Dental Trauma and Mouthguard Use

Dental trauma is a common sport-related injury, particularly in contact and collision sports such as rugby, hockey, boxing, martial arts, basketball and equestrian sport.

Most injuries are minor enamel chips, but avulsion (a tooth knocked out), complicated crown fractures and alveolar or jaw fractures decide the long-term outcome. An avulsed permanent tooth is time-critical: the longer the root is dry, the lower the chance replantation succeeds. Management follows the International Association of Dental Traumatology (IADT) 2020 guidelines.

Each tooth has a crown (enamel over dentine, with the pulp containing nerves and vessels) and a root anchored in the socket by the periodontal ligament (PDL). The PDL cells are needed for reattachment after avulsion, and they start to dehydrate within a few minutes of drying; after about 30 minutes of dry time most are no longer viable. That is why dry time and the storage medium decide the prognosis.

Permanent teeth replace the primary (baby) teeth from around age 6 to 12. An avulsed permanent tooth is replanted as soon as possible; an avulsed primary tooth is never replanted. If unsure which it is, check the age and seek urgent dental advice.

Injury patterns:

• •Tooth concussion: tender, not displaced or mobile
• •Subluxation: mobile but not displaced
• •Luxation: extrusive, lateral or intrusive displacement
• •Avulsion: the tooth is out of the socket
• •Crown fractures, often described by the Ellis classification: Ellis I enamel only, Ellis II enamel and dentine, Ellis III with pulp exposure (a complicated crown fracture)
• •Root fracture, and alveolar fracture, where a bone segment moves with several teeth