Jan 6, 2017
Tooth Truth

By Dr. Nestor Cohenca

Traumatic dental injuries (TDI) occur daily among youth in sports. Yet, when protocols for treating TDI are not followed, healthy front teeth are lost, and the young patient’s quality of life is compromised. Beyond the patient’s health, first responders such as athletic trainers or coaches could be found legally liable if proper protocols are not followed, as insurance companies and/or parents may sue for damages.

Any collision between the face and almost any object can result in a TDI. For example, a student-athlete is injured during a high school basketball game, resulting in the loss of a tooth. The athletic trainer takes the injured player to the ER, along with the tooth, which was placed in a cup or wrapped in a tissue and given to the emergency personnel. While many assume this would be the correct procedure, it is not. Since proper protocol was not followed, the patient will ultimately lose this tooth. Treatment, if even possible, will often be complex, time-consuming, and expensive, requiring multidisciplinary approaches.

Dental trauma guidelines serve as both a treatment roadmap, as well as a legal document by attorneys and insurance companies regarding the proper course of action in the case of trauma. These guidelines are widely published with open access to all. While guidelines are a recommendation, if someone treats a case and does not follow recommended protocols, that person can be liable and at risk for a lawsuit for not following published trauma guidelines and subsequently causing the loss of teeth.

For example, consider an athletic trainer treating an athlete who has suffered a TDI. Legal teams and insurance companies will request all the documentation on the case to evaluate the immediate response and treatment provided at the place of injury, at the ER, and at the dental practice.

The outcome of [traumatic dental injuries] often depends exclusively on the immediate care provided at the site of injury. The first 10 minutes are critical!

At a minimum, to improve outcomes for TDI patients, the following are some useful guidelines in preparing an injured student or young athlete to ensure the best chance to save the tooth:

• Be aware that dental trauma does happen often during games, as well as at school, particularly during P.E. classes and recess.

• The odds of being injured during basketball are seven times more than any other sport.

• It is crucial to act fast, as traumatized teeth and knocked-out teeth require immediate treatment.

• Treatment provided in the first 20 minutes will determine the faith of the tooth and child’s smile.

• In the event of a knocked-out tooth, replace the tooth immediately, or place it in milk. Avoid leaving the tooth in a dry condition.

Get Informed: What Coaches, Athletic Trainers, or Teachers Can Do

The first step toward improving treatment is awareness. Do research and seek out information. There are courses and webinars available as a source of information for athletic trainers, coaches, teachers, and others who may be considered first responders. Visit the websites and social media channels of the International Association for Dental Traumatology, the American Association of Endodontics, and the American Association of Pediatric Dentistry for information and updates on courses and webinars.

The outcome of TDI often depends exclusively on the immediate care provided at the site of injury. The first 10 minutes are critical! Therefore, it’s important to take initiative and learn about how to prevent and treat TDI, as there are plenty of resources available. For more information, visit: www.iadt-dentaltrauma.org.

Following an injury, it is essential to promptly evaluate the injury and take action. Poor treatment protocols can have very unsatisfactory outcomes for both patients and practitioners. With proper knowledge, careful examination, and treatment at the site of injury, TDIs can be properly treated to preserve children’s smiles. Moreover, with proper education, most injuries can be prevented.

To view the NATA’s new position statement on managing dental and oral injuries, visit: http://bit.ly/2gZJ5Ob

Nestor Cohenca, DDS, FIADT, is an endodontist and leading expert in dental trauma and pediatric endodontics. He is in private practice at Lakeside Endodontics in Everett, Wash. He is also an Affiliate Professor with the Department of Pediatric Dentistry at the University of Washington’s School of Dentistry and with Seattle Children’s Hospital. Dr. Cohenca is the upcoming president of the International Association of Dental Traumatology and provides online coursework for dental and non-dental professionals seeking continuing education hours. Visit http://oralsurgeryservices.com/online/dental-trauma/ for more details about these offerings.

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