Many Facial Sports Injuries Are Preventable

Participating in sports, at almost any age, provides health benefits. Depending on the sport, it offers great cardiovascular exercise, develops hand-eye coordination and other skills, and fosters teamwork. But sports also carry risks of injury, often involving the head, eyes and mouth.

Obviously, sports that threaten life and limb are the most serious. Some less-critical injuries involve significant damage to soft tissue and to bones. Sometimes they involve the face, jaws and teeth, requiring treatment by a surgeon like Steven Sewall, DDS, Chief of the Division of Oral and Maxillofacial Surgery (OMFS), part of the Medical College of Wisconsin Department of Surgery. In addition to his daily practice, he is a regular rotating specialist on call for facial injuries at the Froedtert Hospital emergency department.

"The nature of sports injuries is that they are unexpected," he says, "but in many cases, sports injuries to the face can be anticipated and prevented." For instance, he notes, cold-weather sports like football and ice hockey carry a high risk of mouth and facial injuries, but a majority of these injuries are prevented by mandatory face guards and mouth guards. He cited one study that found that 40 years ago, 50% of all football injuries to high school players involved their faces and heads. Today, fewer than 2% do.

Basketball, Soccer, Baseball Players at Risk
"Today, the most common winter team-sport injuries occur in basketball and soccer," he says. "Both involve more contact than ever before, and players get injured because most of them do not wear face guards and mouth guards that are custom-fitted by a dentist.

"Why do I emphasize custom-fitted?" he continues. "They fit better and protect better than mouth guards sold in sporting goods stores - the type where you put the guard in boiling water, then bite down on it to mold it. And because they don't fit properly, they can be dislodged more easily." Custom-made mouth guards can cost between $25 and $100, he says, but they last up to two years.

Fans who watched the 2004 National Basketball Association championships did see one standout player with a face mask, Richard Hamilton of the Detroit Pistons. But he was wearing the mask after the fact, to protect a broken nose suffered earlier in the season.

In summer, the most dangerous team sport for facial injuries is baseball, including softball, Dr. Sewall says, adding that he would like to see baseball players wear more protective mouth and teeth gear. Regardless of the player's age, they stand the risk of injuring their mouth or teeth one of three ways, he says:

• Getting hit by a line drive (a batted ball striking a pitcher, for example).
• Body-to-body contact, such as when two fielders collide while chasing a fly ball, or when a fielder collides with a spectator on the sidelines. Typically a player's elbow slams into the cheekbone of the victim.
• Being struck by a bat that flies out of control from someone swinging repeatedly while on deck, waiting a turn at bat.

Knocked-out Teeth
One of the mouth injuries Dr. Sewall treats in patients of all ages are avulsed teeth, or in laymen's terms, knocked-out teeth. These do occur while playing sports, but they are just as likely to happen as a result of a car accident, household falls or getting caught up in a physical altercation. Knocked-out teeth can be saved and restored to their normal function - if a few precautions are promptly followed, he says.

"Above all, determine whether the victim has suffered a more serious, even potentially life- or limb-threatening injury, and call for emergency help," he says. "The dental injury can wait. If the patient is not responding or is bleeding extensively, those can indicate other, more critical injuries."

But even if the injury seems to be limited to the teeth, it's still important to get immediate help if full function is to be restored, says Dr. Sewall. He recommends going to an emergency room - right after doing some first aid.

First Aid, ER Treatment May Save Tooth
"Don't wait to go to your own dentist," says Dr. Sewall. "The ER should be the first place to go. Emergency physicians and triage nurses know what to do, and when to call in a specialist." Teeth knocked out most often are the upper front teeth, which are more forward in the mouth, he adds.

"The first two hours after the injury are the most critical to saving the tooth," he says. Because time is so important, do some first aid before heading for the hospital:

• First, rinse the displaced tooth with water, but don't scrub it
• Next, put the tooth back in place, ideally in the socket from which it was ejected. If that's not possible, put it between the lip and the gum, called the "vestibule" of the mouth. With children and squeamish adults - or if there's a risk the loose tooth could be swallowed - put the tooth in milk or water (preferably a saline, or salt-water solution) for transporting to the hospital. "This is important, because if the tooth is left to dry out, it essentially becomes a foreign object, and the body will ultimately reject it," he says.
• If the tooth has broken into pieces, collect the pieces and follow the same procedures. If there is bleeding from the socket, rinse with water, and place a wad of tissue or gauze over it and close the mouth.

At the hospital, the tooth will be put into the socket (if it is not correctly in place). The tooth may be further stabilized with wires, similar to a brace used to straighten teeth, and secured with a dental bonding cement, Dr. Sewall says. These stay in place for up to four weeks, and patients are advised to avoid hard foods during the treatment period.

"We advise patients to have follow-up treatment with their regular dentist, to look for infections and monitor for nerve damage," he says.

Prevention Is Best
The best remedy of all is prevention, Dr. Sewall says. A one-time soccer coach, he has preached prevention to numerous youngsters, parents, trainers and coaches. A growing number of trainers and coaches know the importance of assessing head and facial injuries on the field, he says, and many know the first-aid steps to follow to preserve the viability of knocked-out teeth.

It's important to enjoy sports, he adds, and a few safety precautions can make it that much more enjoyable. That warning, by the way, extends to spectators, says Dr. Sewall, who has treated both aggressive athletes and highly charged spectators.

Barbara Abel
HealthLink Contributing Writer

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.