Annually the month of April is National Facial Protection Month. Several well-known medical organizations have joined together to sponsor this month- long effort to raise awareness regarding facial injuries, and preventive measures. These organizations include the American Association of Oral and Maxillofacial Surgeons (AAOMS), the American Academy of Pediatric Dentistry (AAPD), the American Association of Orthodontists (AAO), and the Academy of Sports Dentistry (ASD). The choice of April is a particularly well-timed occasion. As spring begins, outdoor activities become more prevalent; baseball, softball, lacrosse, cycling, and multiple other activities kick into high gear. With this increased activity comes increasing numbers of sports and outdoor related injuries resulting in more doctor and Emergency Room visits. Chief among these are injuries to the head and face. Approximately 40% of sports related injuries involve the head and face, with some sport-specific variations, and variation in injury severity and distribution within the anatomic sites of the head and face.
As in all aspects of medicine, prevention is the best treatment strategy. Before I address specific forms of prevention and safety, it is worthwhile to outline the vast array of possible head and facial injuries of greatest concern. The most severe forms of injury are intracranial injuries such as concussions and other forms of central nervous system trauma. Injuries to the face itself may then be broken down to the multiple anatomic areas of the face including the forehead, nose, eyes and orbits, cheekbones, upper and lower jaws, teeth, and the soft tissues of the face and mouth.
In 1962, high school and collegiate football organizations adopted safety regulations to help protect their athletes. Paramount in these regulations was the requirement that all participants wear helmets with face protection and mouth guards during practice sessions and live competition. Several studies have confirmed that since the inception of these regulations the percentage of oral and craniofacial injuries in football has decreased from nearly 50% of athletes that sustained a facial injury to now less than 1%. It is estimated that an athlete in any sport has a 10% chance of sustaining an orofacial injury each season of play, and a 33-56% chance of sustaining an orofacial injury during their playing career. Dental injuries are the most common form of orofacial injury. According to the Journal of the American Dental Association (JADA), 13-39% of all dental injuries are sports-related, with males being traumatized twice as often as females. The central incisor is the most commonly injured tooth.
Protective devices and equipment include sport specific helmets, eye protection, and mouthguards. Mouthguards have been shown to be an effective method in helping to prevent not only dental injuries, but more severe injuries including concussions, and facial fractures of the mandible, maxilla, zygoma, and injury to the tempromandibular joint.
When considering mouthguards, an ideal mouthguard protects the teeth, soft tissue, bones and joints; diminishes the incidence of concussions; is made of a material that serves as a high power absorption appliance; is well-fit and remains in place securely, allowing breathing and speaking without obstruction. There are three basic types of mouthguards. The “Stock” mouthguard is an appliance that is just that; stock. It is available in limited general sizes, and does not allow for personal fitting. It is consensus opinion of multiple medical and athletic organizations that the stock mouthguard is not acceptable as an orofacial protective device. The second type is the “Formed” or “Molded” mouthguard. This is the most popular mouthguard, used by more than 90% of participating athletes. It is made of a thermoplastic material that is heated and then fitted to the athletes’ mouth, providing secure fit and appropriate protective features. The formed mouthguard is also popular because it is low cost and very effective as a protective device. The third type is the “Custom” mouthguard. This type is made by dental professionals and is superior to all other types in its comfort, fit and retention, though it is more costly.
As I mentioned, the first line of treatment is always taking steps toward prevention. However, proper prevention techniques do not always ensure injury-free activities. Additionally, it is important to know the proper steps to take if you, your child, or a colleague suffers a facial injury. Proper evaluation by medical personnel is paramount in receiving definitive treatment. Any head or facial injury should be evaluated in a timely manner by a medical or dental professional. Appropriate medical personnel would include emergency medicine physicians, one’s primary care physician, a general or pediatric dentist or an oral surgeon who is uniquely trained to manage facial and dental trauma. So, April has come and gone along with National Facial Protection Month, but hopefully the recommendations and awareness it raises will last. Stay active, stay safe.