Sports Dentistry

What are the challenges faced in sports dentistry? We talk to two dentists who treat professional athletes to find out

Acute trauma, periodontal diseases, preparing mouth guards, cosmetic treatment… Two dentists for top sports teams share their insights on the specifics of taking care of the mouths of pro athletes.

A study published in the British Medical Journal after the 2012 Olympics Games in London revealed the poor oral health of professional athletes and highlighted the importance for clinical sports teams to be more diligent about oral health care.

Sports teams and athletes in some countries still lack access to special and systematic dental care under the eyes of professionals, but generally speaking, dentists today are increasingly being regarded as essential members of the sports medical team.

We have asked two sports dentists to describe some of the specifics of treating athletes and how they practice as a sports team dentist. 

Official dentist for the NBA’s Brooklyn Nets:

“If dental issues pop up during the season, it creates a real challenge”

Dr. Andrew Sarowitz is a New York-based dentist who is focused on sports dentistry in three different ways: In addition to being in charge of dental health for the NBA’s Brooklyn Nets and for MMA fighters, he has also founded Impact Dental Designs – his own brand of customized high-impact sports mouth guards.

In his capacity as the official dentist for the Brooklyn Nets basketball team, he and his partners are members of the clinical performance team. “We see the players for normal routine patient care as if they were any other patients, but what makes the job a little different is that we have to be present at every home game in order to treat any in-game injuries suffered by either the Nets or the visiting team. The majority of our gameday work is related to dental or orofacial trauma,” Dr. Sarowitz explains.

Besides the treatment of injuries, prevention is another important aspect of oral care for professional sports. “Prevention is the key for professional athletes. We’re dealing with schedules that don’t allow for regular visits or hours. Coaches don’t want any dental issues to come up that could potentially lead to missing a practice or playing time. It changes the criteria for when we can intervene and how we can treat them,” says sports dentist.

“With most sports, we do pre-season screenings so that we can complete any treatment before the season or training camps begin. If dental issues pop up during the season it creates a real challenge.”

“As far as oral hygiene is concerned, we can’t consider a patient as healthy overall unless they are periodontally healthy. Periodontal disease can lead to a weakened immune system, diabetes, heart disease, stroke … it can cause infections to progress faster and can worsen respiratory illness which is especially dangerous in today’s climate.”

“As far as oral hygiene is concerned, we can’t consider a patient as healthy overall unless they are periodontally healthy.”

According to Dr. Sarowitz, one of the most important factors in improving the oral health of athletes is education: “We try to get the team, coaches, and training staff all on the same page to help reinforce good habits.” 

The dentist stresses that a good oral care routine and regular check-ups help to prevent some more serious problems that can influence training and games. “We’ve had minor issues lead to missed time. Large cavities that turn into root canals for example,” he says. 

Based on his practice, the real challenge for dentists and players alike is sports related trauma: “If a player is injured, it’s all about getting them stable and back into the game if possible. With the Nets, the majority of the injuries we see are lip, cheek or tongue lacerations that require sutures. TMJ (temporomandibular joint) trauma happens on occasion. Typically, with any injury from the neck up, we’re getting called and doing a full evaluation.”

A sports dentistry background, including extensive experience with NBA dental injuries as well as those of MMA fighters, inspired Dr. Sarowitz to create his own brand of customized mouth guards.

According to Dr. Sarowitz, mouthguards always depend on the specific sport and level of protection needed. “The guards we make for the Nets are very different from what we would make for the UFC (Ultimate Fighting Championship). Combat sports is a whole different animal.”

“In basketball, we’re mostly concerned with tooth-to-tooth contact, so we can keep things fairly minimal. In combat sports, where fighters are actually taking strikes to the head, there are a lot of other factors to consider. In addition to preventing tooth-to-tooth contact, we need guards to extend much higher to cover tooth roots and help prevent soft tissue injury, as well as alveolar fractures.”

“We also need to increase the separation between the teeth so that we can get some separation of the mandibular condyle from the temporal fossa in the skull. This added space can help dissipate forces and potentially reduce brain trauma. So, believe it or not, protecting your teeth is just one small part of what goes into the design,” the mouthguard brand founder says.

Dr. Sarowitz says that a mouthguard is not for professional athletes only. “I’d recommended some level of protection for any athlete in any sport. Via Impact Dental Designs, athletes can customize their own guards for any sport they choose. It’s a fun process taking a name, team, logo or anything they can think of and bringing it to life on a mouthguard.”

Want to know more about the work of Dr. Andrew Sarowitz? Follow him on Instagram.

Dentist for professional rugby, football & cricket players:

“Untreated dental decay or periodontal disease should not be the reason for an athlete to miss a game or training session, but unfortunately it is quite common”

Dr. Umair Mohammed graduated from Dundee Dental School in Scotland in 2010. Sports have always been a big part of his life; at a young age he played cricket at an elite level, but later on his studies took priority. He tells us how he came to be involved in sports dentistry and talks about some of the challenges that come with providing oral care for athletes. 

“Dentistry became my career, but I wanted to amalgamate it with my passion – sport. I found a post-graduate certification course at UCL’s Eastman Dental Institute in London, so I travelled there each month for a year to hone my skills and knowledge of sports dentistry.”

After the post-graduate course, Dr. Mohammed commenced UCL’s three-year Masters degree programme in sports dentistry. “Currently, I am in the first year of this course, and hopefully by the end of it, I will be one of a few to have earned a masters degree in sports dentistry. This could open up more opportunities for treating athletes on a national and international stage, and also in major sporting events such as Olympic games, football and cricket world cups and other top events,” he continues.

He has been practicing sports dentistry for about seven years now, treating both amateur and professional athletes. “I am currently affiliated with Edinburgh Rugby, Scotland Rugby, Cricket Scotland and Heart of Midlothian Football Club. Players from other clubs or sports like cycling, hockey, mixed martial arts and others can also contact me directly and I’ll arrange to see them accordingly.”

He appreciates having the opportunity to be involved with professional rugby teams in Scotland. “Our principal, Fiona Davidson, has an official contract with Scotland Rugby, and we as a team of dentists provide the players with custom made mouth guards and also carry out general dentistry for them,” he explains.

“Sports dentistry has evolved to encompass the role that dentists can play within a medical team, as well as their ability to support medical colleagues at major sporting events.” 

Dr. Mohammed believes the role of the sports dentist has become more visible in recent years. “Basically, sports dentistry is the treatment and prevention of oral and facial athletic injuries and related oral diseases and manifestations. But it has evolved to encompass the role that dentists can play within a medical team, as well as their ability to support medical colleagues at major sporting events.” 

As a general practitioner in two private practices in Edinburgh, Dr. Mohammed treats regular patients and also professional athletes. “This can range from routine dental care to cosmetic treatment to treatment of acute trauma. I have done a number of post graduate courses to ensure my skill levels remain high and that I am able to provide evidence-based dentistry,” he explains.

Although the treatments for both groups of patients are similar, sometimes working with the athletes might be a bit more challenging. “Professional athletes tend to have every single part of their day planned out for them. They are always on the move, so getting into a routine can be difficult. With regular patients, more often than not, it’s easier to help them get into a routine with regards to their oral health and work/life commitments. With professional athletes, we need to try and accommodate their schedules.”

But not everything is about particular treatments. Dr. Mohammed says that education also plays a role: “It’s extremely important to educate the athletes around good oral health regimes and the effect that nutrition and diet can have on their oral health. We need to remind them how important it is to be meticulous about their oral health routines and provide them with information on how nutrition can impact oral health. We can only advise what is best for them, but after that it’s up to the athlete and their team. Of course, athletes are at higher risk of trauma, especially those who play contact sports, so that’s why the provision of custom made mouthguards is so essential.”

As with every patient, prevention in the form of proper oral care and regular dental check-ups should be essential for athletes, and the consequences for neglecting it can be even more serious. Dr. Mohammed recalls some of the cases that he has experienced in his practice: “I have had players come to see me as emergencies a day before a game or the morning of a game due to severe toothache or trauma. Untreated dental decay or periodontal disease should not be the reason for an athlete to miss a game or training session, but unfortunately it is quite common.”

“We never force athletes to see the dentist, but we encourage them to have dental assessments/screenings, ideally in the off season, so any underlying dental caries or periodontal disease can be seen and treated quickly and efficiently, and to minimize the risk of anything developing during competition time.”

“There are a number of high profile cases where elite athletes have had to pull out of major championships or races due to acute dental flare-ups…”

“Conditions such as irreversible pulpitis due to dental decay, pericoronitis around partially erupted wisdom teeth or acute apical abscess are the most common complaints we come across as emergencies. These require urgent treatment to relieve the patient of pain and allow them to rest, recover and perform to the best of their ability.”

“There are a number of high profile cases where elite athletes have had to pull out of major championships or races due to acute dental flare-ups – such as Sir Mo Farah, Mark Cavendish and Sir Andy Murray to name a few. If we can reduce this risk with regular examination, then we can identify and eliminate these potential cases.”

We asked the expert if he has any special oral care recommendations for his sports clients. In addition to general tips like brushing twice a day and interdental cleaning, he also suggests they limit acidic/sugary snacks to less than four times a day, and to have them around meal times. 

“All my recommendations are similar to what you would advise your regular patients, but for athletes who will be training and competing on a daily basis, the frequency of acidic/sugary snacks is the biggest factor in reducing dental or periodontal disease.

“Factors such as salivary pH levels, saliva buffer rate, saliva flow, individual or systemic susceptibility etc. do play a role in fighting oral disease. However, physical removal of the plaque biofilm with exceptional oral hygiene and reducing the amount of fermentable carbohydrates from the diet will ultimately stand the athlete in good stead with regards to maintaining good oral health and reducing the need for dental treatment,” the sports dentist emphasizes.

Are you interested in sports dentistry? Follow @scottishsportsdentist on Instagram to learn more about the treatment of pro athletes.

Photo credits: archive of Andrew Sarowitz, archive of Umair Mohammed, @gritmouthguards