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Giving your patients a sporting chance
J Oral Maxillofac 55:113, 1997
Surg
Giving Your Patients a Sporting Increasing numbers of health-conscious Americans are currently active in a variety of sporting and recreational activities for fun, exercise, or actual competition. Although this is a very positive trend, which should be encouraged, the negative aspect is the increasing number of sports-related injuries that are being seen in our patients. This is particularly true in children and adolescents in whom such injuries account for 36% of injuries from all causes. It has been estimated that this represents over 4 million injuries annually, with greater than 1 million classified as serious. Put in simple terms, ten out of every 100 children and adolescents will suffer an injury while engaging in a sport or other recreational activity each year. Although such injuries can involve various regions of the body, as many as 18% involve the oral and maxillofacial area. Given this high prevalence of trauma to the face and mouth, it is obvious that the oral and maxillofacial surgeon needs to be concerned about this public health issue. Such involvement should relate to both the preventive and therapeutic aspects of the problem. From a therapeutic standpoint, the oral and maxillofacial surgeon may be called on to treat an array of injuries ranging from trauma to the teeth and adjacent structures to lacerations of the face and fractures of the jaws and facial bones. Because the successful management of many of these injuries, particularly dental trauma, is dependent on prompt treatment, il is important that those who initially see such patients are aware of our availability to treat them. This includes coaches, team physicians, and athletic trainers, as well as pediatricians, emergency care centers, and hospital emergency rooms. We also need to have an emergency plan in place that will allow us to quickly initiate therapy when there is an unexpected call for our services. Although there is no question about our ability to effectively treat lacerations and fractures, the frequent association of such injuries with dental trauma mandates that we also be expert in the management of these conditions. This is often a neglected aspect of training in oral and maxillofacial surgery, and one that needs lo be addressedif we are to be prepared to provide comprehensivecare for these patients. Although being able to provide appropriate treatment for patients with sports-related injuries is an important issue, it is equally as important to do what we can to prevent or reduce such incidents, particularly when there arc effective ways in which this can be done. If all personswho engagein sporting activities in which there is the possibility for oral and maxillofacial trauma wore proper mouth guards and protective headgear, such in-
Chance
juries would be significantly decreasedor eliminated. Unfortunately, the majority of children and adolescents in whom these injuries are most prevalent do not wear such protective devices even during organized sports, and compliance in adults is even worse. A recent study has shown that even in football, a sport in which the rules require protective gear to be worn, only 75% of the studentswere in compliance, and in soccer, with no rules regarding the use of safety devices, only 7% used mouth guards and 4% wore protective headgear. The approach to better implementation of preventive measuresfor sports-related oral and facial injuries involves activity at various levels. First, there is the need to require mandatory use of mouth guardsand headgear in all organized sports. Although organized dentistry and our specialty have hoth issued strong statements regarding this matter, it needsto be enforced at the state and local level. This may not be easy based on the experience in one slate where the state high school league mandated the wearing of mouth guards in six sports, only to rescind the policy a year later because of public outcry. It is clear that better education of the public will be necessaryto achieve this goal. There are many ways that oral and maxillofacial surgeons can contribute to public education. This can involve speakingto social and professional organizations, health groups, parent-teacher associationsand booster groups, and particularly grade school and high school classesand assemblies.AAOMS has a slide program available for this purpose, as well as cards that can be distributed describing the emergency care of head, neck and face injuries. Various dental groups and societies acrossthe country have also establishedprograms promoting the use of mouth guards and other protective devices, and this is another area that calls for our active participation. Also, there is no better place to provide information than in your own office. This should not only include the dish-ibution of printed material, but also conducting discussionswith patients who engage in athletics, as well asparents and their children, about the benefits of wearing proper protective devices. This can sometimes be included as part of the discussion about the need to remove impacted teeth in persons involved in contact sports becauseof their weakening effect on the mandible and the increased risk of fractures. Finally, you and your family also need to take the appropriate preventive measureswhen engaging in your own athletic endeavors. There is no better way to convince others than by being a role model yourself. DANIEL M. LASKIN
113
Surg
Giving Your Patients a Sporting Increasing numbers of health-conscious Americans are currently active in a variety of sporting and recreational activities for fun, exercise, or actual competition. Although this is a very positive trend, which should be encouraged, the negative aspect is the increasing number of sports-related injuries that are being seen in our patients. This is particularly true in children and adolescents in whom such injuries account for 36% of injuries from all causes. It has been estimated that this represents over 4 million injuries annually, with greater than 1 million classified as serious. Put in simple terms, ten out of every 100 children and adolescents will suffer an injury while engaging in a sport or other recreational activity each year. Although such injuries can involve various regions of the body, as many as 18% involve the oral and maxillofacial area. Given this high prevalence of trauma to the face and mouth, it is obvious that the oral and maxillofacial surgeon needs to be concerned about this public health issue. Such involvement should relate to both the preventive and therapeutic aspects of the problem. From a therapeutic standpoint, the oral and maxillofacial surgeon may be called on to treat an array of injuries ranging from trauma to the teeth and adjacent structures to lacerations of the face and fractures of the jaws and facial bones. Because the successful management of many of these injuries, particularly dental trauma, is dependent on prompt treatment, il is important that those who initially see such patients are aware of our availability to treat them. This includes coaches, team physicians, and athletic trainers, as well as pediatricians, emergency care centers, and hospital emergency rooms. We also need to have an emergency plan in place that will allow us to quickly initiate therapy when there is an unexpected call for our services. Although there is no question about our ability to effectively treat lacerations and fractures, the frequent association of such injuries with dental trauma mandates that we also be expert in the management of these conditions. This is often a neglected aspect of training in oral and maxillofacial surgery, and one that needs lo be addressedif we are to be prepared to provide comprehensivecare for these patients. Although being able to provide appropriate treatment for patients with sports-related injuries is an important issue, it is equally as important to do what we can to prevent or reduce such incidents, particularly when there arc effective ways in which this can be done. If all personswho engagein sporting activities in which there is the possibility for oral and maxillofacial trauma wore proper mouth guards and protective headgear, such in-
Chance
juries would be significantly decreasedor eliminated. Unfortunately, the majority of children and adolescents in whom these injuries are most prevalent do not wear such protective devices even during organized sports, and compliance in adults is even worse. A recent study has shown that even in football, a sport in which the rules require protective gear to be worn, only 75% of the studentswere in compliance, and in soccer, with no rules regarding the use of safety devices, only 7% used mouth guards and 4% wore protective headgear. The approach to better implementation of preventive measuresfor sports-related oral and facial injuries involves activity at various levels. First, there is the need to require mandatory use of mouth guardsand headgear in all organized sports. Although organized dentistry and our specialty have hoth issued strong statements regarding this matter, it needsto be enforced at the state and local level. This may not be easy based on the experience in one slate where the state high school league mandated the wearing of mouth guards in six sports, only to rescind the policy a year later because of public outcry. It is clear that better education of the public will be necessaryto achieve this goal. There are many ways that oral and maxillofacial surgeons can contribute to public education. This can involve speakingto social and professional organizations, health groups, parent-teacher associationsand booster groups, and particularly grade school and high school classesand assemblies.AAOMS has a slide program available for this purpose, as well as cards that can be distributed describing the emergency care of head, neck and face injuries. Various dental groups and societies acrossthe country have also establishedprograms promoting the use of mouth guards and other protective devices, and this is another area that calls for our active participation. Also, there is no better place to provide information than in your own office. This should not only include the dish-ibution of printed material, but also conducting discussionswith patients who engage in athletics, as well asparents and their children, about the benefits of wearing proper protective devices. This can sometimes be included as part of the discussion about the need to remove impacted teeth in persons involved in contact sports becauseof their weakening effect on the mandible and the increased risk of fractures. Finally, you and your family also need to take the appropriate preventive measureswhen engaging in your own athletic endeavors. There is no better way to convince others than by being a role model yourself. DANIEL M. LASKIN
113