Need for Sports Dentistry in India  

In last 2 decades, there has been a steady rise in playing various sports in India, esp.
contact sports. With more and more people opting for contact sports reaching at the top
international levels like in Olympics, there is a high incidence of dental trauma in many
sports. A good properly fitted mouthguard can boost athlete’s confidence & can keep the
oral and facial structures intact. But there is lack of knowledge and awareness among the
athletes, coaches, parents and even the dentists and other medical personnel regarding all
this. Insite of having a good fitness level, a bad oral health can hamper the athlete’s
concentration and performance while playing. This too can be easily prevented by doing
pre-season dental check-ups and preventive dental treatments in athletes. That is why, it is
necessary to introduce Sports Dentistry as a new branch of dentistry in India.

What is Sports Dentistry?
According to the Academy of Sports Dentistry, USA, it is defined as:
“Sports Dentistry is a branch of Sports Medicine that connects dentistry and sports, with a
specific focus on the prevention and treatment of dental injuries and related oral diseases
associated with sports and exercise.”

Role of Sports Dentist/Team Dentist:

The sports dentist is also called as Team Dentist since they have the responsibility of the dental care of the entire team. For better understanding, the roles of the sports dentist are divided into 2 parts – main roles and additional roles

Main roles:
– Dental screenings of athletes annually or before major events
– Perform required dental treatments of athletes
– Mouthguard fabrications for all high, medium and low risk contact sports
– Dental trauma emergency and long term management of athlete
– Inter-disciplinary dental care management: involving team of specialists like
orthodontist, endodontist, paediatric dentist, oral surgeon, etc.
– Create awareness for “dental care and dental injury prevention & emergency
management programs” in athletes, coaches, parents, sports academies, schools,
colleges, professional sports associations, etc.

Additional roles:
– Nutritional guidance for better oral health
– Recognition of doping in athletes
– Tobacco control counselling
– Substance abuse recognition and referral
– Refer to proper medical personnel in case of concussion
– Multi-disciplinary Management with other sports health care professionals

What does history say about Athletes and Dental care:
The history of Sports Dentistry happens concomitant with the occurrence of some of the
major sporting events and refers to the time of the World Cup Soccer 1958, when the dentist
Mario Trigo accompanied Brazillian soccer team during this competition and consequently
in the Cups of 1962 and 1966. In 1958, in Sweden, Trigo performed 118 extractions on 33
players. As a dentist of Fluminense Football Club, Trigo reports had observed that athletes
who waited longer to recover of concussions were precisely those who had dental infection.
After elimination of the infection, athlete’s recovery was faster, optimizing treatment and
facilitating the team squad. Aldo Forli Scocate was the dentist responsible for the oral
health of Olympic athletes in 1992, performed 265 assistances. The average of 14.6 patients
per day is high rate for a delegation with just over 300 members.

As a result of the treatment during the Olympics, there was an increase of psychological
situation of athletes and the improvement of muscle performance reacquired. The dental
care at the Athens Olympics in 2004 was the second most searched service in the Olympics,
behind only physiotherapy. The dental clinic was in the field of medical care area of the
Olympic Village, where 28 dentists treated 658 patients. In Beijing Olympics in 2008, 80
dentists performed about 1600 treatments. When comparing the number of procedures
crippling performed in Beijing Games with the 1968 Olympics, held in Mexico, there is a
decrease in procedures such as tooth extraction, from 370 to 47 cases. This fact highlights
the philosophy and acting of a minimal invasive dentistry, and more careful with the health
of the athlete.

At London 2012 Olympic games, a study was done to evaluate oral health and the effect of
oral health on well-being, training and performance of the participating athletes. Overall, the
results demonstrated high levels of poor oral health including dental caries (55%), dental
erosion (45%), gingivitis (75%) and periodontitis (15%). More than 40% of the athletes were
bothered by their oral health with 28% reporting an impact on quality of life and 18% on
training and performance. More of these types of studies have been conducted in last
10years which are showing similar results.

Dental Treatments for Athletes specific to Sports Dentistry

Mouthguard fabrication: Mouthguards are necessary to protect the teeth esp. for medium and high risk sports like

boxing, mixed martial arts, hockey, football, basketball, rugby, etc. Mouthguards are mainly of 3 types: stock, boil-&-bite and custom fabricated. Stock mouthguards are not recommended, few selected high quality boil-&-bite mouthguards can be used. But the ones recommended by the dentists all over the world are custom fabricated mouthguards that are made in the dental clinic and lab fabricated.
Dental trauma management: Dental injuries are common in sports and certain injuries like
luxation, root fractures and avulsion need emergency management with immediate
reference to the dentist for procedures like replantation, splinting, etc. Long term dental
trauma management needs multi-disciplinary management among different dental
specialties. Severe dental and facial injuries/jaw fractures have to be treated in a hospital.
Performance Enhancement: Dental pain can disturb the athlete, dental infection can cause
fever and fatigue and malocclusion & jaw joint problems can cause imbalance in the body.
Thus, timely correction of all these dental issues can restore oral health and any
imbalances. This can indirectly boost the general health and prevent any hindrance to
athlete performance!

Sports Dentist co-ordination with the Sports Professionals and the Coaches

The sports dentist has to co-ordinate with various sports science professionals, sports
administrators and the coaches while handling various dental issues of athletes:
Sports Physician: Dentist has to co-ordinate for various health issues of athletes esp.
related to sleep, CVS, diabetes, body deficiencies, performance, injuries, etc with the sports
physician. The presence of the dentist at the medical screening camps (as also at the same
time dental screening has to be done) will definitely help to understand if any general health
problems are co-related to the oral health issues of athlete.

Coaches: It is important for the dentist to be in touch with coaches for resolving dental
issues of athletes & stress on preventive treatment. In fact, in many places/ sports clubs,
the physician will not be there on a daily basis. So it’s best to contact the coaches to
understand the type of sport played by the athlete to understand the type of mouthguard
needed, the hours the athlete practices daily, some food or other habits of the athlete that
might be significant from oral health point of view.
Sports Nutritionist: It has now become the need of the hour that the dentist and the sports
nutritionist need to work together so as to achieve a balance between oral health and
optimum nutrition for the athlete. While doing dental assessment, diet history has to be
taken by the sports dentist. Dental treatments that need to be performed have to be
discussed with the sports nutritionist, mainly to remove the source of causing decay and
erosion by modifying the athlete’s diet. The sports dentist can visit the sports nutritionist
for doing oral health assessment of athletes. And if any athlete has specific issues like
severe decay/erosion caused by eating disorders or erratic habits, the sports nutritionist
can visit the dentist at the time of dental appointments to further help in the treatment.
Sports Psychologist: Dentist has to discuss with the sports psychologist in cases of
bruxism, severe stress, eating disorders and dental erosion. Even in case of suspected drug
abuse or tobacco withdrawal & PTSD (Post Trauma Stress Disorder) for dento-facial
injuries. Severe dental and facial injuries can have a profound effect on athlete’s mental
health and needs to be handled well with a team approach. If athlete suffers from insomnia,
jaw pain or frequent headaches, stress related teeth grinding can be the cause. In this case,
a night guard might be recommended to the athlete, but again collaborative treatment with
the psychologist is needed to treat the root cause of the problem.
Sports Physiotherapist: Dentist needs to discuss cases of buccal respiration, h/o frequent
falls & recurrent Achilles tendinosis with the physiotherapist. If an athlete has history of
recurrent dental infection, the dentist needs to ask the athlete if he has had infection of the
Achilles tendon which has not healed. Long standing gum disease can truly cause many
problems for the athlete in the form of infections and inflammations elsewhere in the body
causing hindrance for any injured tissue to heal.

Worldwide Recommendations followed for Athlete Dental Care
FDI (Federation Dentaire International) is one of the oldest organizations in the field of
dentistry and its membership comprises some 200 national dental associations and
specialist groups in over 130 countries. It follows the same definition of Sports Dentistry as
ASD. FDI recommendations for Sports Dentistry/sports dentists (Policy):
FDI recommends to:
– Reinforce the importance of customized mouthguards, shock-absorbing material, and
time of use.
– Promote preventive measures for the maintenance of healthy oral tissues.
– Introduce the indication of customized face masks and shields, made by dentists or
under dental professional supervision.
– Update the dental team on the metabolism of prescribed substances in potential
conflict with WADA regulations.
– State the importance of an athlete’s oral health status to their performance and the
manifestation of oral lesions related to systemic reactions derived from sports
conditions.
– Reinforce the importance of the relationship between an athlete’s oral and general
health.
– Promote the benefits of well-balanced diets for good oral health.

Summary – Preventing Dental Care what the Coaches need to keep in mind:

– Conduct dental check-ups of the athletes at least 2 to 3 months prior to any major event or competition and even at the level when any athlete enters into a sport.
– Insist on doing timely dental treatments, esp. if it is quite clear that the dental
condition might worsen and can cause abrupt pain/swelling during the competition or even training and hamper athlete’s performance.
– Along with the dentist and the sports nutritionist, monitor the diet of the athlete.
– During practice games itself, the athletes should receive guidance regarding different
types of mouthguards and which athlete needs which type of mouthguard. The
athlete should start using the mouthguard during the practice itself so that the athlete
is well adjusted to the mouthguard during the competition.
– The sports team on the field during the day of event or other emergency personnel
need to be trained for how to handle emergency management of dental injuries on the
field. They need to know and equip with emergency dental management kit especially
keeping a solution like milk and saline which can transport a tooth in case the tooth
gets avulsed or is thrown out from the socket during play.
– If there is any acute oral condition or existing dental condition which is not
completely cured and medications for the same are going on, CROSS CHECK with the
anti-doping officer and the dentist as to whether the drug given is banned by WADA
or if any TUE has to be applied in advance for the same

Conclusion

The aim of this article is to sensitize all the stakeholders about athletes dental care and how
and when can it be done. A team dentist is needed at all levels of sports, whether it is grass
root sports or international level games. That is why, it is advisable for the sporting
community to have sports dentistry centers all over the various cities across India identified
for a quick approach when needed. Millions of rupees are spent every year in treating dental
trauma injuries caused due to sporting accidents. However in India, only a few athletes wear
mouthguards to prevent these injuries. In India, dental procedures regarding Sports
Dentistry should be performed at reasonable costs with best of quality at various dental
clinics situated in different cities. This is the aim of organizations like National Sports
Dentistry Committee to keep a holistic approach for athletes oral health.