News feature: An Olympic dental challenge
If Beijing was a baptism of fire for Tony Clough, then London should prove a breeze. On home ground – and only a short trip from where he practises in Chelmsford, London 2012 will – eventually – prove a home-from-home experience, one that he is well equipped to manage. Budgets and bureaucracy aside, he’s looking forward to it.
Tony is dentist and medical team consultant for the 2012 Games. He was thrown in at the deep end for the Beijing Olympics back in 2008, where he got involved in the care of the elite Olympic athletes when his predecessor fell ill. It was a turning point.
He qualified at the Royal London in 1978 and is currently secretary of the Essex Local Dental Committee. He is also advisor to North Essex PCT and is a part-time restorative tutor at Bart’s and the Royal London Hospital dental school. He lectures at Essex University where he is actively involved in the dental health foundation degree course as a clinical educator. He also co-presents the modular course in Sports Dentistry with Barry Scheer at Eastman dental hospital.
Meanwhile, he runs a busy eight-surgery practice in a leafy suburb of Chelmsford – Sharrow Dental – that offers cosmetic work, orthodontics and implant dentistry. There are eight dentists, one orthodontist, three hygienists and two dental therapists, with a further 18 support staff. It’s a practice that’s undergone a complete refurbishment of all the surgeries during the last 18 months.
With all this tucked firmly under his belt, taking time out to recruit, train and organise a dental team for the world’s top athletes is no mean feat – a task of Olympian proportions, it could be said.
A key character trait of Tony’s is the passion he has for an area of dentistry of which, perhaps, little is known or understood. To him, sports dentistry can require a very different professional approach that skews a little of what’s expected in general practice, of which more will be explained later…
His initial involvement in sport led to him working for the International Olympic Committee (IOC) in Beijing as dental advisor with the IOC Medical Commission and now, as dental advisor to the London 2012 medical advisory committee with responsibility for setting up the dental care programme for two years time.
Other sports-related dental responsibilities involve advising and working with the British rowing teams and the British alpine team.
Funding for this mammoth 2012 project comes from the London Organising Committee of the Olympic Games and Paralympic Games (LOCOG). Post-Games there are plans to use this space as a legacy – a provision for the future in an area of need and an underprivileged population; Newham primary care trust will run the dental clinic with six chair.
Tony says: ‘After the Games, there will be a marvellous polyclinic left within the Olympic village and it will be good to leave it as a legacy to the area. The footprint is there.’
The blueprint for the clinic includes eight chairs in the dental surgery and the plan is to undertake all emergency treatments. Tony predicts at least 700 dental-related incidents that his team will have to tackle. The population in the month-long Games is estimated at 40,000 in total – 15,000 athletes, 15,000 backroom people and 10,000 officials and families.
Tony explains: ‘Amongst the elite athletes, there are a lot of pretty underprivileged people, and we will undertake routine dental work in addition to emergency cases so we need a team that can carry out oral health screenings.
‘A major, or key, problem is dehydration and rehydration. Athletes use sugary, acidic drinks for rapid rehydration and this obviously impacts on their oral health so we are offering fluoride mouthwash advice, too.’
In an IOC evaluation of the health of elite athletes that followed the Beijing Games – and which drew on Tony’s assessment – it was concluded that ‘good oral health will ensure good function and the ability of the athlete to compete at an optimal level without being compromised by dental disease or an otherwise preventable emergency’.
In other words, dental care is of the utmost importance during the month-long Olympics if athletes are going to do well.
Tony is keen to hammer home the message that this needs to continue outside of the Games, too. He says: ‘The athletes need to know that good oral health care is essential not just during the games, but in the years leading up to the major event – and afterwards, too.’
Statistics collated by the IOC at Beijing highlight the level of dental disease in many participants. Other findings include the identification of erosion, the prevalence of which was estimated to be 25.4-37.4% in the athletes. This may be an indicator of the excessive use of sports drinks. The presence of wisdom teeth and certain malocclusions are risk factors for future injury. The presence – or absence – of wisdom teeth may affect the risk profile for mandibular fracture in combative sports. Additionally, associated periodontal infection may affect athlete performance.
The evaluation – released in March 2009 – also suggests that efforts should be made to educate these athletes and sports authorities about the considerable benefits in preventing dental injuries by providing custom-made mouthguards.
Tony insists there will be a huge drive to encourage an across-the-board use of custom-made mouthguards in combative sports at the London Games, having been shocked to discover in
Beijing that 90% of boxers were failing to use them. Interestingly, women’s boxing is to make its debut as a new medal sport at the 2012 Games.
The mouthguard programme will be carried out in conjunction with the oral health screening. At this year’s Winter Olympics in Vancouver, Oral-B electric toothbrushes were distributed as an encouragement to every athlete to attend a screening. Tony is hoping for a smiliar scheme here.
‘I learned from Vancouver that you’ve got to look inside an athlete’s mouth and ask the question, is there anything in here that’s a time bomb?
Basically, NICE guidelines are out of the window. The aim [of sports dentistry] is to cut out any possibilities of incidents.
‘I cut my teeth – if you’ll pardon the pun – in running a dental emergency service in a region of Essex. The whole gamut of emergencies was there – trauma, a victim of a fight, a tooth pushed to the back of the mouth, a broken jaw. You can gain a huge amount of experience in this way.’
Criteria for Olympic team recruitment will no doubt require this level of experience.
Key dental areas to be addressed includes:
• Prevention of injuries and, in particular, the fitting of mouthguards
• Monitoring of diet i.e. isotonic drinks, with regard to their impact on general oral health
• Trauma that happens in any sport and the immediate fixing of the injury in order to get the athlete back onto the field of play as quickly as possible.
Tony mainatains that it is a key job of the dentist to get injured athletes back into the action as soon as is possible. The treatment that takes place pitchside, for example, may only be a temporary fix to get the patient back in the game.
More involved, more detailed treatment will then perhaps take place here in the surgery after the game – or even after the whole Games as there is often no room for a course of treatment during an event. Therefore, any work needed – orthodontics, fillings, crowns or extractions – needs to fit into the events schedule so that player’s oral health does not compromise their playing ability.
As the dentist is often without the equipment and tools usually to hand, the ability to provide rapid pitchside diagnosis and emergency treatment is vital.
‘The turnaround time is limited so there has to be a compromise,’ Tony explains. ‘You have to show due respect for the health of the athletes. The team I put together will be well versed in showing respect for athletes. You have to compromise.
‘I’m looking for experienced dentists who can give 10 days [plus the two weeks leading up to the Olympics]. At peak time, we will have seven dentists in the clinic with dental hygienists and therapists on two shifts covering 7am until 10pm.’
Tony will also need maxillofacial specialists, orthodontists, endodontists and surgeons as well as dental nurses and DCPs. Another factor will be language. Tony explains that there will be an interpreter team available for all disciplines, but anyone who can speak French, Spanish, Russian and Arabic will prove invaluable, too.
He concludes that it will not necessarily be an easy role to fill. ‘The important thing is knowing what to do, when to do it and when not to do it. If we’re there, we’re there to work together with our medical colleagues. Security can also be a major issue that will need to be addressed and the team will also need training for the housekeeping.’
‘I’ve worked hard to make sure the profession gets the respect it deserves. It’s why I keep coming back.’
Volunteers dentists, dental nurses and DCPs are needed for London 2012 Olympic and Paralympic Games. Applicants must be registered with the GDC.
Priority will be given to any dental professional who can offer accommodation to fellow health professional volunteers.
Send a brief expression of interest to Tony Clough at [email protected]