Diagnosis & Treatment Planning

NOW, an athlete has just knocked your door

First appointment as a regular patient will be for a thorough dental examination that includes identification of his chief complain, taking of each athlete’s medical and dental history, a detailed oral and dental examination and appropriate radiographs (X-rays), study casts or laboratory investigations. The oral and dental examination like medical examinations, provide the information necessary for diagnosis and to develop a proper plan for treatment. Medical history is checked to see if there might be a connection between what is happening in athlete’s mouth and general health and his/her performance.

In fact, the subject of diagnosis is too broad and multi-factorial and could not be discussed comprehensively in this limited space. So, I preferred to publish my view as short stories of athletes presented to me through out over 30 years of experience on Sports Dentistry in both governmental and private sectors. However, only some thoughts will be mentioned and it is deeply advised to refer to the specialized textbooks.


The athlete may show-up ­clinically with one or more of the following situations:

  • Old or recent trauma:

Unfortunately, Inherent risk accompanies participation in sports. Contact sports present an increase in the probability that a serious injury could occur. So, it is not uncommon that athletes knocked your door seeking for your management of sports-related dental trauma.

Soft and hard tissue injuries of soccer athlete.


  • The bad suturing of the soft tissues (not respecting the layering of mucosa and submucosa).
  • The enamel fracture of tooth # 9 and slight lateral luxation of tooth# 10
Soccer goal keeper lost his upper central incisors during playing few years ago. As a result of leaving him untreated, closure of the available space to restore two teeth.


Fracture at crowns of teeth # 8 & # 23 of handball goal keeper.

A broxus player with incisal edge affection at tooth # 8

A non-profisional basketball athlete with sports-related crowen fracture in tooth # 9 and sever periodontal inflammation at lower anterior teeth is also noticed.

Avulsion of tooth # 8 at a young boxer,


Un-treated labial migration of tooth# 8. A case with late referrals of multiple intrusions. A case with lateral luxation of # 21 which was late referral.


  • Periodontal examination (gums and underlying bone structure): 

Some athletes are affected by sever periodontal diseases as loose teeth or bleeding gums on slightest touch and during heavy exercises. Accordingly, in some sports, they may discontinue playing and lose the game by referee’s decision due to unstopped oral bleeding. Added to that, there are some recent researches that correlate between bad periodontal health and decreased athletic performance.

A field hockey athlete who had been traumatized on his mouth. He had disharmony of his front upper and lower teeth with bad oral hygiene, sever periodontal (gum) disease and loose tooth # 7.


A soccer referee with sever periodontal disease

A soccer athlete practicing sports only for leisure had lost moderately loose lower anterior tooth # 25 due to athletic trauma.



  • Mucous membrane examination (lips, cheeks, roof of the mouth and under the tongue).

Dipping and chewing tobacco, which is popular with many athletes, may affect the area of tobacco usage that may vary from only slight irritation to premalignant lesions as leukoplakia or even malignant lesions as carcinomas. Khat, which is popular in some areas in Middle East and Africa, is another example of dipping and chewing some plants. So, oral cancer screening examination would be of great importance.

On the other hand, it is not uncommon to find bad habits as lip or cheek biting among some stressed athletes.

A case of a long distant runner. He had presented himself complaining of broken tooth # 9!!? Surprisingly, he was unaware neither from the rampant caries nor the crust at lower lip as result of habitual lip biting to hide bad esthetic. His condition was aggravated due to dryness as a long distance runner.


  • Occlusion or bite is checked:

The mode of occlusion could affect the decision of the dentist concerning many issues as susceptibility for trauma, the design of the mouthguard as fabricating bi-maxillary mouthguard and the need for orthodontic treatment.

Additionally, it would be most beneficial to bear in mind the recent multiple publications that correlate between malocclusion and gait, which of course is of great importance for athletes as they may run back and forth, by side in addition to unusual forms of movements during training and competitions.

An athlete who has severely protruded upper anterior teeth with conducted orthodontic treatment. He is highly susceptible for trauma, and custom-made mouthguard should be constructed.



This soccer referee with malocclusion had had some difficulties to pass the balance test from the first shot. However, too much work should be done to substantiate between gait and malocclusion in sports.


  • Missing teeth are noted.

Impacted canines or wisdom teeth may tend to make some athlete more prone to recurrent spontaneous and sometimes unexplained pain referred to other remote area as athlete’s ear or neck.



A Paralympic athlete

CBCT on tooth # 1

(Impacted UR wisdom)

Panoramic view CBCT on tooth # 32

(Impacted LR wisdom)


Restoration of missing teeth is performed for functional, esthetic and psychological reasons. However, it may be more critical in athletes more than in normal patients as it may affect greatly athletic performance and psychology. Additionally, it is of great importance to study more local (intra-oral) and general (extra-oral) factors as:

  • Type of sport and Level of competition.
  • Gender, age of athlete and time of final retirement from competitive contexts.
  • Site, length of missing teeth span and quality of bone.
  • Player’s education and attitude towards wearing of other devices as athletic mouthguards or night guards.
  • ……………..etc.


  • The teeth are checked for decay, erosion or fluorosis.

Rampant caries, multiple decayed teeth and / or erosions in athletes may result from excessive use of acidic, or sweetened sport drinks or other athletic nutritional disorders. Additionally, excessive intake of fluoride in water or in sports drinks may cause fluorosis.


  • Teeth fractures and discolorations.

These, in most of the cases, were associated with old dental trauma.


An athlete suffering from discolored upper central incisor (# 8) caused by a previous trauma while ignoring to wear his mouthguard.

Another athlete suffering from discoloration of the same tooth caused by a previous trauma while ignoring to wear his mouthguard.


  • Broken or deteriorating fillings are noted.

An athlete suffering from decayed upper central incisors was caused by a previous trauma nutritional disorder.


  • All dental appliances are checked:


(Mouthguards, scuba diving mouthpieces, night guards, orthodontic appliances, crowns, bridges, partial dentures or full dentures).

Removable appliances were found to be used by a soccer referee 24 hours/day!!He was advised to revert to better types and not to wear them neither during sleep nor during any sports activities. A defective fixed bridge, that were found in a soccer referee, who had reported that he had lost 2 incisors during a soccer game. He was advised to remake it and to wear custom made athletic mouthguard during any future competitive sports activities.


Stock Mouthguard

Boil and Bite Mouthguard

Shell- liner mouthguard

All these mouthguards are not recommended and athletes are advised to revert to custom made mouthguards fabricated by a dentist.


  • Tempromandibular joint (TMJ) and chewing muscles are checked:

They are always affected due to recurrent trauma and/or repetitive athletes’ different stresses leading to bruxism habit.


Another broxus player with more involvement of incisal edges’ roughness of anterior teeth and starting of occlusal facets formation on occluding surface of posterior teeth.




TMJ views of two non-professional athletes

Right and Left

Open and Close


After completing the examination, the dentist will discuss with the athlete the results of the examination and status of his/her oral health. The dentist will outline specific treatment depending on the results of the examination, and will try to answer his/her specific questions and concerns. Then, a detailed report is sent to the athlete’s federation for financial approval.

Sports Dentistry vision and regular Check-Ups:

Ideally, regular dental checkups every six months are the best way to make sure that gums and teeth stay healthy, allows dentist to diagnose any problems, and to take preventive action to stop problems before they develop. The dentist may suggest that the visit more or less often depends on how well the athlete cares for his/her teeth and gums, problems he/she has that need to be checked or treated, how fast tartar builds up on teeth, his/her training and competitions schedule, athletic injuries, and so on. The goal is to catch small problems early.

However, sometimes this protocol of checkups is hardly achieved. Then, the athlete will be recalled automatically with his team before any upcoming important international championship.

Sports dentists are trained to look for anything unusual in athlete’s mouth, throat and neck, including the oral manifestations of diseases, oral cancer, infections, early signs of gum disease, eroded fillings and dental decay.

They understand the treatment alternatives available to each athlete, doping rules, and can help him/her make informed decisions about dental care while still participating in both training and competitions.

There are a number of oral health conditions that only the dentist can see. Various medical conditions can also be detected during the dental checkup, often in their early stages. The sports dentist has been trained to identify the oral manifestations of these conditions, and can refer the athlete to other health professionals for treatment. Anorexia athletica, Anorexia nervosa and bulimia are just examples.