Dental Injuries in Watersports: Cold Hands and No Dentist Nearby

Four hundred metres from the beach, two metres of swell, a teenager holding his mouth with blood running down the inside of his forearm. Hold that picture, because every sensible piece of dental first aid you will ever read quietly assumes you are standing on a floor, indoors, near a phone.

Watersports have a specific dental problem, and it is not that mouths get hit more often than in hockey or rugby. It is that the twenty minutes after the hit are far harder to manage. Salt water, numb hands, a boat, no signal, and a long way to anywhere useful.

I am not a dentist. I taught this stuff for twelve seasons and I have made most of the available mistakes, which is a different qualification entirely.

How mouths actually get hit out there

The injuries I saw were remarkably repetitive:

• The bar or handle coming back. Far and away the most common. A bad edge, the line goes slack and then loads, and a piece of aluminium arrives at your face at speed.
• Your own board. Falls where the nose swings round and catches you, usually in shallow, choppy water.
• Somebody else's board. Rare, ugly when it happens, always in crowded water.
• The bottom. Face into a sandbar in half a metre of water. Nobody expects this one, because the surface looks deep.
• The boat. Ladders and transoms account for more chipped teeth than any dramatic wipeout, and almost always at the end of the session when everyone is tired and cold.

Only one of those is exotic. The rest are mundane, which is precisely why they keep happening.

What the water changes

Salt water is not a storage medium. If a tooth comes out and lands in the sea, it is far too salty to keep the root cells alive, and it is not clean. That does not make the tooth worthless, but the clock is already running badly before you have done anything. Fresh water is bad in a different way. Lake water and tap water both wreck those cells quickly.

Cold is the second factor, and it is underrated. After forty minutes in cool water your hands are close to useless for anything requiring precision, and picking up a small tooth by the crown without touching the root is a precision job. So is getting a carton open one-handed while somebody bleeds. I have practised that, which sounds absurd until you try it with numb fingers in a rocking boat.

Third is distance. From the far side of the water where I taught, getting a casualty ashore, out of a harness, into a car and in front of an emergency dentist was fifty minutes on a good day. Half of the thirty-minute window is gone before we reach the sand. That one fact is why I changed what I carry.

What lives in my dry bag

• A small carton of long-life milk. Survives a year in the bag, costs almost nothing, and is the best storage fluid I can realistically carry.
• Two sachets of sterile saline. Lighter than the milk, and they double for rinsing an eye or a graze.
• A screw-top container about the size of a film canister, so a tooth cannot escape during a bumpy drive.
• Gauze pads rather than plasters. Something clean to bite on is worth more for a mouth injury than anything else in a standard kit.
• Nitrile gloves, because blood and cold water.
• A laminated card with the out-of-hours dental number for the area and the address of the nearest emergency department. Phones die and get wet, and nobody recalls a number mid-incident.

The whole lot weighs less than a spare leash and lives in the same bag as the flares.

The first three minutes

Get them stable and out of the water first. A tooth is never the emergency. Airway, breathing, head injury and drowning risk all outrank it, and a hit hard enough to remove a tooth is hard enough to concuss. Then look in the mouth, count what is missing, and search for fragments, because a piece can end up buried in a lip or, much worse, inhaled. Then handle the tooth by the crown, into milk, lid on. Then the phone call, made by somebody who is not driving. In that order, every time.

If you carry nothing else, carry the milk. Everything after that is refinement, and I have put the full step-by-step in the first thirty minutes after a tooth comes out.

What we changed at the school

Three things, none of them expensive. Guards became compulsory for anyone riding a cable park or being towed behind a boat, and we kept a box of the mould-at-home kind for people who turned up without one. Having any guard in beats having a better one in the van, though I do have opinions on the difference and they are in custom versus boil-and-bite. The dental section went into the staff first-aid refresher and took nine minutes. And the milk went into every boat bag, not just mine.

In the six seasons after that we had four mouth injuries. Two were lips, one was a chipped corner that got bonded the following morning, and one was a full avulsion that went back in and held. That is not a controlled trial and I am not claiming it proves anything about causation. But nobody has lost a permanent tooth on my watch since we started carrying a two-euro carton of milk, and I will take it.

If you run sessions for other people's children, read the NHS guidance on urgent dental care once, on a quiet evening, so you already know what the pathway looks like. You do not want to be working that out for the first time at seven o'clock on a Sunday with a crying kid in the back of the van and a tooth in a cup.