Return-to-Play Protocols After Orofacial Injury: The Dentist’s Role in Athlete Safety

When an athlete sustains an orofacial injury, determining when it is safe to return to play (RTP) is a critical decision that requires careful clinical judgment and close collaboration among healthcare professionals.

While the immediate focus is often on the injury itself, the ultimate goal is a safe return to competition. Dentists, athletic trainers, and team physicians must work as a unified unit to ensure that oro-facial trauma is fully assessed, properly treated, and the athlete is adequately protected in order to minimize further injury before an athlete steps back onto the field.

The Interdisciplinary Team Approach

Effective management of dental trauma relies on a clear division of labor and mutual respect between providers:

• Athletic Trainers (ATs) are often the first to evaluate an injury on the field, coordinating immediate care and triage.

• Team Physicians oversee the athlete's overall medical clearance and systemic health.

• The Team Dentist plays the pivotal role in assessing dental and maxillofacial injuries, stabilizing affected structures, managing pain and infection risks, and determining necessary protective appliances.

Open communication among all providers enables timely referrals, consistent treatment planning, and unified decision-making that prioritize athlete safety above all else.

Strategies for Effective Collaboration with Athletic Trainers

Athletic trainers are essential partners in the management of orofacial injuries. Because they are the "eyes and ears" on the sideline, building a strong working relationship with them is paramount for a team dentist.

Here are four key strategies to strengthen this partnership:

1. Pre-Season Preparation: Dentists should take time before the season begins to review emergency action plans with the athletic training staff. This includes discussing referral pathways and aligning on concussion and trauma protocols to ensure everyone is on the same page.

2. Education and Guidelines: Provide the AT with concise, easy-to-reference guidelines on dental injury management—specifically regarding avulsion handling, splinting timelines, and pain control considerations. This ensures rapid, appropriate care in the critical moments immediately after an injury.

3. Accessibility: Share contact information, availability, and expectations for after-hours coverage. Knowing exactly how to reach the dentist streamlines communication in urgent situations.

4. Sideline Presence: When possible, attending practices or games allows the dentist to become familiar with the training environment, equipment, and workflow. This familiarity makes sideline coordination significantly more efficient during actual emergencies.

Establishing Clearance Criteria

The decision to clear an athlete must be based on both clinical stability and functional readiness. A standard RTP protocol for orofacial injuries should verify:

• Stability: The absence of uncontrolled pain or bleeding.

• Structural Integrity: Teeth and supporting structures are stable with no risk of further displacement or fracture.

• Protection: The ability to wear appropriate protective equipment (such as a custom splint, mouthguard,or facial protection) without discomfort or interference with breathing or communication.

For more severe injuries, ongoing imaging, specialist consultation, and a staged return-to-play protocol may be necessary.

The Importance of Documentation

Detailed records are the backbone of a safe return-to-play process. Thorough documentation of the injury, treatment rendered, recommendations, and clearance decisions supports continuity of care and provides legal protection for all parties.

Crucially, these clearance recommendations must be communicated in writing. Ensuring that athletic trainers, physicians, coaches, and families receive consistent written guidance reduces confusion and ensures strict adherence to the established safety protocols.

Conclusion

By collaborating closely with athletic trainers and physicians, applying clear clearance criteria, and maintaining precise documentation, team dentists help ensure that athletes return to competition safely and confidently. When the dental team is proactive and integrated into the sports medicine unit, the athlete wins.