Story originally published in Issue 6 of the WSDA News.

Dr. Ron Hsu first got interested in dental trauma as a resident at the University of North Carolina, Chapel Hill, where he worked on a number of cases involving young athletes. His interest never waned, and he ultimately became a member of the International Association of Dental Traumatology (IADT), a group dedicated to educating practitioners and interested parties in education, sports, industry, and appropriate governmental agencies about optimal prevention, research, and treatment service in the field of traumatic dental injuries. 

Hsu knows that tooth avulsions are a rarity. As the on-call pediatric dentist for Legacy Salmon Creek Pediatric Emergency Department in Clark County, Wash., he sees a handful of trauma cases and about one avulsion a year. However, he is concerned with educating school nurses, coaches, and referees about the different types of dental trauma that can happen in sports, on school playgrounds, and in scuffles during school. But so many misconceptions abound — that transporting an avulsed tooth in water or on ice is a good thing, for instance — that Hsu reached out to Clark County school administrators and pitched a plan to educate area nurses about the different types of tooth injuries, how to treat them, and how to increase the likelihood that an avulsed tooth can be saved. To date, Hsu has provided educational programming for 56 nurses serving 71,000 children in grades K though 12. He would love to reach out to coaches and referees, too, but for now, his mission to meet with as many nurses in his county as possible. 

For Hsu, the first line of defense is the Save-A-Tooth kit, a small sealed container full of Hanks Balanced Salt Solution, a tissue storage and transport media that can keep the root cells of up to four teeth alive beyond the typical 15 minutes. Properly used, it expands the window of opportunity for successful replantation of the tooth by up to 24 hours. Armed with a grant from Clark County Dental Society (CCDS) and a substantial discount from Henry Schein, Hsu has given a kit to every nurse and has supplied two kits to Cascade Little League for each of seven baseball field first aid kits. Because there are many other Little League athletic programs in the county, he would like to widen his distribution circle to include more sports. “Luckily,” Hsu says, “we don’t see as many injuries in football and basketball because those children routinely wear mouth guards and helmets. However, in sports like lacrosse and soccer, where kids don’t wear mouth guards, it’s more common to see injuries. A lot of softball and baseball pitchers are beginning to wear helmets to safeguard against accidents.” So far, the program has donated 62 kits at a cost of about $850. CCDS has committed $2,000 to cover two more renewals of the kits, which will cover all schools in Clark County for six years.

The high cost of avulsions

In his presentation to the nurses, Hsu first explains the differences among subluxation, extrusion, intrusion, lateral luxation, and avulsions, using actual case studies and showing pictures of the injuries. Additionally, he covers the types of lacerations most commonly seen in these injuries and explains best practices for their treatment. Hsu points out that a tooth lost to an avulsion as a child could easily cost the patient $10,000 over his or her lifetime, depending on the restoration and re-restoration of the affected tooth. That information seemed to resonate with the nurses on the day we accompanied Hsu for his presentation in Battle Ground, a thriving community with a mix of low-income and affluent families.

There’s an app for that

Dental trauma isn’t a well-understood field, Hsu says, adding, “We’re better now than we were. A Danish oral surgeon named Dr. Jens O. Andreasen was an early pioneer in dental traumatology, and over the years he and his team were able to collect enough data from Scandinavian countries to determine what treatments work better than others, and what the prognoses are based on treatments.” Today, the IADT promotes research in dental traumatology, stimulates the development of educational curricula in managing dental injuries, and promotes public awareness of the prevention and management of dental injuries. To that end, the association recently developed a free app called ToothSOS, which is available on multiple platforms. It’s a great companion reference to the Save-A-Tooth kit, and something every referee, coach, and parent should have access to on their phone. Additionally, the IADT has posters translated into more than 20 languages available for download on its website.

Get involved!

Hsu would like to see his work replicated statewide. He’s currently compiling a list of dentists willing to see trauma patients in Clark County and hopes that other component societies will pursue their own programs locally. If you would like to join Hsu’s team, email your name, your office name, and the phone number where you would like to receive dental emergencies to dr.hsu@storybookdental.com. Hsu will put you in touch with the right people at Henry Schein to get a comparable discount on the Save-A-Tooth kits. Local nurses, coaches and referees will welcome the information and training, and with so many children in sports programs across the state, you’re sure to have a lasting impact in your community by adopting Hsu’s model.