In last month's article, I spoke of the importance of wearing a mouthguard. The statistics are irrefutable that mouthguards prevent injury to the teeth and the supporting bone as well as the jaw and jaw joint. Unfortunately, even in the face of all of these facts many sports do not require the use of mouthguards. Coaches should be insisting that their players utilize a proper fit protective devise. It is inevitable that sometime during this school season I will have a patient in my office with some type of dental trauma.

Obviously, dental trauma doesn't occur in a setting where immediate dental care is available. So what is it that should be done to help promote the healing of the traumatic injury? There are several important things that should be done to help us dental professionals have a favorable outcome in treating these traumatic injuries.

The most common traumatic injury that I see is the chipped tooth or teeth. The next most common is the tooth that gets dislocated from its usual position. Fortunately, rarely do we see the tooth that is completely knocked out, or avulsed, but it does happen.

For the chipped tooth and the knocked out tooth the most important thing to remember is to keep the fragment moist. The best way to transport a tooth that has been knocked out is in the patient's mouth. Saliva is the best medium there is. If that isn't an option due to the patient having a lot of bleeding, etc. then the next best is to place the tooth in milk. The third option would be water.

The most important things to remember are to not wrap a tissue or gauze around the tooth and to not let it dry out. There are cells on the surface of the tooth that are very fragile. These cells are important to the soft tissue ligament that is between the tooth and the bone and will be vital in the long-term success of saving the tooth. If there is any debris on the tooth, leave it for your dentist to clean off.

The optimal situation is to have an emergency tooth avulsion kit. Most emergency sports kits contain one of these. There is a vial of a special solution to put the tooth in. Time is of the essence for a knocked out tooth. Usually if it can be replanted within 30 minutes then the success rate is good.

The chipped tooth falls into different categories for the dentist but there are two main ones. The first is a chip without exposing the pulp and the second is a chip exposing the pulp. Either way, if the broken piece is kept moist in milk or saliva then studies have shown that it can be rebonded to the tooth with success. Nothing is better that the God-made material. If the pulp is exposed, it may be necessary for the pulp of the tooth to be treated with root canal therapy.

These are the most common traumatic injuries that we see as dentists. There are certainly others which I will talk about in the future. The most important point to remember is to treat the broken piece of tooth or the whole knocked out tooth with care as described.

October is Domestic Violence Awareness Month. This is sponsored by the National Coalition Against Domestic Violence. The American Academy of Cosmetic Dentistry is instrumental in promoting this through its Give Back a Smile program.

I am proud to be a participating dentist in helping victims of domestic violence regain their self esteem by reconstructing their smile. Please be supportive of these programs by visiting www.givebackasmile.org and www.ncadv.org.

Dr. Michael K. Keating, DDS, is a dentist in Auburn and can be reached at 252-7278 or e-mail him at DrMike@FingerLakesSmiles.com