Policy Statement 2.2.5 - Prevention and Management of Oral Injuries

Position Summary

Recreational and work environments should be designed to minimise oral and facial injury. There should be public education programs, social marketing and community action to promote awareness of potential oral injuries and protocols such as the use of mouthguards to reduce these risks. Dentists should adopt the International Association of Dental Traumatology1 guidelines for the management of traumatic dental injuries.

1. Background

1.1. Oral damage is often irreversible, frequently complex, difficult and costly to repair.

1.2. Oral injury can occur anywhere. Young children and teenagers have been identified as high-risk groups, particularly when learning to walk and when new and/or high risk activities are involved.

1.3. Certain occupations expose workers to particular oral injuries. Such hazards can arise from:

• Physical impact from work equipment where fracturing of teeth is likely, including labourers, tradespeople and riggers.

• Tooth abrasion where abrasive dust or particles may enter the mouth, including miners,
bricklayers and tilers.

1.4. Different risk levels are associated with participation in particular sports. These can be categorised into four risk levels with oral protective measures appropriate to the risk:

• Sports during which the use of mouthguards is strongly recommended, including off-road bike riding, skateboarding, rock climbing, white-water rafting, trampolining, combat sports, football, basketball, squash and field hockey.

• Sports during which protective equipment for the head is worn, which may thus obviate the need for mouthguards, including full-face helmets in ice hockey and goalkeepers in field hockey cricket, roller-blading and cycling.

• Sports during which oral protective equipment is not normally worn but where mouthguard use could be justified under certain circumstances, including high diving, surf-boarding and skiing.

• Sports where mouthguard use would be impractical or not warranted due to low risk of injury, including swimming, athletics, aerobics and rowing.

1.5. Oral piercing jewellery may also increase the risk and degree of oral injury.

1.6. Preventive dentistry includes the prevention of physical injury, particularly to the teeth and associated structures.

1.7. Children with prominent front teeth may be a higher risk of injury and may benefit from assessment and early treatment by an orthodontist to reduce this risk.

1.8. The most effective protection against oral damage is a custom fitted, upper jaw mouthguard, where precision fit and quality materials offer maximum injury prevention.

1.9. Further information is contained in Australian Standard HB209-2003 “Handbook: Guidelines for the Fabrication, Use and Maintenance of Sports Mouthguards”.

1.10. Significant oral injury may still occur despite preventive activities and promotion.

1.11. The management of damaged teeth depends on many factors including whether the damaged teeth are baby or adult teeth, the time elapsed since the injury and the type and extent of injury suffered.

1.12. Prompt assessment by a dentist and proper diagnosis, treatment planning, treatment and follow up are important to assure a favourable outcome. 

Definition

1.13. COMBAT SPORT includes any sport, martial art or activity in which the primary objective of participants is to strike, kick, hit, grapple with, throw or punch one or more participants.

2. Position

Prevention

2.1. Prevention of oral injury should be a high priority.

2.2. Recreational equipment and environments should be designed to minimise oral injury.

2.3. Appropriate health and safety requirements should be observed at the workplace, such as dust extraction or filtration when generating abrasive particles.

2.4. No sports should have the aim of inflicting physical injury.

2.5. Public education programs should promote awareness of potential oral injuries and the importance of parental supervision and protective equipment.

2.6. There should be social marketing to ensure appropriate protection is normalised and expected in the community.

2.7. All relevant bodies should be encouraged to develop and promote protocols for risk minimisation of oral injury.

2.8. There should be appropriate legislation/regulation on the use of protection, assessment of risks and training of supervisors of activities at risk.

2.9. There should be targeted training in assessment and provision of oral protection in schools, sporting clubs and workplaces.

2.10. Protective equipment such as helmets and mouthguards should be used during training as well as actual competition.

2.11. There should be community action in sports clubs, schools and workplaces to reduce risk and encourage mouthguard use.

2.12. The need to wear a mouthguard should be assessed by a dentist based on risk factors, including an individual’s sporting or occupational activities and dental anatomy.

2.13. Where a serious risk of oral injury exists, sporting bodies should adopt a mandatory mouthguard policy such as that outlined in Appendix 2.

2.14. Over-the-counter self-fitted mouthguards are not recommended (except in limited circumstances as advised by a dentist) as they offer low levels of comfort and protection.

Management

2.15. Persons who have suffered oral injury should be promptly assessed by a dentist and be treated and reviewed as recommended by the dentist.

2.16. Dentists should adopt the International Association of Dental Traumatology (IADT) guidelines for the management of traumatic dental injuries.

2.17. Appendix 1 sets out the 2020 IADT guidelines for the management of avulsed teeth and should be adopted by all relevant bodies.