Head and dental injuries or other dental problems in alpine sports

Abstract In the hectic daily life, spending our leisure time outdoor in the mountains becomes more and more popular. Although information describing dental injuries in various sports is available, data specifically on dental trauma and other dental problems in alpine sports are lacking. Data of 1,128 alpinists were generated by using a standardized questionnaire. The questions focused on the frequency of head and dental injuries and other dental problems. The participating alpinists have been recruited through the network of alpine clubs and an outdoor equipment supplier. Injuries were most frequently caused by a fall while doing alpine sports (14.7%, = 154). Of the participants, 8.2% (n = 93) suffered from a facial injury: 16% (n = 15) of these had a dental trauma. Other dental problems such as barodontalgia were more common than dental traumas. A sensation of pressure or pain was noticed in 13% (n = 135) of the participants at least once. Of all the participants who suffered pain, 54.1% reported one or several previous restorations. Pain medication was beneficial in 92.1%. Dental traumas are rare while doing alpine sports but not negligible because of its requirement of lifelong therapy and incurs substantial treatment costs. An intraoral pain of a usually asymptomatic tissue occurred, in this sample of participants, nearly as often as in pilots and divers. Pain killer is an efficient tool for the alpinists to reduce the pain until they reach a lower altitude.

Various harms have not only been caused by a fall or rockfall but also by the changing ambient pressure provoking dental barotrauma.
The aim of this study was to evaluate the occurrence of head and dental injuries such as dental problems while doing alpine sports.

| MATERIAL AND METHODS
A total of 1,128 alpinists (defined as someone doing mountaineering sports above 1,500 mamsl) have been surveyed by using standardized questionnaire. The questionnaire contained 23 questions about the epidemiology (age, sex, and frequency of mountaineering), general facial and dental injuries, and other dental problems (Table 1). After getting the permission of Swissethics (Req-2017-00825), the questionnaire was uploaded to the provider Survey Monkey, San Mateo, CA, USA. The link to the created website (including the link to the questionnaire) was distributed through the network of alpine clubs and an equipment outdoor supplier.
The statistical evaluation assessed the frequency of alpine sports, the occurrence of injuries, and dental problems. Patient characteristics, self-reported medical history, and routine as alpinists are presented descriptively. Categorical data are presented as frequencies and percentages. For continuous variables, the mean, the standard deviation, or the median and the interquartile range are presented as appropriate. The proportion of alpinists with pain or pressure is estimated together with its 95% confidence interval (CI) according to Blaker (2000). The level of significance was determined to be P ≤ 0.05.
The sample includes experienced participants who often reach high altitudes up to participants who rarely ascend to great altitudes. Two hundred sixty alpinists (23%) are doing sports once a week between 1,500 and 2,500 mamsl, 363 mountaineers (32.2%) are twice up to six times a year between 2,500 and 3,500 mamsl (Table 3). Two hundred fourteen participants (19%) are twice up to six times a year around 3,500-4,500 mamsl, and six alpinists (0.5%) are even weekly over 4,500 mamsl.

| Injuries
Most alpinists (n = 91, 59%) had suffered from a muscle, tendon, or ligament injury. Sixty-one mountaineers (40%) had a bone fracture(s) while being in the mountains (Table 4). Sixteen percent of the participants who reported to have ever suffered from a facial injury (n = 93) had a dental trauma. In most of the facial-injured mountaineers, 61.3% had a graze or laceration (45%; Table 5).

| Pressure and pain
A total of 1036 participants answered the questions regarding pressure or pain. Ninety-two did not answer this question. In total, 135 (or 13%; CI [11.1, 15.2]) participants reported a sensation of pressure or pain at least once. Eight alpinists reported repeated pain or pressure. Forty-four alpinists (32.6%) suffered 1 hr or longer, 27 (20%) a day or longer, and 53 (39.3%) had less than an hour toothache. The location of the pain was in most of the participants the upper jaw.
The mountaineers had been mostly a few hours "climbing/hiking" before their tooth/teeth started hurting (Table 6). Of the participants, 35.6% reported pain at 2,500-4,955 mamsl (Table 7).

| Response to pain
Thirty-nine out of 135 alpinists took pain medication with a 92.3% success rate (long or short term). Ten out of 135 mountaineers had, due to the pain, to descend-with 70% long-term success of being pain free at a lower altitude ( Table 8). Most of the alpinists (n = 48) described the pain to be dull, second most they reported that they felt it throbbing (Table 9).
Of the participants, 45.2% could not remember if they ever had a treatment on that specific tooth. Sixty-three alpinists knew they had at least once or even repeated a treatment (Table 10).
There were 73 participants who reported to have had a previous treatment(s) (filling, root canal treatment, crown, and bridge) on the aching tooth. In total, 54.1% (95% CI [45.5, 62.6]) of all participants who suffered pain also reported one or several previous treatments ( Figure 1).

| Bruxism
Of the participants, 11.9% (n = 45) reported pain at least once up in the mountains and do grind or press their teeth. Three hundred seventy-eight of the participants have been told to be grinding/pressing their teeth by their partner or have a sensation of tension in the area of their jaw. Of the climbers, 11.9% have a bite splint (Table 11).   This study evaluated the frequency of head and dental injuries such as dental problems while doing alpine sports. Of all participants, 14.7% (n = 154) had injuries with a need of medical assistance by a      & Stainer, 2000) or mountaineering/rock climbing (Addiss & Baker, 1989;Bowie, Hunt, & Allen Jr, 1988).
There is an association between facial fractures and dental injuries (Lieger, Zix, Kruse, & Iizuka, 2009). Sixteen percent of the participants who reported to have ever suffered from a facial injury had a dental trauma, rather rarely in comparison with 48.25% of the overall incidence of dental trauma in facial injuries and in sports-related facial trauma (Gassner et al., 2000). Generally, articles on dental trauma due to sport have incidence rates around 13-39% ( Skrinjaric, 2009). Owing to their exposed position (Altun et al., 2009), the upper front teeth and the upper jaw are most often affected. Even if severe dental traumas are not as common as in contact sports, it is still important because of its requirement of therapy and treatment costs (Wong & Kolokotsa, 2004).
This discomfort can be produced by odontogenic or nonodontogenic origin (Zadik, 2009a;Zadik, 2009b). The pathophysiology is until now not fully investigated (Zadik & Drucker, 2011). There are several cofactors leading to the pain such as odontogenic