172 SECTION 3 • MEDICAL PROBLEMS IN THE ATHLETE
is alert. The tooth will click into place, but make sure
the tooth is properly positioned. After reimplantation
onsite temporary splinting can be done with aluminum
foil, silly putty, or chewing gum to the surrounding
teeth (Kenny and Barrett, 2001). The athlete should
then follow up with a dentist immediately for defini-
tive diagnosis and management.- If reimplantation is not able to be done onsite then a
proper medium for tooth transport is critical. The
most suitable transport medium is Hank’s balanced
salt solution(HBSS) because of its pH-preserving
fluid and trauma-reducing suspension. Save-a-Tooth
(Biologic Rescue Products, Conshohacken, PA) is one
HBSS-type product. HBSS should be readily avail-
able at schools, emergency rooms, athletic coach
trainer kit, and at private medical offices. - If HBSS is not available then milk, saliva, and physi-
ologic saline are good alternatives. Tap water is not a
good alternative because it can cause periodontal cell
death within minutes (Kenny and Barrett, 2001). Cool
milk has been shown to work as a better medium than
warm milk. Also, getting the tooth into a medium
within the first 15 min increases cell survival and
reimplantation success (Trope, 2002). - An avulsed tooth needs immediate attention and refer-
ral to a dentist because speed of treatment affects
prognosis. A tooth that has been out of the mouth
greater than 30 min decreases chance of survival. If
the tooth is reimplanted within 15–30 min there is a
90% chance the tooth will be retained for life
(Douglas and Douglas, 2003).
•Primary avulsed teeth should not be reimplanted
because this could injure the permanent tooth follicle
(Douglas and Douglas, 2003).
INFECTION
•Pulpitis is when an inflamed pulp will become
necrotic causing inflammation around the apex of the
tooth. The tooth will then have localized pain and
swelling and sensitivity to percussion. Referral to
dentist for either a root canal or extraction is needed.
Pain medication may be given but antibiotics are not
necessary (Douglas and Douglas, 2003).
- An apical abscess is localized, but if not treated a cel-
lulitis may follow. Cellulitis is a diffuse painful
swelling. This infection may spread into the fascial
spaces of the head and neck possibly causing airway
problems. The infection may spread to the periorbital
area with complications such as loss of vision, cav-
ernous sinus thrombosis, and central nervous system
(CNS) involvement. A patient with cellulitis should
be placed on antibiotics and incision and drainage
performedwhether cellulitis is indurated or fluctuant
to allow for a pathway of drainage.
•Patients with severe swelling in the head/neck with
possible airway compromise often need hospitalization.
These patients will need surgical drainage and IV broad
spectrum antibiotics immediately.- Periodontal disease is an inflammatory destructive
process resulting in loss of attachment of tooth and
bone. The PDL and alveolar bone are destroyed by
bacterial plaque. Athletes with evidence of periodontal
disease should be referred to the care of a periodontist. - Dental decay or caries is caused by oral bacterial dem-
ineralizing tooth enamel and dentin. The acid produc-
tion from the fermentation of dietary carbohydrates
by oral bacteria demineralizes the tooth. Dental caries
begins with no symptoms but can be seen as opaque
areas on the enamel that progress to brownish cavities
(Padilla, 2003).
PREVENTION•A properly fitted mouth guard should be protective, com-
fortable, resilient, tear resistant, odorless, tasteless, not
bulky, cause minimal interference to speaking and
breathing, and have excellent retention, fit, and sufficient
thickness in critical areas. Mouth guards are worn in
football and it has been reported to have 0.07% orofacial
injuries. On the contrary in basketball where mouth
guards are not routinely worn oral facial injuries are 34%
(Dorn, 2002). The American Dental Association (ADA)
estimates mouth guards have prevented 200,000 injuries
per year. A properly fitting mouth guard will protect the
teeth and may reduce the incidence of concussion from
a blow to the jaw (Padilla, 2003).- There are four types of mouth guards: stock, boil and
bite, vacuum custom, and pressure laminated custom. - Stock mouth guards are available at most sporting
good stores and are the least expensive and least pro-
tective. They are ready to use out of the package but
considered bulky and have little retention. - Boil and bite mouth guards are the most common on
the market. The mouth guard is immersed in boiling
water and formed in the mouth by fingers, tongue, and
biting pressure. This mouth guard does not cover all
the posterior teeth decreasing the protective qualities
and increasing concussion chance. - Custom mouth guards are made by a dentist after a
complete dental examination and proper questioning.
An impression is taken of the athlete’s mouth allow-
ing the dentist to make a stone cast of the mouth. A
single layer thermoplastic mouth guard material is
adapted over the cast. A vacuum custom mouth guard
can be made in the office.