Sonny Fulks
Sonny Fulks
Managing Editor

Sonny Fulks is a graduate of Ohio State University where he pitched four varsity seasons for the Buckeyes from 1971 through 1974. He furthered his baseball experience as a minor league umpire for seven seasons, working for the Florida State League (A), the Southern League (AA), and the American Association (AAA). He has written for numerous websites, and for the past fourteen years has served as columnist and photo editor for The Gettysburg Magazine, published by the University of Nebraska Press, in Lincoln Nebraska. His interests include history, support for amateur baseball, the outdoors, and he has dual arts degrees from Ohio State University.

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You don’t see it often, but when the unthinkable happens in sports it’s what you need to know on what to do, and when to do it, for injuries to your mouth.  Our expert tells you here.

It happened in the bottom of the sixth inning in a recent tournament baseball game played in southern Ohio.

A routine ground ball was hit to the left side of the infield, the third baseman and shortstop converging on the ball.  The third baseman, like so many hundreds of times before got good position on the ball to make the play…and then it became not-so-routine.  The baseball took an erratic hop, suddenly, violently, at 70 miles per hour, and struck him flush in the mouth.  It happened so quickly that no one actually saw it happened…they only saw his teammate pick up the ball and throw the runner out at first base.  But the minute the play was over everybody, even the batter who hit the ball, was forced to look the other way.

There was blood…lots of it.  A split lip bleeds profusely, and as coaches and teammates gathered to assess the damage, they discovered some missing front teeth, as well.  Bravely, he stayed in the game and even recorded a hit in his next at bat.  His team won, but afterwards, joy mixed with concern over what to do, and when to do it, when you suffer a major injury to your mouth.

In 26 years of practice Dr. Mark Armstrong, of Troy, has seen it all…just about every conceivable thing that can happen to your mouth and with your teeth.  He smiled as I detailed the story last week, then winced over the reality of time lost at the end of the game in seeking care for the broken teeth.

When we met with him at his office in Troy, Armstrong, an athlete himself, and supporter of the Press Pros site, sought to address the issues of oral safety and vital treatment procedure when bad hops happen.

“I didn’t see it, of course,” he began.  “But with any injury of the mouth timing is everything.  That is, getting treatment as soon as you possibly can.  Ideally, within an hour of the injury is a must.  Within 30 minutes is even better because you want to address it before important tissues begin to die or infection can set in.  It’s definitely not something you want to put off until the following day.”

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But more, Armstrong and dentistry colleagues everywhere stress the on-going campaign for oral safety, the wearing of a correct mouth guard as a convenient, preventative measure for good dental health.

“Well, it’s important that you take care of your teeth, primarily because of your overall health,”  says Armstrong.  “Obviously, your nutritional intake is processed through the mouth and if you have your natural set of teeth, statistically, you’re going to live longer than someone that does not have their natural teeth.  Why?  Because you can eat more of the proper food you’re supposed to and digest it better.”

But for the sake of sports, and sports medicine, exactly why is it so important to have a plan in mind when the unthinkable occurs?  It happens in basketball with flying elbows.  It happens in ice hockey with flying pucks.  And, it can happen in soccer, softball, and baseball…any sport where your face is exposed.

“Again, when there’s a traumatic injury time is of the essence,”  adds Armstrong, himself a triathlon participant.  “When a tooth has been fully knocked out of the mouth you have about an hour to get that tooth back into place and have any decent chance of success.  If you get in within 30 minutes your chances of retaining that tooth are about 90%.  If you get down to an hour it’s only about 50-50.  And it goes down very dramatically after that.

“There’s actually a difference in having a tooth knocked out, and a tooth broken off.  A tooth that’s knocked out, the whole tooth with the root, is different than having a tooth break off at the gum line.  A broken-off tooth cannot be re-implanted.  But if the tooth is knocked out intact the body can actually graft it back in if you get to it quickly enough.  I didn’t see the incident you describe, of course, but in any event wearing a mouth guard of some kind certainly does help.  And yet, I can’t remember ever seeing a baseball player wear one.”

Armstrong_inset0622There are other risks, aside from broken teeth, that Armstrong waxes eloquently about, particularly that of injuries to the jaw and the TMJ joint (temporomandibular joint), which can cause pain, improper bite, and even hearing disruption over time.

“Getting hit on the chin can cause a number of different issues,”  says Armstrong.  “You’re talking about a disruption of the TMJ joint.  You can either break the mandible itself, or go back into the actual ball-and-cup joint.  The ligaments and tendons can be bruised or stressed.  The disc can be damaged.  That can lead to difficulty with speaking, with chewing, and a host of other problems.”

Mouth guards may not help with issues of the temporomandibular joint, but recent research has shed light that a properly fitted device can minimize the occasion of concussion that comes from other blows to the head, the most hotly debated topic with all contact sports.

“Research that I’ve seen is very dependent on the type of mouth guard you buy and use,”  he adds.  “It’s important to have one that provides good stabilization to not only the teeth, but the jaw.  It’s a difficult thing to quantify, because these devices are not the typical boil-and-bite mouthpieces.  We’re talking about something that actually interlocks the top and bottom jaw together to help prevent having the lower jaw driven back into the joint.”

Statistics say that fewer than 25% of people questioned are aware of the importance of dental safety with competitive sports…that less than 5% ever consider the fact of having a tooth, or teeth, actually knocked out of one’s mouth.  It’s bad news if and when it happens, and shocking, given that it happens with such infrequency.

But if it does, Armstrong reminds that the good news is directly associated with getting good professional help, and making it a priority over finishing the game before seeking assistance.

“The good news is the quicker you get to it the lesser the chance of infection, and the greater the chance for success with any treatment option,”  he says, confidently.  “Because after the trauma tissues in the mouth tend to break down, so you lose the support of the gum and the bone around the tooth, and that complicates restoring that tooth, or even replacing it with something else.

“But time is of the essence.”

(Edited By Julie McMaken Wright)

“Getting hit on the chin can cause a number of different issues, particularly that of injuries to the jaw and the TMJ joint (temporomandibular joint)”  -  Armstrong.

Getting hit on the chin can cause a number of different issues, particularly that of injuries to the jaw and the TMJ joint (temporomandibular joint).  (Photo by Julie McMaken Wright)

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