Dentistry: Orthodox or Southpaw?
WINNER - SANDS COX CHARITY ESSAY PRIZE 2018 - DENTAL STUDENT
Ibrahim (Mohammed) Ahmad
Prior to attending dental school, I was unware of the striking association between allegedly brutal combat sports and oral health care provision. One could compare the two as a beautiful dance form against rapacious and sadistic dentistry.
How could a pugilist ever be skilled enough to wield a surgical scalpel, potentially causing immense harm to a patient? How can fighters provide adequate medical or dental attention when they are so strongly associated with causing others to seek it?
Those that immerse themselves in these arts are stereotypically notorious for causing harm to others, not helping them. Which begs the discussion on if they would struggle to adhere to the first principle of bioethics: Primum non nocere – first do no harm.
It was during the summer term of the second BDS year and we were taking mandibular alginate impressions for the first time on each other. The clinician directing the session demonstrated how the operators are to stand with the stock tray loaded in front of the patient. After observing my somewhat upright and rigid stance, he walked up to the clinical bay and put his fists up. Surely this wasn’t the time or place to engage in fisticuffs? Of course not. He then proceeded to explain the importance of a basic right-handed orthodox, or left-handed southpaw, boxing stance for increasing the stability of the operator to have good impression-taking technique.
This was reinforced after attending the introductory oral surgery lecture on the principles of tooth extractions, where the lecturer had discussed the different surgical instruments used for extractions and the correct technique in performing them. One part of the lecture which took the audience by surprise was a seemingly random presentation slide showing a photograph of the legendary boxing bout between the great Mike Tyson and Franklin Bruno. The slide was titled “Operator Position” and highlighted again the importance of keeping the knees bent and the body as relaxed as possible.
Brown et al in 2010 researched the causes of early retirement as a result of ill-health amongst dentists whereby the majority, out of the 189 surveyed, had shown that the most common cause was musculoskeletal disorders. Adopting this “boxer’s stance” would be more beneficial to the operators involved in the long term.
History has shown that combat sports have always been popular, with some seeing it as a primal release to their tension, and others seeing it as a physical form of chess. With popularity amongst the general public arguably reaching its highest for combat sports, it would be wise for dental students and professionals to understand its impact upon patients.
In terms of patients who are involved in contact sports such as boxing, this would most probably involve tremendous external forces being loaded against the head region in particular. This has not only been shown to be detrimental neurologically but also dentally. The most common cause of dental trauma amongst boxers was shown to be clinical crown fracture, followed by tooth dislocation, found by Ifkovits et al in 2015. Thus, the provision of mouthguards has been shown by Ifkovits et al to have reduced the incidence of dental trauma amongst boxers during their training sessions. Also, they had shown in this study that bespoke mouthguards made by the dentist, which have also been appropriately cared for by the user, have been shown to be the most protective against dental trauma.
Dentists have always been associated with pain by the general public and there has been a relatively recent push by dental professionals to dispel this myth. However, with the multi-layered correlation between pugilism and dentistry, can they really be blamed?
Brown J, Burke F J T, Macdonald E B, Gilmour H, Hill K B, Morris A J, White D A, Muirhead E K, and Murray K. Dental practitioners and ill health retirement: causes, outcomes and re-employment. Br Dent J 2010; 209(5): E7.
Ifkovits T, Kühl S, Connert T, Krastl G, Dagassan-Berndt D, Filippi A. Prevention of dental accidents in Swiss boxing clubs Swiss Dent J. 2015; 125(12): 1322-35