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Cover
Preface
1 Introduction
1. 1.1 The Prevalence/Incidence of Dental Trauma During Sport
2. 1.2 Dealing with Trauma to Teeth
3. 1.3 The Role of Saliva in Tooth Surface Loss
4. 1.4 The Role of Education
5. 1.5 The Role of Sports Dentistry
6. References
2 Dealing with Dental Trauma: The Adult Athlete
1. 2.1 Introduction
2. 2.2 Classification of Injuries
3. 2.3 Trauma to the Periodontal Ligament
4. 2.4 Root Fractures
5. 2.5 Splinting Techniques
6. 2.6 Ankylosis
7. 2.7 Soft Tissue Injuries
8. 2.8 Developing an Emergency Dental Kit
9. References
3 Dealing with Sporting Dental Trauma in Paediatric Patients
1. 3.1 Introduction
2. 3.2 Dental Trauma: Children vs. Adults
3. 3.3 Dental Development and Trauma
4. 3.4 Alveolar Bone Growth and Trauma
5. 3.5 Epidemiology
6. 3.6 Preventing Trauma
7. 3.7 Emergency Management of Dental Trauma
8. 3.8 Management of Soft Tissue Injuries
9. 3.9 Management of Trauma to the Primary Teeth
10. 3.10 Dental Management of Trauma to the Permanent Teeth
11. 3.11 Prognosis of Trauma in Young People
12. References
4 Restoration of Teeth Damaged by Trauma
1. 4.1 Introduction
2. 4.2 Principle Components of Modern Composite Resins
3. 4.3 Restorative Techniques
4. 4.4 Success with Anterior Composite Restorations
5. 4.5 Clinical Sequence
6. 4.6 Partial Bonded Porcelain Restorations/Minimally Invasive Bonded Porcelain
7. References
5 Dealing with Endodontic Problems Following Sporting Trauma
1. 5.1 Introduction
2. 5.2 Guidelines for Sports Doctors, Coaches, and Team Members
3. 5.3 Nature of Injuries
4. 5.4 Pulp Survival/Review of Pulp Status
5. 5.5 Examination/History
6. 5.6 Treatment
7. 5.7 Review
8. References
6 Dealing with Tooth Wear in Athletes
1. 6.1 Introduction
2. 6.2 Types of Wear
3. 6.3 Dental Erosion vs. Erosive Wear
4. 6.4 Prevalence of Erosive Tooth Wear
5. 6.5 Dietary Erosive Wear
6. 6.6 Gastro‐Oesophageal Reflux Disease (GORD)/Laryngopharyngeal Reflux (LPR)
7. 6.7 Eating Disorders
8. 6.8 Effects of Alcohol
9. 6.9 Rumination
10. 6.10 Short‐term Causes of Erosive Wear
11. 6.11 The Role of Saliva and Pellicle in Erosive Wear
12. 6.12 Distribution of Wear Facets and Colour as an Indication of Progression
13. 6.13 Erosive Wear in Elite Athletes
14. 6.14 Management of Erosive Wear
15. References
7 Prevention of Sporting Dental Injuries
1. 7.1 Introduction
2. 7.2 Concussion
3. 7.3 The Role of Schools in Mouth Guard Wear
4. 7.4 The Use of Helmets in Preventing Sporting Trauma
5. 7.5 Early Intervention Orthodontics
6. 7.6 Mouth Guards
7. 7.7 Helmets
8. 7.8 Face Shields
9. 7.9 Education About Diet
10. 7.10 Sports Drinks
11. 7.11 Prevention of Dental Diseases
12. 7.12 Performance‐enhancing Mouth Guards
13. 7.13 Conclusion
14. References
8 The Role of Nutrition in Sport: Current Sports Nutrition Advice
1. 8.1 Introduction
2. 8.2 What is the Optimal Diet for an Athlete? Is it Different for the Recreational Exerciser?
3. 8.3 Hydration
4. 8.4 Supplements
5. 8.5 Gastro‐intestinal Complaints Related to Exercise
6. 8.6 Eating Disorders in Sport
7. 8.7 The Future
8. 8.8 Summary
9. References
9 Oral Health, the Elite Athlete, and Performance
1. 9.1 Introduction
2. 9.2 Oral Health in Elite Athletes
3. 9.3 Causes of Poor Oral Health in Elite Sport
4. 9.4 Causes of Performance Impacts
5. 9.5 Interventions for Athlete Oral Health
6. 9.6 Centre for Oral Health and Performance
7. 9.7 Summary
8. Acknowledgements
9. References
10 Screening for Dental Disease Amongst Elite Athletes
1. 10.1 Dental Care of the Sportsperson
2. 10.2 Exercise Effects on the Oral Cavity
3. 10.3 Associated Dental Diseases
4. 10.4 Tooth Surface Loss
5. 10.5 Tooth Structure
6. 10.6 The Acidic Challenge
7. 10.7 Dental Caries
8. 10.8 FA Initiative 2014
9. 10.9 Acute and Chronic Infections
10. 10.10 Temporomandibular Joint Dysfunction
11. 10.11 Barotrauma
12. 10.12 Mouth Guards
13. 10.13 Other Issues
14. 10.14 Sports Team Dentist Roles and Responsibilities
15. 10.15 Screening Programmes
16. 10.16 Prescribing
17. 10.17 Prevention and Considerations for Care
18. References
11 Delivering Dental Facilities at Sporting Events
1. 11.1 Introduction
2. 11.2 Types of Sports Dentistry Support
3. 11.3 Referral Pathway
4. 11.4 Sports Dentistry Support for the Individual Athlete
5. 11.5 Sports Dentistry Support for a Team
6. 11.6 Sports Dentistry Support at a Competition
7. 11.7 Sports Dentistry Support at Major Events
8. 11.8 Level of Cover
9. 11.9 Recruitment of Dentists and Dental Care Professionals
10. 11.10 Training Recruits
11. 11.11 Types of Equipment
12. 11.12 Legacy
13. 11.13 Conclusion
14. Reference
Index
End User License Agreement

List of Tables

Chapter 01
1. Table 1.1 Concussion rates for various sports.
2. Table 1.2 Showing the number and percentage of dental traumas due to cycling.
3. Table 1.3 Soft tissue injuries
Chapter 02
1. Table 2.1 Types of repositioning following an intrusion injury (courtesy of dentaltraumaguide.org) [8].
Chapter 06
1. Table 6.1 Examples of erosive foods and drinks.
2. Table 6.2 Examples of common drinks showing their pH and titratable acidity.
3. Table 6.3 Symptoms of GORD.
4. Table 6.4 Comparison between GORD and LPR.
5. Table 6.5 BEWE index for scoring erosive wear.
6. Table 6.6 Factors to consider when assessing acidic dietary intake
Chapter 08
1. Table 8.1 Energy sources from food and drinks.
2. Table 8.2 Classes, sources, and examples of different carbohydrates and artificial sweeteners.
3. Table 8.3 2010 Guidelines/Categories – daily needs for fuel and recovery (consider total energy needs, specific training needs, feedback from training) [4].
4. Table 8.4 Supplements that can be considered within a well‐balanced food plan.
Chapter 09
1. Table 9.1 London 2012 oral health data: participants.
2. Table 9.2 London 2012 oral health data: oral health conditions.
3. Table 9.3 Examples of oral health prevention actions. This is not a comprehensive toolkit but illustrates some of the possible actions. Note, there is much overlap and where one action may help other conditions, this is not duplicated. (Based on Delivering Better Oral Health 3rd Edition [71].
Chapter 10
1. Table 10.1 Common signs and symptoms of tooth surface loss.
2. Table 10.2 Signs and symptoms that may be included in anorexia athletica.
3. Table 10.3 Zadik’s [45] summary of Frejentsik and Aker (1982) barotrauma classification.
4. Table 10.4 The advantages/disadvantages and considerations of screening.
5. Table 10.5 Objectives of dental screening.
6. Table 10.6 The advantages and disadvantages of a dental surgery‐based screening program vs. an on‐site training facility screen.
7. Table 10.7 Dental materials list.
8. Table 10.8 The important factors in caries assessment.

List of Illustrations

Chapter 01
1. Figure 1.1 Current IRB guidelines on dealing with concussion.
2. Figure 1.2 SCAT form to record levels of concussion.
Chapter 02
1. Figure 2.1 The main classification systems identified by da Costa Feliciano.
2. Figure 2.2 Standard arrangement of periodontal tissues.
3. Figure 2.3 Comparison of root resorption rates with extra‐oral period; three‐year follow‐up, following soaking in sodium fluoride [13].
4. Figure 2.4 Effects of using systemic antibiotics following reimplanting avulsed adult teeth [14].
5. Figure 2.5 Ellman mesh splint.
6. Figure 2.6 Kevlar thread.
7. Figure 2.7 Titanium trauma splint (Medartis AG, Basel, Switzerland).
8. Figure 2.8 Graph of transient ankylosis following replantation [23].
9. Figure 2.9 Graph of ankylosis following replantation [23].
10. Figure 2.10 The most common periodontal repair patterns observed during replantation [14].
11. Figure 2.11 Distribution of dental trauma in female field hockey players.
12. Figure 2.12 Contusion of gingival tissues.
13. Figure 2.13 Abrasion of upper lip.
14. Figure 2.14 Laceration of lower lip.
15. Figure 2.15 Penetrating wound from an air gun pellet.
Chapter 03
1. Figure 3.1 Increased overjet being measured.
2. Figure 3.2 Diagram of an upper permanent incisor tooth illustrating key structures.
3. Figure 3.3 Crown fractures of central incisors.
4. Figure 3.4 Radiograph showing root fracture in the middle part of a tooth.
5. Figure 3.5 Simple wire and composite splint.
Chapter 04
1. Figure 4.1 Clinical example and images of reattachment.
2. Figure 4.2 Palatal composite baskets.
3. Figure 4.3 Dehydrated teeth.
4. Figure 4.4 Rehydrated teeth.
5. Figure 4.5 Anterior tooth anatomy. Illustrated by Jurgita Sybaite.
6. Figure 4.6 A Class IV restoration before.
7. Figure 4.7 The final composite restoration.
8. Figure 4.8 Opalescence in natural teeth.
9. Figure 4.9 An attempt to recreate the effect in composite.
10. Figure 4.10 Wedges of dentine and enamel composite made from the actual material.
Chapter 05
1. Figure 5.1 Cross‐section of a tooth and supporting tissues.
2. Figure 5.2 The periodontium, showing its constituent parts. (Images courtesy of Eleanor Robson).
3. Figure 5.3 A traumatized tooth showing its rotation and areas of compression (blue), and stretching and tearing (red).
4. Figure 5.4 CBCT showing the difference in anatomy that occurs around anterior teeth, resulting in different injuries.
5. Figure 5.5 (a) Transient apical resorption resulting in resorption of the root tips of mandibular incisor teeth (see arrows) followed by (b) complete healing.
6. Figure 5.6 The radiographic appearance of pulp obliteration.
7. Figure 5.7 Pulp necrosis, resulting in chronic apical periodontitis, seen radiographically as a periapical radiolucency.
8. Figure 5.8 Graph showing minimum and maximum prevalence of pulp necrosis for hard tissue injuries (infraction [4,5]; enamel fracture [7,8]; enamel/dentine fracture [8,9]; root fracture [10,11]).
9. Figure 5.9 The development of pulp necrosis in luxated [12] and avulsed [13] teeth.
10. Figure 5.10 A bore light (a) can be used to transilluminate teeth, when looking for infraction lines, and is covered with a clear plastic shield (b) for cross‐infection purposes.
11. Figure 5.11 A fractured crown of a permanent central incisor.
12. Figure 5.12 Pulp exposure, following a crown fracture.
13. Figure 5.13 Luxated right maxillary incisors which have been poorly splinted. Note their lower position when compared to the contra‐lateral teeth.
14. Figure 5.14 Colour changes in the crowns of teeth following luxation (a), after pulp necrosis (b) and root canal obliteration (c).
15. Figure 5.15 A cold refrigerant spray, used to thermally test the pulps of teeth.
16. Figure 5.16 An electric pulp tester used on an isolated tooth (a) and the patient holding the lip hook to complete the electrical circuit (b).
17. Figure 5.17 A crown fracture in a 9‐year‐old, showing its sub‐gingival nature due to the crown not being fully erupted.
18. Figure 5.18 Impact Air 45® handpiece.
19. Figure 5.19 A partial pulpotomy, following pulp amputation and haemostasis (a), application of calcium hydroxide (b) and sealing with IRM® (c).
20. Figure 5.20 The position of teeth, when marked on a rubber dam (a), often differ in position to those marked with a stamp (b). Marking the true positions on the dam make placement straightforward (c).
21. Figure 5.21 Placement of rubber dam when a splint is still attached to teeth, using an IVORY #9 clamp.
22. Figure 5.22 Radiographic images compared to actual anatomy, seen when root canals are stained and then cleared in a maxillary lateral incisor (left) and mandibular lateral incisor (right).
23. Figure 5.23 From the left, an access cavity when seen palatally, prepared through the cingulum, with a balanced preparation, and straight‐line access.
24. Figure 5.24 Hedstrom files, Flex‐o‐Files, and Gates Glidden burrs are often the only instruments required for root canal preparation.
25. Figure 5.25 An obliterated root canal can sometimes extend a good distance coronally (a) as well as being patent throughout its whole length and curved apically (b).
26. Figure 5.26 Sterile interdental brushes, used to clean wide root canals.
27. Figure 5.27 In root‐fractured teeth, instrumentation and obturation are completed up to the fracture line.
28. Figure 5.28 Several root‐fractured teeth reviewed five years after trauma, immobilised with a wire splint (a) and with healthy pulps (b), despite the accumulation of calculus.
29. Figure 5.29 A dense, uniform fill of calcium hydroxide, introduced with an amalgam carrier and packed with pluggers.
30. Figure 5.30 Chloroform‐customised gutta percha points often reveal the intricate anatomy at the end of the root canal at their tips.
31. Figure 5.31 An MTA obturation treatment in a tooth with an incompletely formed apex immediately after MTA was placed (a) and following completion of treatment (b).
32. Figure 5.32 A radiograph of traumatised maxillary central incisors in an eight‐year‐old patient, showing the relatively thin walls of the roots present at this age.
33. Figure 5.33 A resected root tip of a tooth with an obliterated root canal. Note the porous tertiary dentine in the centre of the tooth formed after dental trauma, which would remain unsealed following preparation and obturation of the main root canal in the centre of the tooth.
34. Figure 5.34 Retroplast® is a flowable composite, used to seal resected roots.
Chapter 06
1. Figure 6.1 Showing the interactions between various factors in erosive wear.
2. Figure 6.2 Picture showing erosive wear of teeth due to nocturnal reflux. The teeth on the left side are more affected than the right.
3. Figure 6.3 Picture showing erosive wear of teeth due to nocturnal reflux. The teeth on the left side are more affected than the right. This picture shows the wear facets more clearly on the left side.
4. Figure 6.4 Labial surfaces of upper and lower anterior teeth affected by wear. Early erosive wear is evident on the LL 1 and LL2. The upper teeth have been covered with composite as a temporary measure.
5. Figure 6.5 Palatal surfaces of the upper anterior teeth affected by erosive wear.
6. Figure 6.6 (a) A wedge‐shaped wear facet on the labial surface of a canine tooth primarily due to abrasion. (b) Wear facets on the labial/buccal surfaces of the teeth primarily due to erosion, having a typical washed out/dish‐shaped appearance.
7. Figure 6.7 Labial stained wear facets in a patient that has had erosive wear as a result of GORD.
8. Figure 6.8 Palatal surfaces of the teeth affected by erosive wear due to GORD.
9. Figure 6.9 Palatal restorations of the teeth shown in Figure 6.8 with Dahl effect composite restorations.
10. Figure 6.10 Labial surfaces of the teeth shown in Figure 6.7 showing indirect composite restorations.
11. Figure 6.11 A fixed metal Dahl appliance.
Chapter 07
1. Figure 7.1 Suitable cycle helmet with faceguard.
2. Figure 7.2 American Football helmet and mouth guard.
3. Figure 7.3 Ski helmet.
4. Figure 7.4 Severe overjet and incompetent lip morphology.
5. Figure 7.5 The Drufomat machine for fabricating custom‐made mouth guards.
6. Figure 7.6 Stock mouth guard for upper and lower teeth.
7. Figure 7.7 (a) Forces (F) acting on a tooth with and without the use of mouthguard during a soft object collision. (b) Forces (F) acting on a tooth with a high stiffness mouthguard. (c) Forces (F) acting on a tooth with a low stiffness mouthguard.
8. Figure 7.8 Ideal shape for mouth guard, labial view.
9. Figure 7.9 Ideal shape for mouth guard, occlusal view.
10. Figure 7.10 Cycle helmet.
11. Figure 7.11 Ice hockey half face shield and grill.
12. Figure 7.12 Cricket helmet with grill, showing the inadequacy of the protection.
13. Figure 7.13 Performance‐enhancing mouth guard.
Chapter 08
1. Figure 8.1 Energy supply systems.
2. Figure 8.2 Basic units of carbohydrates.
3. Figure 8.3 Use of different multiple transportable carbohydrates (glucose and fructose) results in greater fluid and carbohydrate delivery compared to glucose alone
4. Figure 8.4 Urine colour chart.
5. Figure 8.5 Monitoring fluid status.
6. Figure 8.6 Health consequences of relative energy deficiency in sport (RED‐S) showing an expanded concept of the female athlete triad to acknowledge a wider range of outcomes and the application to male athletes (* Psychological consequences can either precede RED‐S or be the result of RED‐S).
7. Figure 8.7 Potential performance effects of relative energy deficiency in sport (** aerobic and anaerobic performance).
Chapter 09
1. Figure 9.1 The Polyclinic (health centre) constructed for the London 2012 Olympic Games.
2. Figure 9.2 Prevalence of oral diseases in research data.
3. Figure 9.3 Examples of oral health problems in elite athletes. Track and field athlete with pain and swelling from acute pericoronitis. (a) Panoramic radiograph, (b) impacted, partially erupted third molar. (Images courtesy of Dr Geoff St George, Centre for Oral Health and Performance, UCL, London, UK). (c) Premier league professional footballer with severe pain showing extensive dental caries extending into dental pulp (nerve chamber).
4. Figure 9.4 Self‐reported impacts of poor oral health on athlete performance and wellbeing.
5. Figure 9.5 Complexity of factors determining oral health in athletes.
6. Figure 9.6 Model of mechanisms of impact of oral health on wellbeing and performance.
7. Figure 9.7 Illustration of estimated total surface area of ulcer within combined periodontal pockets in a person with generalised moderate to severe chronic periodontitis. The square on the palm represents the combined size of ulcerated epithelium [56].
8. Figure 9.8 (a) ‘Gob in a bag’ kit. Including key items for oral health care for athletes with recommended minimum athlete ‘drills’. (b) Athlete drills.
Chapter 10
1. Figure 10.1 The Stephan curve (from www.wrigleysoralhealthcare.co.uk).
2. Figure 10.2 Occlusal pitting and altered tooth anatomy with sharp edges and buccal abrasion lesions.
3. Figure 10.3 Palatal view of tooth surface loss with incisal edge pitting anteriorly.
4. Figure 10.4 Dental caries on tooth LL7 (a) and UL6 (b).
5. Figure 10.5 Tooth surface loss due to prolonged constant straw holding in between teeth and sipping from an energy drinks bottle in a triathlete.
6. Figure 10.6 Dental (abscess) swelling and chronic infection associated with upper (a) and lower (b) front tooth.
7. Figure 10.7 Clinical picture of poor oral hygiene with gingival inflammation and calculus.
8. Figure 10.8 Clinical pictures demonstrating cracked tooth syndrome from bruxism.
9. Figure 10.9 Custom‐made mouth guards fabricated on a dental model taken from an accurate impression.
10. Figure 10.10 Snus.
11. Figure 10.11 Typical dental surgery for optimal dental examination.
12. Figure 10.12 Off‐site dental screening facility will vary according to circumstances.
13. Figure 10.13 A screening examination sheet.
14. Figure 10.14 A screening report sheet.
15. Figure 10.15 A dental screening day is a good time to educate on optimal oral health measures and distribute oral health packs as above.
Chapter 11
1. Figure 11.1 An example of an on‐site screening facility.
2. Figure 11.2 Practice building via social media.
3. Figure 11.3 Oral laceration suffered during competition.
4. Figure 11.4 Mouth guard worn at time of injury.
5. Figure 11.5 Treatment of injury.
6. Figure 11.6 Treated soft tissue injury with sutures.
7. Figure 11.7 An example of on‐site impression facilities.
8. Figure 11.8 Providing support during Rio Olympic Games 2016.
9. Figure 11.9 An example of adequate space, boxing event at Baku Islamic Solidarity Games, 2017.
10. Figure 11.10 Laceration received during competition.
11. Figure 11.11 Warm‐up area before competition.

This edition first published 2019
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Library of Congress Cataloging‐in‐Publication Data

Sports Dentistry

Principles and Practice

List of Contributors

Preface

Acknowledgements

About the Companion Website