DENTAL INJURIES IN SPORTS NICHOLAS E. NICOSIA DDS

DENTAL INJURIES IN SPORTS NICHOLAS E. NICOSIA DDS

Academy for Sports Dentistry International Association for Dental Traumatology

The Hockey Smile

The Role of the Team Dentist

Be a licensed dentist in compliance with the dental practice act of his/her state. Be a member in good standing of the Academy for Sports Dentistry [ASD] Attend and complete the ASD Team Dentist course Complete a minimum of fifteen credit hours of continuing education in sports dentistry-related subjects every three years Acquire the knowledge and expertise to educate health care professionals, certified athletic trainers, coaches, athletes and parents on the benefits and methods of prevention of sports-related oral facial injuries and oral diseases Be proficient in the fabrication and delivery of properly fitted mouthguards including impression techniques and establishment of occlusion Be well-versed in the diagnosis and treatment of ora-facial trauma including but not limited to: Oral-facial first aid resulting from contusions, lacerations Emergency/immediate treatment of dental luxations, avulsions and tooth fractures Identification of maxillary and mandibular fractures Identification and treatment of TMJ injuries and dislocations Identify medical complications of head trauma Be familiar with doping issues and the effects of illicit and performance enhancing drugs Establish a support team of dental specialists and auxillary staff. Cooperate with the other members of the Sports Medicine Team to ensure the health and well being of the athletes.

Mitch Callahan

Classification of Dental Injuries and Their Management

Subluxation An injury to the tooth supporting structures resulting in increased mobility, but without displacement of the tooth.

Extrusion Partial displacement of the tooth out of its socket

Lateral luxation Displacement of the tooth accompanied by a fracture of the labial or lingual bone

Splinting

Intrusion Displacement of the tooth into the alveolar bone

Avulsion The tooth is completely displaced out of its socket

Keep the patient calm. Find the tooth and pick it up by the crown If the tooth is dirty, wash it briefly (10 seconds) under cold running water and reposition it. If this is not possible, place the tooth in a suitable storage medium, e.g. a glass of milk or a special storage media for avulsed teeth if available (e.g. Hanks balanced storage medium or saline) Seek emergency dental treatment immediately.

Restoration with a Dental Implant

Enamel fracture A fracture confined to the enamel with loss of tooth structure.

Enamel-dentin fracture A fracture confined to enamel and dentin with loss of tooth structure, but not involving the pulp.

Enamel-dentin-pulp fracture A fracture involving enamel and dentin with loss of tooth structure and exposure of the pulp.

Root Canal Therapy

Root fracture A fracture confined to the root of the tooth involving cementum, dentin, and the pulp.

Alveolar fracture A fracture of the alveolar process; may or may not involve the alveolar socket.

Fracture of mandible or maxilla A fracture involving the base of the mandible or maxilla and often the alveolar process (jaw fracture).

Dental Injury Prevention in Sports

Types of Athletic Mouth Guards Stock Boil and Bite Custom

REIMBURSEMENT

The Dilemma Very few dentists will accept Workers Comp /No Fault cases Low reimbursement rates A ton of paperwork A hassle to get paid

Unlike physicians, chiropractors, podiatrists, ophthalmologists and psychiatrists-dentists do not have to be authorized by the Workers Comp Board

The National Law Review June 9,2015 Dental claims may be rare, but they are one of the most expensive types of workers comp claims

Due to infrequency many claims professionals have limited knowledge of dental terminology, coding and billing procedures Average dental claim requires 17 provider visits Any trauma involving the neck up usually involves dental injury Traditionally relied upon preferred provider organizations(ppo) to render treatment

Recommendation To recruit dentists who understand and are willing to work within the workers comp system Dentists perform a prospective oral examination to determine what is billable in relation to work related injury Clinical team needs to recognize when a payer is not liable for entire dental history(pre existing conditions)

The Dreaded TMJ Case One of the most costly dental injuries Treatment can easily exceed $100,000 in costs Need network in place providing clinical oversight

Workers Comp and the Team Dentist A unique situation Hockey is required to have a dentist and orthopedic doctor at every game Already have an established relationship with the team, the parent club, coaches, front office and most importantly the trainers

Team Dentists are responsible for the home team, the visiting team as well as the officials.

A Change in Reimbursement In past claim was submitted directly to trainer who would then forward it to parent club who would eventually simply pay the bill Now is treated like any other job related dental injury

Have to be part detective

Chris Taylor

THANK YOU!!!!