Dr. Michael Salyzyn, a sports dentist with extensive experience, discusses his journey into sports dentistry and the importance of field of play treatment versus in-office care. He also discusses advancements in sports dentistry, such as CBCT technology, 3D printing of mouthguards, and sensors in mouthguards to monitor concussions.
Read the audio transcript below:
Dr. Luisa Schuldt (LS): Hi, everyone, and welcome to Brush Up, presented by Oral Health Group, the dental podcast where we chat with industry experts about everything from technology, finance, and practice management. I’m your host, Dr. Luisa Schuldt, a periodontist and prosthodontist based in Fonthill, Ontario. In this episode, we are joined by Dr. Mike Salyzyn to discuss treatment of sports related injuries.
Dr. Salyzyn has been in private practice since 1988 and has been a lecturer in the Department of Community Dentistry at Dalhousie Dentistry for 20 years. Mike has been an avid skier, hockey player and sports enthusiast all his life. He volunteered for the Canadian Ski Patrol locally for the last 20 years and was President of the Canadian Ski Patrol Atlantic East division. He was successful is authoring a protocol for the Canadian Ski Patrol to treat dental injuries and has presented this to many European ski patrols and has collaborated with the European Academy for Sports Dentistry, co-authoring a universal dental examination protocol in Sports that has been adopted by FIFA. He was fortunate enough to be a dentist at the Vancouver Olympic games in 2010, working in the athlete’s village at Whistler. He has worked with the International Olympic Committee, the International Ice Hockey Federation, FIVB volleyball, numerous U sports final 8 tournaments as well as the Halifax Hurricanes Basketball Team. He has been the Chief Dental Officer for the Canada Winter Games and recently the Chief Dental officer for North American Indigenous Games. He is a Fellow of the Academy for Sports Dentistry and the current President elect.
Welcome, Mike. Thank you so much for joining us today.
Dr. Michael Salyzyn (MS): Thank you so much for having me. It’s an absolute pleasure.
LS: So, we mentioned a little bit about just how much you love sports and how active you are. Is that part of what inspired you to become more active in sports dentistry, or was there something specific that that got you started?
MS: I I think it had a big bearing on how I got involved with this whole thing. And it’s funny, when we start these journeys in our careers, it doesn’t end up where we think it’s gonna end up. And in fact, the reason I got into all this about twenty years ago was because I passed a car accident on the side of the road, and I didn’t know what to do. Do I stop? Do I help? I’m a dentist. What do I do? And I joined the Canadian Ski Patrol because I wanted to find out how to provide basically advanced first aid, in case this ever happened again.
So, with that, surprisingly enough, as I took the course, I found they talked about dental injuries on the ski hill, and I said, well, it doesn’t seem very complete what we’re teaching. And I started to investigate a little bit more and a little bit more, and I found out that, boy, we need to really educate some of these other organizations about what to do in the event of dental emergencies. So, this is where it all started. It started from passing an accident at the side of the road and not knowing what to do.
So, with that, it just kind of took off and looked at changing the protocol in the first aid program, took that over to Europe. It kind of ballooned from there, and, then I said, well, gee, I gotta investigate this even more. And I found the Academy for Sports Dentistry. And that’s a North American organization that basically looked at a similar thing. I wanted to get educated. I wanted to learn more. So, dentistry is a continuing learning experience as we all know. I want to learn more and it was a great way to, you know, enjoy sport at the same time.
LS: Wow. Well, you mentioned something that really caught my attention and that is that, you know, trauma is a large part of sports medicine, but it’s not the only thing. So, I hope that throughout our conversation, some of that will come out as well. How would you compare, field of play treatment versus in office treatment, and what are the different goals or factors that are overriding these situations?
MS: That’s a great question, and there’s so many different levels to look at that question because, basically, field of play versus in your office. Field of play, we don’t have access to all the wonderful toys we have in our office, so we have to really look at stabilization. We have to look at control of bleeding. We have to look at the medical side of it at the same time. It also depends on the level of play. If you’re doing field of play treatments in the NHL, it’s totally different than field of play treatment for a U-10 soccer team, right? So, you know, the NHL, which we have a lot of members who are NHL dentists and NBA and FIFA dentists that, these organizations have full dental suites in the stadiums that most people aren’t aware of. They can take radiographs underneath the stands. They can do lots of things to get their athlete back on the play field because they’re worth millions of dollars, unlike a U-10. So, there’s two different things.
We also look at, you know, what can you have in a bag to take with you to your U-10 sport event? What do you have in your bag to take with you to a higher lead athlete event? Sometimes they’re the same, sometimes there’s difference. But that’s something you learn over time, what to bring with you.
LS: I would assume probably field of play treatment is also kind of more immediate emergency type care. And then the in office, you would be chatting about, like, long term care, preventive care, and of other facets of care also related to sports dentistry?
MS: Yeah. Definitely. I mean, feel the field of play is really stabilization and control of bleeding, the medical side of it. In our office, we look at how to restore. It’s funny when you think back in dental school, which seems like yesterday for me, but it was a very long time ago, there was always compartmentalization of trauma. We looked at, was it perio an issue? Was it endodontically? Was it restorative? How do they all interrelate and how do they all connect? And that was a problem as a student to try to figure out how these three or four different areas come together as one.
There’s a wonderful group that I encourage people to look into as well. It’s called the IADT, International Association of Dental Traumatology. Our Academy for Sports Dentistry usually has joint meetings with them every four or five years. We have one coming up, I believe, in two years. We’re not sure where yet. We’re thinking Cancun.
LS: Wow.
MS: Right now, I think the IADT is in Japan. Our meeting is in Washington DC next year. So that’s another great group. There is a wonderful app that the IADT has. It’s a free app. I encourage everyone to download this, dental professionals or non-professionals, and it’s called Tooth SOS. It’s Android and iPhone compatible. It’s a great app because you can basically just scroll down and say, I have a tooth injury, and it will list all the different types of things and what to do in the field of play.
But also too, as a dental professional, you can go in and say, I have a tooth injury. I have an avulsion. And it will list all the dental things we can do, and they’re supported by the research papers.
LS: I’m so happy you started talking about this. I was just about to lead up into my next question, which is what can a non-dentist do, if there’s a field site dental emergency? And for that case, what can a dentist do? But it sounds like starting out with that app is just a great place to start.
MS: Oh, it’s wonderful. Yeah. Absolutely wonderful. It’s a free app, that is easily downloaded and passed along, and I encourage you to basically tell your patients about this as well. This is not just for dental professionals, but if you want to learn more about what to do in these situations, it’s a wonderful app for us as dental professionals because the papers are actually there, and you can reference them. You can talk about, you know, how long do you ligate the tooth, how long do you do this, what is the treatment protocol for this, a chipped tooth, an avulsion, an intrusion, an extrusion, a misplaced tooth, all kinds of great information in that for us as dental professionals in one spot.
LS: I know of some hygienists or dentists in the area that dedicate a portion to their practice to making sports guards. If they can share the information regarding this app to the athletes, their parents, that would create a huge network of people with the app available, some dental knowledge, what to do in case of an emergency. These kids aren’t always or young athletes, they’re not always wearing their protective measures they should, and accidents happen. And not every sport has those protective measures as part of the gear that the athletes are wearing.
You mentioned the U-8 and U-10 soccer. It just so happens my son’s also in soccer U-8, and I’m his coach. So, I’m really happy to, you know, review this information in a little bit more detail. Thank you. So, you were recommending that we can have things with us that can help us in the case of emergency. We might know we have it with us or we should consider bringing it. As far as, let’s say, a medium for an avulsed tooth, what is the best way to handle that? Where should we put that tooth?
MS: Luisa, you know, that’s a great question. And the reason it’s such a great question is there’s so many conflicting studies done on this. The IADT is coming out with a statement in 2025. I expect it after their yearly meeting. There’s a variety of different media that we talk about. You know, in dental school, we were taught stick this in milk. Why? Well, the whole idea of an avulsed tooth is to preserve the periodontal ligament cells. You know, these injuries usually occur only from four percent to sixteen percent of all dental injuries are avulsions. They’re a very small amount, or total avulsions. An age group is usually, like, seven to fifteen, normally, centrals and laterals. It’s not ubiquitous across the entire dentition. It’s very isolated.
What do we use? Do we use coconut milk? That’s another one. Do we use saliva? Do you just stick it in your mouth and walk away with it? How do you handle that avulsion? We’re not supposed to touch the root surface. That’s hard to teach a layperson not to touch the root surface.
LS: They might not even recognize which end of the tooth is the root surface.
That was the most difficult thing to teach ski patrollers, where the tooth goes back in. Because the protocol is put it back in as soon as you can. That is the best single thing that we can do as a sideline, non-dental professional. It’s very difficult to put the thing in sideways or backwards. Even for us, sometimes, we have to look at a tooth and go, yeah, how does that really go in there?
LS: Especially if the root is also fractured. Maybe a portion is missing, making the anatomy not as clear.
MS: And it may not be able to be inserted for that. So, yeah, it’s very difficult. So, it’s tough. In terms of medium, the latest studies basically say the Hanks Balanced Salt Solution is the best for periodontal ligament cell health up to twenty four hours. Milk is the next best. The problem with milk is that I don’t know how many people on you can have a container of milk on the sideline. Usually, they have Gatorade. So it’s not really readily available even though everyone says it’s readily available. I’ve yet to see milk at the hockey rink.
So, that’s an issue. There there’s two wonderful little products that we can get. One is called Save-A-Tooth. I don’t know if you’re familiar with that. The other one is called EMT Toothsaver. They’re basically little containers of Hank’s Balanced Salt Solution, which is basically a histological media. Very stable, and you can just throw it right in there. You have twenty four hours of cell health once it’s in that balanced salt solution to have for successful reimplantation.
LS: Versus just in the air, which is, an hour
MS: Exactly. So, it’s great. We encourage our athletic trainers to have them in their kits. And anyone I’ve come across to say, please get this, put it in your kit. They’re not inexpensive, but they’re not overly expensive. They used to be a lot less expensive. For some reason, Amazon right now is selling these Toothsaver for about fifty dollars Canadian each. I found the EMT Toothsaver from a company in Ontario, and I think they’re about thirty-two dollars each. So, they’re stable for years. It’s not a bad investment for thirty-two dollars to have one on the sideline. They also work for chipped teeth. So, if you throw that tooth in there, it keeps it hydrated and makes the restorative dentist side of it a lot easier. So, if we can bond that fragment back on, it looks pretty darn good because it has been kept hydrated all the way through.
LS: Modern adhesive dentistry lets us get away with a lot of that much more easily.
MS: It really does. So, it’s a great product. There’s two good ones out there.
LS: Okay. What other new technologies or treatments are important we as dentists or dental hygienists be aware of in the specter of sports dentistry?
MS: There’s some exciting things that are around the horizon. One of the biggest things I think in our own private offices well, a few things. One is our CBCT technology. It’s become becoming more of the standard of care. That ties in with your first question about what do you do off the field in your own office. It’s wonderful to scan these athletes or someone who has had a sports injury to see is there, you know, buccal plate fractures, are there fractures of roots, are there anything underlying that a normal two direct dimensional radiograph can’t tell us. So that helps a lot in diagnosis and treatment.
I think the second thing is use of scanners. Some of the cool things that we do with scanners now, I’ll give you a little story that goes on behind the scenes in the National Hockey League. What happens is all those players have pre-screening dental exams at training camp. There is an assigned dentist, mostly, every team has one, and they will screen all the players and they will scan all the players. So they will scan their upper and lower teeth. If, for example, a player forgets their mouth guard, goes to another city to play a game, they’ll call up the dentist in another city and say, here, I’ll send the STL file for you. Can you print the model and make a mouth guard for player X? And they do, and they deliver it.
LS: They can make it within minutes.
MS: Exactly. So that’s the beauty of scanning. These are things that go on all in the background, unbeknownst to most people. The other thing is 3D printing. We’re 3D printing mouthguards now. Problem with 3D printing mouthguards are there’s not enough information for the materials we’re using to print. Are they as protective as our gold standard mouthguards, which are it’s two or three layers of pressure laminated EVA. They’re not vacuum form mouthguards at all. That’s your grandfather’s mouthguards. The technology has improved a lot, and there’s ways to do it. You want to find out more about that? Look on our website, the Academy for Sports Dentistry. We’re protection.
LS: So the quality of the night guards, the way they should be made is all reviewed there on the website.
MS: Yeah. There’s two other really interesting things happening right now too. We’re starting to put sensors in mouth guards. There’s two commercially available ones. There’s one that’s used in Ireland right now for the Rugby Union. And what they’re measuring is lateral forces. They’re actually measuring heart rate as well in real time.
LS: Wow.
MS: So, we’re looking at how much force is applied to someone’s head and where is the magic number? Does that correlate into concussions or TBIs?
LS: I was just about to ask you if that has something to do with concussion medicine, which has been in the news over the last few years so much.
MS: Well and that’s changed too because when I first started this journey, there was no link between concussions and mouthguards and dentistry. It’s like that was bunk. Now there’s a different thought, and the Amsterdam conference in 2022 came out with a landmark paper that said there is a correlation between mouthguard usage and reducing concussions. How much? We don’t know. What is the correlation? I don’t know. But there’s a lot of research actively going on now that, hey, there may be something to this. So that’s exciting as well.
The final thing that’s really exciting is now we’re studying biomarkers in saliva that come from cerebral spinal fluid after a concussion. So, there’s commercially available kits in Germany right now that you can test for certain biomarkers to help determine whether or not your athlete has sustained the TBI. So the dentistry is really blowing up in the sports world right now, and there’s a lot of really cool, applicable things that are coming down the pipe. It’s not just in North America. This stuff’s in Europe. It’s in India. It’s in South America. FIFA is leading the way for a lot of these things as well. The soccer folks know the value of their dentists.
LS: Now they know the value of having a healthy athlete, and that’s a great example of a sport where they’re wearing very minimal protection. So, making sure that they’re being careful is very, very valuable. Is there anything else, you mentioned the night guards, having that medium just in case an avulsion takes place in the field. What else can we as dentists do to promote protection and prevention of sports injuries, specifically in in the oral cavity?
MS: I think the biggest thing is get educated ourselves on these new things that are coming through. Take the time to talk to our patients in the chair, in the recare exams to say, you know, do you play sports? Have you thought about a mouth guard? Yes. I go to the Sporting Goods store and I buy my twenty-dollar Boil & Bite mouth guard. And I have my four-hundred-dollar hockey stick that I break three times, but I didn’t want to spend seventy-five dollars on a real mouth guard. And that’s the biggest thing.
LS: Hockey stick, yes, not the mouth guard. Okay. Education. Right? We need to let them know just how important that is.
MS: We really do. And I think it starts with our hygiene department. I think it starts with us as GPs. I think it starts on our social media. I think we have an obligation, as oral health care providers, to educate, and it’s a great opportunity to reach out to the community. And, you know, the easy way to do it is pick a sports team like your U-10 group and say, “Hey. I’m going to make mouthguards for all the kids, gratis.” And that’s a good marketing tool at the same time. It really doesn’t cost you very much. You can do it in office, and it gets them used to wearing a mouth guard. MLS is big in the US and Canada as well. They promote mouth guard usage in in soccer. FIFA does as well. You look at the NBA, all these basketball players are running around, half of them have mouth guards.
LS: Yeah. They do.
MS: Because it’s a very, very, traumatic sport. A lot of elbows in the face, a lot of broken teeth. So we we have a lot of education to do, I think, in the grassroots.
LS: Yeah. Do you have any memorable cases that you’ve worked on? I see, unfortunately, a lot of these young athletes after they’ve lost the tooth and now have to chat about replacement being a perio-prosthodontist. But I think early intervention and prevention are just so important. Do you have some cases that you were able to intervene early and maybe have some nice outcomes for them?
MS: Sadly, they don’t listen. They’re amazed to how we can fix things, and they walk back on the field of play without their mouth guard, or it’s in my bag, and it reoccurs again. Usually, it’s really devastating things. I, you know, I thought about this. Are there memorable ones? Yeah. There’s some great memorable ones. There’s ones where you really help people. The basic ones are the ones that that really stick with you. I’ll give you a quick little for instance. I was really fortunate to be part of the dental team of Vancouver Olympics. And we as a country basically provided medical and dental services to over eight thousand, eight thousand services at the public clinics during those Paralympics and Olympic programs. Dentistry did almost eleven hundred. We were the busiest service at the Vancouver Olympics.
LS: I did my specialty training in Vancouver, not at the time of the Olympics, but I heard a lot of wisdom teeth came out. With some of the kind of scheduled treatment?
MS: No. It was emergency treatments.
LS: Mostly emergency. Okay.
MS: Yeah. What we found was that a large percentage of our Olympic family athletes had very, very poor dentist dental care. You know, these athletes really don’t get much funding. Even our Canadian athletes have very little funding. Their pay rates are really high. The periodontal disease is really high. And part of it is, you know, they’re ingesting four or five thousand calories a day just to maintain the body weights. A lot of high sugary drinks, a lot of energy drinks, a lot of things that that we would never, as general population, use. So, we did extract a lot of teeth. We did a lot of restorative. Basically, we had patients for an hour, and we would try to do as much restorative as possible in the hour. And I remember this one young fellow from Georgia, and, it’s an Eastern European country, very small, and we had him there for an hour. And I don’t know, I think we did five or six restorations on him, and he came back again for another hour, another five or six. At the end of it all, he looked at me and smiled and he said, “First time I’ve never felt anything.” I’m like, what? He said, yeah. In Georgia, they don’t use any anesthetic.
LS: No wonder he was coming back for more.
MS: So, you know, we take so many little things for granted in North America, but there’s some wonderful people out there and if you can help them, that’s part of what we do as dentists. We’re very empathetic. We like to help people. So it’s a great way to help people get involved in the sports world.
LS: Thank you so much, Mike. That’s, been a really wonderful conversation. I appreciate your time and what you’re doing for our athletes, not only in Canada, but all over the world with everything you’ve done through the different organizations you work with.
The more I do these podcasts, I also noticed that some of our conversations tie in with other podcasts we’ve done recently. So, if anybody wants to hear a little bit more about caries and preventive care in athletes, please feel free to look up our other podcast on this topic. You brought up scanning. We have a podcast also on the amazing use of technology and the advantages of digital scanners. So please feel free to look up that one as well. Thank you again, Mike. Thank you to our listeners.
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