What can a Winter Olympic gold medal winner teaches us about the frontlines of orofacial trauma?

Imagine the roar of the crowd at the Milano Cortina 2026 Winter Olympics. The atmosphere, electric. After years of training, sacrifice and relentless pursuit of sporting excellence, Jack Hughes stands on the podium with an Olympic gold medal around his neck. It is the moment every athlete dreams of, the culmination of countless hours of work distilled into a single image that will be seen around the world.

As the cameras gather, Hughes lifts the medal and leans forward for the traditional “victory bite”. The shutters fire, capturing what should be the defining photograph of his Olympic triumph. Yet, alongside the glint of gold, the images reveal something else: the jagged, unmistakable outline of a fractured maxillary central incisor (1).

To the millions watching at home, those fractured teeth might simply add to the image of an athlete who has been in battle, a visible reminder of the physicality, collisions and sacrifice that can accompany elite contact sport. Within sporting culture, injuries can become part of an athlete’s story, even worn as evidence of resilience.

To the dental professional, however, the same photograph tells a very different story.

Behind that fleeting podium moment lies a traumatic dental injury (TDI) sustained in a fraction of a second, but with consequences that may follow an athlete long after the final whistle, the medal ceremony and even their sporting career have ended (2).

What appears to be a simple fracture can mark the beginning of years, and potentially a lifetime, of dental monitoring, restoration, repair and retreatment.

For younger athletes, the implications can be even more significant. Traumatic dental injuries may involve immature teeth while dentofacial development is still

ongoing, meaning treatment decisions must account not only for the injury in front of the clinician, but also for continued pubertal facial growth and the athlete’s future restorative needs.

The photograph, therefore, captures two stories at once: the immediate triumph of sporting success and the potentially lifelong legacy of dental trauma.

The architect of prevention: Primary strategies

As clinicians, our role begins long before the first whistle. Primary prevention is the cornerstone of sports dentistry, involving the education of athletes, parents, and coaches regarding the inherent risks of TDI (3). The International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD) emphasise that regular dental examinations are the ideal opportunity to identify risks and provide customized mouthguards (3).

While stock or "boil and bite" guards are common, they lack the tailored fit required for optimal protection. Beyond mechanical barriers, screening for oral health is increasingly recognized as a vital component of athlete welfare and performance science (4, 5). A proactive sports dentist identifies potential vulnerabilities, such as increased overjet or previous untreated trauma, that significantly elevate the risk of future injuries (3).

Pitch-side action: The critical "golden hour"

When trauma does occur on the field, the immediate response often dictates the long-term prognosis. The primary goal of current clinical guidelines is to outline a structured approach for urgent care (6);

1. Baseline Assessment - Professionals should conduct a careful history and

clinical examination, documenting the injury through photographs (7, 8)

These act as a permanent record for monitoring healing or tooth discoloration and provide essential medico-legal documentation (8, 9)

1. Immediate Management - For fractures and luxations, clinicians must assess

mobility and sensibility (2). While sensibility tests (such as cold/electric pulp

tests) can be unreliable, in the acute phase due to transient neural damage,

establishing a baseline is critical for future comparisons (10).

1. The Digital Toolkit – Handy smart phone apps, such as the ToothSOS app,

provide immediate, evidence-based guidance for pitch side management,

ensuring that even under high-pressure "field of play" conditions, the IADT

protocols are followed (3, 11).

Secondary prevention and long-term follow-up

Secondary prevention is almost entirely dependent on the dental team’s adherence to the latest management guidelines (3). Follow-ups are mandatory (9). The main post-traumatic complications include pulp necrosis, infection, and various types of root resorption (9).

In cases of immature permanent teeth, every effort must be made to preserve the pulp to allow for continued root development and apex formation (12). If pulp necrosis is detected, emerging therapies like pulp space revascularization aim to create conditions for tissue in-growth, a significant shift in how we manage the "dead" tooth in a young athlete (12, 13).

Integrating into the sports medicine team

There is a need for Sports Dentists to be fully integrated into the Sports and Exercise Medicine (SEM) team. Traditionally, dental health has not been considered as a main area of concern with respect to athlete health. However, we are now entering a new era where oral health is recognized for its influence on sports performance and athlete welfare (4, 14).

A sports dentist does not just fix teeth; they are part of a multidisciplinary team including physiotherapists, team doctors, and performance scientists. By integrating dental screening and trauma protocols into the team's standard operations, we ensure that athletes like Hughes receive comprehensive care that protects both their performance and their long-term quality of life (14, 15).

A call to action in Sydney

To bridge the gap between clinical excellence and pitch side reality, we invite you to the launch of the ANZ Sports Dentistry Association Conference. This landmark event will be held in Sydney on Saturday, 17th October.

Sign up here.

This conference is designed to empower dental professionals with the skills to lead trauma management and integrate seamlessly into elite sports medicine teams.

Delegates will not only gain insights into the world of Sports Dentistry but will also have the unique opportunity to network with some of the Australia and New Zealand’s leadings Sports Medics and attend the exclusive Hospitality at the Bledisloe Cup (Australia vs NZ rugby union) at the Accor Stadium.

References

1. International Association of Dental Traumatology (IADT). (2024). Guidelines for

the Management of Traumatic Dental Injuries.

1. Bourguignon, C., et al. (2020). International Association of Dental Traumatology

guidelines for the management of traumatic dental injuries: 1. Fractures and

luxations. Dental Traumatology.

1. Academy for Sports Dentistry (ASD). (2024). Position Statement on the Efficacy of

Customized Mouthguards in Contact Sports.

1. Needleman, I., et al. (2018). Oral health and elite sport performance. British Journal

of Sports Medicine.

1. Ashley, P., et al. (2015). Oral health of elite athletes and association with

performance: a systematic review. British Journal of Sports Medicine.

1. Levin, L., et al. (2020). International Association of Dental Traumatology guidelines

for the management of traumatic dental injuries: General introduction. Dental

Traumatology.

1. Al-Sane, M., et al. (2011). Management of dental injuries in the pitch-side setting.

Dental Traumatology.

1. Piccinino, M. V., et al. (2023). Management strategies for sport-related traumatic

dental injuries: a systematic review based on case reports. PMC/Sports Health.

1. Andersson, L. (2013). Epidemiology of traumatic dental injuries. Journal of Oral

Rehabilitation.

1. Cohenca, N., & Berman, L. H. (2017). Pulp sensibility testing: what is the evidence?

Dental Traumatology.

1. ToothSOS Mobile App. (2024). Clinical Decision Support Tool. International

Association of Dental Traumatology.

1. Galler, K. M., et al. (2016). European Society of Endodontology position statement:

Revitalization procedures. International Endodontic Journal.

1. Kim, S. G., et al. (2018). Pulp revascularization/revitalization: A review. Dental

Traumatology.

1. Fouad, A. F., et al. (2020). International Association of Dental Traumatology

guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent

teeth. Dental Traumatology.

1. Day, P. F., et al. (2020). International Association of Dental Traumatology guidelines

for the management of traumatic dental injuries: 3. Injuries in the primary dentition.

Dental Traumatology.