Beyond chipped teeth

March 9, 2000

Robyn L. Loda

The term "sports-related dental injury" rarely strikes fear in the hearts of even the most dedicated athletes, let alone recreational sports enthusiasts. But it should. According to Peter J. Fos, the term could spell serious trouble.

Last year, Fos, who is an associate professor of health systems management and director of the Master's of Public Health program, finished creating a model to predict the risk of dental-related sports injuries. His work was recently published as a chapter in the book Sports Dentistry. While many people believe a chipped tooth is the worst dental-related injury they can sustain playing sports, concussions caused by trauma to the mouth and jaw are far more injurious, says Fos, who holds a degree in dentistry.

When a person endures a blow to the lower jaw, the pivot points of this bone are crushed into the delicate housings of the joints that are separated from the brain by only a thin, bony plate. Getting hit in the jaw repeatedly can result in brain damage, causing a loss of speech and motor skills, Fos says. These types of head and neck injuries are on the rise, and there is a growing body of research that shows that a high-quality mouth guard, fitted by a dentist, is one of the best protective measures.

Fos points to research showing that most individuals who suffer concussions did not use mouth guards. In fact, within collegiate and professional athletics, only professional ice hockey and NCAA football mandate mouth guards. Elementary and high school programs are regulated on a per-school basis. Beyond that, Fos' research has concluded that mouth guards are "almost useless" unless they have been properly fitted by a dentist.

Fos realizes that schools can't provide dentist-created mouth guards for every athlete. At about $200 each, they also are too expensive for recreational sports players. This is where Fos' model comes in. He has identified more than 30 factors to help assess the risk of injury, including age, gender, equipment, velocity and intensity of the sport, exposure time, level of coaching, previous injury and abnormality of a person's jaw position.

Values associated with the risk factors are entered into a database Fos has created to quantify the threshold of risk. Individuals whose scores reach or exceed the threshold are identified as at high risk for injury. Fos says there may be practical applications to his research.

"It could be used as part of the dental exam, it could be part of the medical exam, or used by pediatrician or family physicians who treat children. It could help a lot of people avoid injury."

There's already a buzz in the dentistry world about Fos' model. Since presenting it at an Academy of Sports Dentistry meeting in Toronto last June, he's been flooded with requests for the program. "It's a great program because patients stay in the database and you can track them each time they are assessed," says Fos. "It keeps track of the risk as it changes over time. You can see how a person's risk changes as his or her life changes, as the risk factors change. Then you can recommend special treatment accordingly."

But he's not ready to distribute it quite yet. He first intends to obtain a grant to validate his model by using it in clinical trials. "I want to test it retrospectively," he says. "This means looking at cases where people had sports-related injuries, then looking at the characteristics to determine whether or not you could have predicted it."

Tulane University, New Orleans, LA 70118 504-865-5000