Sports Dentistry Treatment Can Prevent TMJ Damage

Sports Dentistry Treatment Can Prevent TMJ Damage

Sports Dentistry Treatment Can Prevent TMJ Damage

By Dr. Brad Eli

Learn how sports dentistry and temporomandibular joint (TMJ) care can enhance athlete health.

Sports Dentistry is a branch of sports medicine focusing on preventing and treating dental injuries and related oral health conditions, according to the Academy for Sports Dentistry. This definition integrates oral health into sports medicine, a concept often overlooked when considering overall athlete health. It also highlights that temporomandibular joint (TMJ) disorders are within the scope of sports medicine. In this article, we’ll delve into how sports dentistry contributes to enhancing athlete health, with a specific focus on preventing and treating temporomandibular disorders (TMDs).

Table of Contents

What is Sports Dentistry?

Sports dentistry is a specialized field that focuses on the oral health of athletes and its impact on their performance and well-being. Athletes face unique challenges related to their oral health, including the risk of traumatic dental injuries and the potential development of TMDs due to the physical demands of their sports. Sports dentists are trained to address these issues and collaborate with athletes, coaches, and healthcare professionals to optimize oral health.

The scope of oral health issues that commonly affect athletes is broad. As you would expect, athletes are at a higher risk of having traumatic dental injuries. Common dental injuries in sports include tooth (crown) fractures; tooth intrusion, extrusion, and avulsion; and temporomandibular joint damage. Mouth guards worn during play help prevent most injuries and do not significantly affect ventilation or speech if fitted properly. However, several other less obvious conditions can affect athletes. These include dental carries, dental erosion, and oral inflammatory diseases.

Dental Trauma in Sports

How prevalent are dentofacial injuries in contact sports?

The prevalence of dentofacial injuries (teeth, alveolar bone, jaw, lips, and/or cheekbone pain) in contact sports is around 30%.

This number can be higher depending on the sport and the rate of compliance with mouth guard use. For instance, Table 1 illustrates the prevalence of dentofacial injuries in various sports, along with the external cause of injury. [1]

Table 1: The prevalence of dentofacial injuries in selected sports and their external cause
Sport Injury Prevalence External Cause
Boxing [2] 74% Glove to jaw*
Jui-jitsu [2] 53% Hand, elbow, or kick to jaw
Soccer [3] 44% Head, body, elbow to jaw; Ball to jaw*
Rugby [1] 37% Body, elbow, or kick to jaw; Ball to jaw*
Hockey [4] 34% Body, elbow to jaw; Puck, stick, or helmet to jaw*
Basketball [1] 27% Body, elbow to jaw; Ball to jaw*
Football [5] 11% Body to jaw; Helmet to jaw*

* Indicates that the cause includes sports-equipment-related trauma.

What is dentoalveolar trauma?

Dentoalveolar injuries encompass injuries that involve the teeth, the alveolar bone portion of the maxilla and mandible, and the nearby soft tissues. They are among the most severe dental conditions.

Ehsan N. Azadani’s Traumatic dental injuries in high school athletes in the United States of America from 2005 to 2020 study findings reported Nobember 2022:

  • Slightly more than half of the traumatic dental injuries were sustained during competition.
  • 43.6% were sustained during practice.
  • The rate of dental injury in competition was 3.6 times higher than the rate in practice (RR: 3.6, 95% CI: 3.0–4.4).
  • Dental injuries comprised 0.4% of the total 108,574 injuries sustained by athletes.
  • Among girls’ sports, field hockey had the highest rate (3.5 per 100,000 AE).
  • Among boys’ sports, basketball (2.4 per 100,000 AE) had the highest rate of dental injury.
  • The most common mechanism of injury was contact with another player (276; 60.4%) followed by contact with apparatus (146; 31.9%).
  • In the majority of dental injuries (308; 75.1%), the athlete was not wearing a mouthguard when the dental injury was sustained.

Mouth Guard Types to Prevent Dental Trauma in Active Sports

Many variables go into dental facial trauma prevalence patterns. For instance, American football is a high-contact sport, but it also has extensive rules regarding mandatory mouthguard use. Basketball is considered a low-contact sport, but low mouthguard use and the high frequency of elbow-to-mouth contact give it a higher rate of dentofacial injuries.

Mouth guards significantly reduce dentoalveolar trauma, with a prevalence of 8% among users compared to 48% in non-users [6]. This data supports calls for mandatory mouthguard use in sports. However, concerns about their impact on aerobic performance persist, leading to widespread issues with compliance.

Mouth guards are predominantly of two types:

  • 67% are boil-and-bite.
  • 29% are custom-made by dentists.
  • The rest are unclassified. [7]

Creating custom mouthguards stands as a core specialty of sports dentists. Their expertise in dental anatomy and sports demands enables them to create protective and comfortable mouthguards, playing a crucial role in preventing sports-related dental injuries.

Role of Mouth Guards in Sports Injuries and TMJ

Besides protecting against dentoalveolar trauma, sports mouth guards (MG) can also help prevent TMJ injuries. The Role of Mouthguards in Preventing Temporomandibular Joint Injuries During Contact Sports: A Prospective Study evaluated the effect of mouthguard use by athletes on the incidence of TMJ-related symptoms. It discusses how mouth guards can help if an athlete experiences clicking or grating noises from the temporomandibular joints. The results showed a significant measure of protection against TMD symptoms with mouth guard use in every parameter studied (see Table 2).
Symptom Parameter With MG Use (%) Without MG Use (%) P Value
Pain 18.6 81.4 <0.001
Clicking 17.4 82.6 <0.001
Dislocation 0 5.6 —
Deviation 24.7 75.3 <0.001

(Table adopted from the study by Singarapu, et al, May 2023)

One interesting statistic from the above study is that only 6.9% of participants were aware that TMJ injuries can occur from sports. When this is contrasted with the high prevalence of TMJ pain symptoms found in the study group, it argues not only for improved mouthguard use but also for improved education about TMJ injuries in sports.

How to know if TMJ damage occurred while playing sports?

Your dentist or an orofacial pain specialist may assess aching facial pain and the following:

  • Clicking or grating noises from the temporomandibular joints.
  • Pain around the jaw or temporomandibular joints.
  • Asymmetric mouth opening.

Athletes Are at Risk of Jaw and Muscle Injuries

Damanged TMJ ligaments during aggressive contact sports

Beyond dental trauma, sports also place athletes at an increased risk for jaw and muscle sprain/strain (JAMSS) injuries. These injuries specifically concern the orthopedic aspects of the temporomandibular joint and surrounding muscles and ligaments.

A sprain typically involves the TMJ’s lateral ligament. The lateral ligament (also called the temporomandibular ligament) helps maintain the proper alignment of the TMJ. It ensures that the condyle of the mandible remains within the articular disc and the glenoid fossa (socket) of the temporal bone. This stability is essential for smooth and pain-free jaw movements during activities such as chewing, talking, and other functions involving the jaw. When a lateral blow to the jaw occurs, it can lead to a sprain injury of the contralateral ligament. This can lead to pain, swelling, and limited jaw movement.

A strain injury usually affects the muscles responsible for jaw movement. Overexertion or excessive stress on these muscles can cause strain, resulting in muscle pain, stiffness, and difficulty in opening and closing the mouth. It appears that the lateral pterygoid muscle is the one that is most affected by sudden stretch injuries. This is also the most common muscle affected during whiplash injuries.

Common symptoms of JAMSS include jaw pain, muscle tenderness, headaches, clicking or popping sounds when moving the jaw, and limited range of motion in the jaw joint. These symptoms can be acute or chronic, and they may affect a person’s ability to speak, eat, and perform everyday activities comfortably.

Infrequently, sports-related injuries can lead to temporomandibular bone fractures, particularly in high-impact or contact sports. These fractures affect the bones forming the temporomandibular joint (TMJ), causing pain, swelling, and jaw issues. Prompt medical evaluation of the jaw is necessary and surgical intervention is often required.

Rate of TMJ Disorders in Contact Sports

Given the various mechanisms of TMJ trauma in sports, it’s not surprising that studies show that the rate of TMDs in athletes is also elevated compared to non-athletes [10]. This is because TMJ trauma is highly correlated with the subsequent development of TMDs. This correlation is particularly strong with high contact sports, with the rate of TMDs in boxing and mixed martial arts (MMA) being 78% and 62%, respectively [11].

The vast majority of TMJ disorders are classified as myofascial TMDs. Here, the issue is not related to degenerative changes intrinsic to the joint space, but rather to functional and neurological factors as the relate to the soft tissues surrounding the TMJ apparatus. In myofascial TMDs, individuals often experience symptoms like muscle pain, tenderness, and discomfort in the jaw, face, and neck, and headaches. These symptoms are typically associated with muscle overactivity, excessive clenching or grinding of teeth (bruxism), and heightened stress levels. Additionally, central factors, including the brain’s perception of pain and the central nervous system’s response to stress and anxiety, can play a significant role in exacerbating myofascial TMD symptoms.

How Sports Dentistry Helps with TMD Prevention

Painful TMDs start with a period of prolonged inflammation after an acute injury. This causes changes in the way the brain processes pain, a phenomenon called central sensitization. These changes cause the mapping of pain signals onto central pain pathways. Over time, these central connections become sensitized, leading to the perception of pain, even in the absence of the original pain source.

Sports dentistry can actively intervene in this process through preventive measures, emphasizing the importance of early medical intervention in TMJ trauma. This underscores the potential for prevention through prompt attention to seemingly minor injuries or discomfort following jaw impacts, which are quite common in many sports.

Non-invasive treatments for TMJ trauma involve conservative treatment using oral appliances, distinct from the protective mouthguards discussed above. Devices such as anterior deprogramming splints are specifically crafted to restrict the activation of the major masticatory muscles. This relaxation helps reduce the overstimulation of nerves around the TMJ, ultimately aiding in preventing prolonged inflammation and, consequently, central sensitization.

Additional conservative approaches for preventing the development of TMD involve strategies like applying hot/cold therapy, employing physical therapy methods to relax jaw muscles, and implementing behavioral pain techniques aimed at modulating the central pain response.

Effective Mouth Guards for Athletes’ Dental Injury Management

Athletes suffering from craniofacial injury need early intervention and prevention.

Sports dentistry is pivotal in optimizing athlete health and addressing dental injuries and the broader spectrum of oral health issues that athletes frequently encounter, including TMJ issues. The dental trauma prevalent in various sports underscores the importance of using effective mouthguards, as these devices significantly reduce the risk of dentoalveolar injuries. Custom-fabricated mouth guards, a specialty of sports dentists, offer superior protection and comfort, whereas non-custom mouthguards may contribute to the burden of oral health issues in athletes.

Temporomandibular joint (TMJ) trauma, common in contact sports, can lead to a range of TMJ related disorders, with myofascial TMDs being the most prevalent. Central sensitization is a key factor in their development, especially in sports with repetitive head injuries. This highlights the significance of early intervention and prevention through timely medical attention. The use of oral appliances, distinct from the protective mouthguards used during sports, can play an important role in preventing the development of chronic TMDs. Conservative interventions like hot/cold therapy, physical therapy techniques, and behavioral strategies to manage TMJ pain can also help prevent chronic pain.

Study Shows Additional Athletes’ Oral Health Issues

Aside from trauma, several other oral health issues are managed by sports dentistry. This study by Singarapu also suggests that a universal protocol for dental examination should be adopted, given the poor dental health of athletes. They cite that the rate of dental caries in athletes is 15-75%, and the rate of dental erosion is 35-85%. Other studies have highlighted the high rate of oral inflammatory disease in elite athletes, such as gingivitis (58-97%) and periodontitis (41%) [9].

What causes this relatively poor oral health profile of athletes? Some suggest that it can be attributed to dietary habits, including the consumption of sports and energy drinks, which can be acidic and detrimental to dental health. Dehydration and sports-related stress may exacerbate these effects by reducing saliva’s protective impact. Furthermore, there appears to be an educational component that needs to improve athletes’ awareness of oral health. Regular dental check-ups should be encouraged, as studies indicate a lack of knowledge and infrequent dental visits among this group.

Ironically, mouthguards themselves may contribute to the oral health problems of athletes. For instance, “boil and bite” mouthguards have been shown to harbor various bacteria, yeasts, and molds. Improperly designed or damaged mouth guards can also lead to oral mucosa injuries like hyperkeratosis, erythema, and ulcers.

These injuries may also create pathways for oral surface microorganisms to enter the bloodstream, potentially causing systemic infections such as endocarditis, pericarditis, or pneumonia. These findings stress the distinct advantage of having a sports dentist custom-fabricate a mouth guard for an athlete.

Oral health concerns for athletes extend beyond trauma, encompassing issues like dental caries, dental erosion, and oral inflammatory diseases. Awareness of these issues and promoting regular dental check-ups is crucial to improving athletes’ oral health. This underscores the importance of incorporating sports dentistry into the broader efforts of sports medicine.

Conclusion: Sports Dentistry and TMJ care

Athletes suffering from craniofacial injury need early intervention and prevention.

In conclusion, incorporating sports dentistry and TMJ care into the broader context of sports medicine enhances overall athlete health. By addressing oral health comprehensively through sports dentistry, athletes can not only perform at their best but also safeguard their long-term health and well-being.

Other Factors that Increase Risk of TMJ Damage

Author bio:

Author Dr. Brad EliDr. Brad Eli, DMD, MS graduated from UCLA’s postdoctoral Orofacial Pain program. He specializes in the field of orofacial pain, temporomandibular disorders, and headache treatment and is a member of the Academy of Sport Dentistry (ASD). Dr. Eli has also been on the educational staff at university hospitals, pain centers, and the clinical staff of Southern California hospitals. He will be presenting at the 2024 annual meeting of ASD.

 

References

[1] Mariana Oliveira Werlich, et al., “Prevalence of dentofacial injuries in contact sports players: A systematic review and meta-analysis,” October 2020, https://pubmed.ncbi.nlm.nih.gov/32176431/.

[2] Helena Polmann, et al., “Prevalence of dentofacial injuries among combat sports practitioners: A systematic review and meta-analysis,” April 2020, https://pubmed.ncbi.nlm.nih.gov/31420968/.

[3] Muawia A Qudeimat, et al., “Prevalence and severity of traumatic dental injuries among young amateur soccer players: A screening investigation,” October 2019, https://pubmed.ncbi.nlm.nih.gov/30865370/

[4] Simran Kaur Sarao, et al., “Dental Trauma Among Hockey Players: Preventive Measures, Compliance and Injury Types,” Jun. 2021, https://jcda.ca/l8

[5] Gundeep Singh, et al., “A Study of Sports Related Occurrence of Traumatic Orodental Injuries and Associated Risk Factors in High School Students in North India,” September 2014, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4267491/

[6] Loyse M Fernandes, et al., “The use of mouthguards and prevalence of dento-alveolar trauma among athletes: A systematic review and meta-analysis,” Feb. 2019, https://pubmed.ncbi.nlm.nih.gov/30222244/

[7] Farzad Mojarad, et al., “The Prevalence of Sports-related Dental Injuries and the Rate of Awareness of Mouthguard Use among Child Athletes,” July 2020, https://cms.galenos.com.tr/Uploads/Article_39808/JPR-7-358-En.pdf

[8] Athanasios Stamos, et al., “A suggested universal protocol for dental examination in sports,” June 2023, https://experts.umn.edu/en/publications/a-suggested-universal-protocol-for-dental-examination-in-sports.

[9] Cordula Leonie Merle, et al., “The Significance of Oral Inflammation in Elite Sports: A Narrative Review,” Dec. 2022, https://pubmed.ncbi.nlm.nih.gov/36643596/

[10] Hannah Charlotte Freiwald, et al., “Effects of competitive sports on temporomandibular dysfunction: a literature review,” https://link.springer.com/article/10.1007/s00784-020-03742-2

[11] Vito Crincoli, et al., “Effects of Contact Sports on Temporomandibular Disorders: An Observational Study,” Sep. 2022, https://www.mdpi.com/2304-6767/10/10/180