14.3 Qualifications of a Team Dentist

The Academy for Sports Dentistry (ASD) has defined the qualifications necessary to be a team dentist. ASD has developed a course to qualify member dentists to be certified team dentists from bettingmafia
. The course covers topics of definitions of the sports medicine team members, preseason preparation, dentoalveolar trauma, performance-enhancing drugs, concussion and prevention of dental trauma, and the athletic mouthguard. These qualifications have been adopted by the Major League Soccer organization with other professional sports organizations certain to follow. The MLS requests the team dentists of all Major League Soccer teams be certified by the Academy for Sports Dentistry.

It was the vision of the Board of Directors of the Academy for Sports Dentistry to work toward being able to place qualified dentists with sports teams of all levels.

14.4 Education of the Sports Medicine Team: Dental Issues

The nineteenth century in the USA saw the separation of dental education from medical education. Education of dentists and physicians has remained segregated ever since the formation of the first dental school in the USA in Baltimore Maryland in 1840. Physicians receive very little training in anything dental . This requires the team dentist to take on training for team physicians and also for the certified athletic trainers.

Team dentists need to teach trainers and physicians which dentoalveolar injuries require immediate treatment and which injuries do not and can receive delayed treatment. Subluxation and crown fractures both simple and complex are usually fine with delayed treatment. Extrusive luxation, lateral luxation, intrusion, alveolar fractures gingival and oral lacerations, and avulsion injuries usually require immediate care. Most of the injuries that require immediate treatment are due to occlusal issues. Avulsion is one injury that if not treated immediately there is a rapid decrease in the survival chances of the tooth long term. For this reason physicians and trainers need to have first aid training for avulsion injuries. The team dentist may not be at a game and will likely not be at practice, so avulsion first aid is required at least of trainers. Avulsed teeth need to be reimplanted or placed in an appropriate storage medium preferably within 5 min of the injury (► Chap. 3). Effective storage media in order of effectiveness are cold skimmed milk, cold whole milk, fresh Hank’s Balanced Salt Solution (HBSS), and Save-A-Tooth (HBSS). The team dentist then needs to be immediately involved in emergent care, splinting, and long-term management. The team dentist should have dental first aid protocols for all the dentoalveolar trauma types that require immediate dental care. This needs to be reviewed at regular intervals with the other members of the sports medicine team. Reference materials may also be prepared for these injuries to be used by the trainers. Laminated cards with easy access cookbook-type references and diagrams may be the best materials. The Academy for Sports Dentistry (ASD) has a laminated trauma card that is available to academy members. (◘ Fig. 14.2)

Educating the rest of the sports medicine team on the benefits of wearing properly fitted mouthguards is another important educational duty of the team dentist (► Chap. 7). Prevention of athletic injuries is the duty of all members of the sports medicine team, and the athletic mouthguard is dentistry’s main area of prevention of injury in sports.

14.5 Preseason Dental Screening

Athletes at every level devote countless hours of time and energy preparing themselves to compete. The further the athletes continue pursuing their sport, through college and even into a professional career, the more their sport places demands on their time and energy. This may include additional demands placed on them by coaches, team athletic trainers, personal trainers, agents, and the media, not to mention personal and family time demands. All too often, an athlete’s oral health is over looked until there is a dental problem.

Dental literature contains information from surveys taken at championship events, including Olympic events that clearly demonstrate the need for basic dental care. Even though these athletes are in pristine condition to compete in their sport, many athletes present with dental conditions that are below the level of what would be considered normal for the average population.

In addition to the demands of time placed on athletes, as mentioned above, there are other reasons an athlete may not see regular dental care. While many athletes may have limited financial assistance and possibly no dental insurance, a major reason athletes do not seek regular dental care is their lack of knowledge and awareness of the importance of oral health as it relates to their general health and ability to perform their sport. That is a major reason why it is very important for the team dentist to provide education toward the realization of the importance of good oral health for the athlete. This responsibility falls directly on the shoulder of the team dentist and if he or she fails in this respect, the athlete is underserved.

Most advanced levels of organized sports include some form of preseason exams and screenings and many sports require a preseason exam. The purpose of this exam is to assess the athlete’s physical and mental condition and to establish baselines for the conditions of the athletes prior to their competing and to identify any conditions that might preclude or impair the athlete’s performance. Valuable medical information is gained at these exams, and preexisting medical conditions may be uncovered at these examinations. Cardiovascular problems, hypertension, medication allergies, vitamin deficiencies, thyroid problems, and numerous other medical conditions may be detected by the team physician at the preseason examination, so the physician can optimize the health of the athlete. Even in high school, athlete participants are required to undergo a preseason physical exam. This is usually done by the athlete’s primary care physician not by a team physician, but the rationale is the same, identify preexisting conditions and optimize the health of the athlete.

The ideal time for the dentist, and possibly the only time for the dentist and athlete to discuss dental health, is at a preseason dental screening. The preseason screening and exam is an ideal opportunity for the dentist to gather this valuable information and to meet the athletes and discuss the importance of oral health as well as the importance of wearing a mouthguard for all sports activities including conditioning, practice, and competitions. While most athletes are free from dental-related life-threatening conditions, other oral conditions may be discovered which, if not treated, may pose a significant health risk or possible loss of playing time during the upcoming season. Among these may include general unhealthy dental conditions; broken, missing, and decayed teeth; gingivitis and periodontal conditions; soft tissue anomalies; impacted or partially impacted third molars; pericoronitis; and pathologies of the head, neck, and oral cavity. Additionally, it would be an appropriate time to talk to the athletes, one on one, while performing the screening, regarding the pitfalls of sports drinks and the health hazards of smokeless tobacco. While most athletes consume sports drinks, far fewer engage in smokeless tobacco. Nevertheless, smokeless tobacco is used by a significant number of athletes in some sports. Oral conditions are noted and then may be treated to optimize the athlete’s oral health as the season begins.

Of the five major professional sports leagues, NFL, NBA, NHL, MLB, and MLS, only the NHL requires preseason screening exams to include a dental screening as well. While dental preseason screenings are not required by the NBA, NFL, MLB, and MLS, specific teams within these leagues do include dental screenings at the preseason screening day. Even though it is not a required, preseason dental screening exams have become part of the overall preseason exam process for many teams due to the recognized importance of dental screenings. If you are the dentist on the sports medicine team in a league that does not require dental involvement in the prescreening exam process, it is very worthwhile and beneficial to start including dental involvement. Some of the components of a preseason dental evaluation can be seen in Box “Components of a Preseason Dental Examination”.

Ideally, the preseason dental exams would occur at the dental office or facility where x-rays, mouthguard impressions, and complete exams can take place. However, as most sports team dentists will agree, this is rarely the case. Most preseason exams and screenings occur at locations other than a dental office or facility. Many preseason screenings are held at practice and game facilities including coach’s office, training rooms, and even hotel rooms. This requires a very insightful level of preparation on the part of the dentist and dental staff performing the exams; every detail must be anticipated. As such, it is incumbent upon the dentist to prepare a sort of mobile dental office.

Providing a good visual clinical oral examination is only possible with adequate lighting which will rarely exist outside the dental office. The use of a good headlight (◘ Fig. 14.3) is recommended to maximize intraoral vision during the examination. A list of necessary and suggested supplies for providing preseason dental screening examinations for up to 60 athletes is shown in Box “Preseason Exam List for 60 Exams and Mouthguards”.