Lesson

Dental PCMA

It is important to recognise the importance of oral health in the general well-being of an athlete. While oral pathology is rarely career- or life-threatening, it can and does result in many days/weeks per year of lost training and in many cases, exclusion from competition. It is no exaggeration to say that competitions have been lost because of dental problems.

Importance of oral health

  1. It is important to keep the athlete free from pain and pathology that could negatively impact on both the ability to train and performance.
  2. The athlete has the ability to train and compete at an optimal level without being compromised by dental disease or an otherwise preventable emergency.
  3. Good function is essential to ensure the ability to eat, communicate and breathe easily and correctly.
  4. Maintain good aesthetics.
  5. Poor oral health and periodontal disease have been directly connected to systemic conditions including heart disease, diabetes cancer and respiratory illness.
  6. A properly balanced occlusion with few or no missing teeth will help to stabilize the upper body and may result in improved performance.

As with other areas of the PCMA, the main aim is to identify and prevent dental disease or injury. The following problems can be identified during a screening assessment. The presence of any of these issues should prompt a referral to a dentist for an assessment and treatment.

Click on the following tabs to learn about the different elements of the dental PCMA.

Identify dental disease
Tooth decay (caries)

Undetected and untreated dental caries can give rise to a number of problems, including dental infection and abscesses, tooth loss, pain and cosmetic issues. The main causes of caries in elite athletes are:

  • Sports beverages
  • High sugar intake
  • Poor oral hygiene
  • Lack of dental advice and limited access to care
  • Dehydration and reduction of the protective benefits of saliva

 

Periodontal (gum) disease

This may present in an acute form (such as acute ulcerative gingivitis – AUG), or in the more commonly seen chronic periodontal disease, both of which may be equally disruptive to an elite athlete.

AUG is more commonly seen in younger athletes and is caused by a bacterial infection caused by poor oral hygiene. Borrelia vincenti is commonly identified as the causative pathogen, hence the alternative name “Vincent’s disease”.

AUG may be identified by the following:

  • Bleeding around the necks of the teeth
  • Necrosis of the dental papillae
  • Loss of gum contour
  • A highly offensive odour
  • General malaise

Chronic periodontal disease is widely prevalent in the older cohort of athletes and is commonly characterised by the following:

  • Severe inflammation, red angry appearance of the gingival tissues
  • Large deposits of calcified material (calculus) around the necks of the teeth
  • Bone loss causing teeth to become loose
  • Generalised inflammation of all surrounding soft tissues
  • Tooth loss with ensuing occlusal instability
  • Drifting and random movement of teeth, commonly in the incisor region
  • Bad breath

Identify a predisposition to trauma
A number of conditions which can predispose to trauma can be identified during the PCMA.

 

Overjet and orthodontics

An athlete with a significant overjet of the maxillary incisor teeth in excess of 6mm is much more likely to sustain a dental injury. Orthodontic appliances (braces) may increase the potential for soft tissue injury.

 

Impacted wisdom teeth

Wisdom teeth (third molars) provide two potential problems for athletes. Primarily, they can become infected and swollen, severely influencing the ability to train or compete. Also, there is a much higher risk of jaw fracture. 4,5 Wisdom teeth should be assessed between 16-21 years and extracted where appropriate at a time that will least impactful on the athlete’s training or competition.

Diagnose oral pathology
Regular screening in athletes and the early identification of disease can minimise or prevent more serious consequences. Early detection may enable any required surgery to be scheduled around training and competition schedules.
Identify high-risk habits
Practices such as the use of chewing tobacco and betel nuts as well as high-altitude outdoor training are believed to increase the risk of lip and oral carcinoma. Note the eythematous appearance, hyperkeratotic surface of the mucosa and degree of tooth wear present. Broken teeth with sharp edges that give rise to chronic irritation may also cause these changes.

Click on the following images to see examples of the problems that can be identified during a dental PCMA.

  • Overjet

    Significant Overjet of the maxillary incisor teeth

  • Impacted wisdom

    Impacted wisdom teeth can predispose to mandibular fractures

  • Cystic change

    These cystic changes were identified early during a screening assessment

  • Tooth decay

    Undetected and untreated dental caries can create health and performance issues

  • Gum disease

    Acute ulcerative gingivitis and chronic periodontal disease can be disruptive

The goal of the dental PCMA is to recognise and record any oral pathology or other conditions that might predispose the athlete to trauma or time loss due to disease or infection. It is also important to ensure that the athlete is strongly encouraged to arrange appropriate treatment and to advocate for preventative strategies including mouthguard use.

Dr Anthony Clough

Sport, Implant and Restorative Dentistry