and immediately consult a dentist.
  2. Crown and root fractures: Crown fracture is the cracking of enamel without loss of tooth structure. Cracks can occur in the most superficial part of the tooth, known as the outer coating or tooth enamel. The most severe case is when the pulp is fully exposed and contaminated. These injuries are common after a powerful side-on blow to the head.
  3. Avulsion: Avulsion is a clinical term for knocking your tooth out. Similar to tooth extrusion except the tooth is completely displaced. If the tooth is outside its socket for more than an hour, then the chances of recovering it are slim, but a full recovery is possible with quick treatment so consulting your dentist immediately is the first step. Don’t try to re-implant the tooth yourself. Cold milk is the best liquid that you can use to transport the tooth.
  1. Cracked tooth: A chipped or cracked tooth can be most probably fixed with a white colored filling or bonding depending on the extent of the injury. A more complicated treatment may be required if the broken portion of the tooth exposes the pulp or is affecting the nerve of the tooth. In any case, consult your dentist immediately when a sporting injury has damaged or broken one of your teeth. 

Dehydration

With water representing on average 60 percent of body mass in people, fluid balance fluctuates in the body at different rates depending on their hydration. During moderate exercise, water loss via sweat secretion can be significantly elevated approaching 8-16L per day.

Sustained exercise performed in an environment of heat stress, where water intake is infrequent or not enough to replace loss can result in a one percent water loss for every 30-40 minutes of steady state sweating.

Dehydration will impact the amount of fluid available in saliva glands that ultimately decrease saliva flow. Low saliva will result in dry mouth that reduces its protective role in the mouth.

In athletes who consistently expose themselves to dry mouth, the flow of minerals and acid balancing factors will be lowered in chronic dehydration. However not only is there less saliva, the composition of proteins in the saliva that impact the acidity and management of the oral cavity is also altered.

Olympic athletes have been shown to have an increased risk of tooth decay due to dry mouth and lower saliva flow.

Sports Drinks Consumption

Not only will the lack of fluid during sport increase the risk of problems associated with dry mouth, the wrong types of fluid replacement can have a negative impact on the oral cavity. Sports drinks are often high in sugar and acids that when consumed in combination will damage the surface enamel of the teeth causing tooth decay or enamel erosion.

The problem in many sporting situations is that athletes will push themselves to dehydration, reducing saliva flow and replace the fluids with a high sugar acidic sports drink. This situation puts people at extremely high risk of acidic damage to the teeth or tooth decay.

Prevention Is Always Better Than Cure

Firstly, during contact sports, protection for the head and mouth area is essential to lower the risk of harmful impacts to the teeth.

Properly fitting helmets, facemasks or a well-fitted mouthguard are the easiest and most effective ways to prevent sports-related oro-facial injuries.

Mouthguards provide protection against injury or severity of injury to the oro-facial area, including teeth, tongue, lips, gingival, mucosa and cheeks. They act as a cushion and absorbs the shock experienced by a blow to the face which otherwise may lead to an injury to mouth or jaw. Mouth guards may also help prevent head and neck injuries and concussions by maintaining a separation between the head of the mandibular condyle and the base of the skull.

An ill-fitting mouthguard can make it difficult to breathe or talk.

An effective mouthguard should:

  1. Protect both the teeth in the arch and the surrounding tissues.
  2. Have adequate thickness in all areas in order to ensure reduction of impact forces.
  3. Have a seated equilibrated occlusion so that the bite is even. This helps a lot in absorbing the impact energy.
  4. Have a secure that won’t be dislodged on impact.
  5. Allow for proper speech.

Mouthguards in general are classified into three groups:

  • Stock Mouthguards: These mouthguards can be purchased from a sports goods store, pharmacy or a departmental store. The advantage is that they are relatively cheap. The downside is that in most cases a ‘one-size fits all’ approach is rarely effective.
  • Mouth-Formed Protectors: There are two types of mouth-formed protectors: the shell-liner and the thermoplastic mouthguard.  The shell-liner type is made of a preformed shell with a liner of plastic acrylic or silicone rubber. The preformed, thermoplastic type is one that can be continuously remoulded to the athletes’ teeth as required. This is also known as “boil and bite” mouthguard and is the most popular among athletic population.
  • Custom Made Mouthguards: This mouthguard is made in two steps. First, the dentist makes a cast mold of the athlete’s mouth, then a mouth guard is fitted accordingly.  These mouth guards have a lot of advantages such as perfect fit, ease of speech and breathing, comfort and retention. It also reduces the incidence of concussion by a blow to the jaw because the mandible sits in a slightly different position. These mouth guards are the most expensive but they provide for the best protection.

Rehydration

Drinking fluid during exercise helps to prevent a drop in performance caused by dehydration and fluid after exercise. It’s important to be aware of the amount of fluid and the timing of the drinks depend on individual and also the type of sport as well as the environment.

Tips to rehydration to prevent dry mouth and exercise related dental disease.

  • Remember to hydrate at least two hours before commencing any sporting activity. Beginning an activity with adequate fluid levels decreases your risk of becoming dehydrated. Be careful not to over hydrate as it can lead to excessive urination and bloating.
  • Plan out drink times so that you have a pre-established schedule for rehydration. Plans for drink-breaks should be based on your own sweat levels, those who perspire more may need more frequent rehydration.
  • You can monitor your dehydration by weighing yourself immediately after exercise. Your body will continue to lose fluid during recovery so you need to plan to replace fluids for a few hours after finishing exercise.
  • Thirst isn’t a necessary indicator of hydration status. If you push yourself to the point of thirst during training your body is already dehydrated and you may be at risk of dental disease.
  • Plain water is the most effective drink for fluid replacement, especially in low-intensity short durations sports.
  • For athletes performing longer, endurance sports and requiring sports drinks, make sure to have water before and after consumption of the sports drink. Another option is to dilute the sports drink with water to reduce its acidic and sugary concentration and impact on your teeth.
  • Avoid drinks with caffeine on days of exercise as it can increase fluid loss and greatly diminish your ability to produce saliva.
  • Avoid drinking excessive alcohol after a sporting event as it will impair recovery processes and also cause further dehydration in the body.

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