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Dr. Larry Emmott

by User Not Found | Sep 12, 2012

hockey dentistAs a fifth grader growing up in Canada I had made up my mind. When I grew up I was going to be either a hockey player or a dentist. Then my parents moved us all to Arizona, my hockey dreams faded and I settled for becoming a dentist.

In 1988 one of my hygienists became an enthusiastic fan of the Phoenix Roadrunners hockey team and suggested we look into becoming the team dentists. I called them up and asked. Sure enough, they were looking for a new dentist. My partner Ron Foeldi also grew up in Canada playing hockey so we jumped at the chance to work with the team.

Eight years later in 1996 the big league NHL Phoenix Coyotes came to town. As the established “hockey dentists” in the area, the Coyotes sought us out and again we jumped at the chance to work with the team. So for the last 23 years I have been a professional hockey team dentist.

When people learn that I am the team dentist they usually say “That must keep you busy.” After all, the popular media perception of a hockey player is a big goon with missing front teeth. The fact is not every hockey player is a big goon with missing teeth. On the other hand hockey is a fast, hard hitting and often violent sport. As a group, the players have a lot more missing and damaged teeth than your typical healthy twenty-something guys.

As a team dentist I see a lot more facial-dental trauma than I did in my everyday general practice. Dental-facial hockey injuries happen when the player gets hit by one of three things: another player; a stick or by far the worst; a puck.

The most common injuries are the results of hard contact with another player either in the form of an elbow, a shoulder, or occasionally a fist to the face. These are usually minor involving little more than a cut lip and some soft tissue trauma.

Stick injuries, either from a blunt end or from the blade are less common, yet tend to be more serious injuries often involving fractured or loosened teeth and more serious soft tissue damage. In theory, a player is supposed to control his stick at all times and any contact with the blade above the waist is a penalty called high sticking. At least that’s the theory.

The third and most serious type of injury comes from the pucks. A hockey puck is a rock hard frozen disc of solid rubber that can easily exceed speeds of 100 mph. When a puck hits a player in the face it is always serious. Puck injuries usually result in avulsed teeth, crushing of the alveolar bone, severe soft tissue damage and possible fracture of the mandible or maxilla. Fortunately in over twenty years we have seen just four of these.

Back in the Roadrunner days we dealt with a facial injury at almost every game, in fact, often several a game. With the Coyotes we see less of these dental-facial injuries. I think there are several reasons for this. Today more players wear mouth guards and face shields. Back in 1988, there was an underlying tradition that real men, especially real Canadian men, did not wear mouth guards. Mouth guards and face shields were just for those sissy, girly Europeans.

There is also less fighting. For better or worse hockey is famous for its fights. Times have changed. There is less fighting today in general and there is less fighting in the big leagues than in the minors. Which brings us to the final reason we see less facial trauma, the Coyote players are just better than the minor leaguers. There is less high sticking and the players are better at avoiding injury.

Today, most players do wear mouth guards and more wear face shields although they are still more common with the European players than those from North America. The technology of mouth guards has improved tremendously with dual laminates but many players still think of a mouth guard as a boil and bite that doesn’t fit, falls out and hurts. If you can get the player to try a dual laminate mouth guard usually they like it and use it all the time. coyotoes dentist

Dual laminate mouth guards protect the player in several ways. Of course they protect the teeth from damage. They also help prevent or reduce soft tissue damage, an example being a tooth that is forced through the lip. Finally there is evidence that mouth guards can significantly reduce concussions from hard blows to the mandible.

The use or more accurately the non-use of facial shields throws an interesting light on the psyche of hockey players. On several occasions we have had a player who had just suffered a significant injury. For example their lower incisors were knocked lingually several millimeters and one even had a partial mandibular fracture. The player/patient usually would rather lose a tooth than miss a period of play. They want to get back on the ice immediately. So we advised the player that he should wear a face guard to prevent another even more damaging blow to the injured area.

“Oh no.” the players all say, “If I wear a guard the other players will know that’s where I am hurt and they will go after me and try to hit that area.”

In addition to treating game day injuries the team dentists do pre-season physicals. These are fairly basic. In fact, the hardest thing is to remember to use the Canadian tooth numbering system printed on the forms instead of the 1-32 system we use in the US. The primary purpose is to describe the condition of the player’s mouth right now so that the team knows if an injury was due to a practice incident or if the player arrived with the condition. The second purpose is to identify any conditions which could exacerbate and affect the player’s ability to play. In dentistry these are pretty rare, but could include a bombed out tooth that is ready to abscess.

Generally there are five medical staff people at every game. This includes an x-ray tech (who does most of the work) a general physician an orthopedic physician, an ophthalmologist, and the dentist. The physician and orthopedist seem to have something to do at every game. The dentist and eye doctor often do not have anything to do at the game but when a high stick slaps someone in the eye or a butt end snaps off a central, we are suddenly very busy.

People often ask if we travel with the team. The answer is no. The home team medical staff treats both the home team and the visitors. The exception to this is the playoffs. With seven consecutive high stakes games against the same team, knowing the medical condition of players can be a strategic advantage so the doctors go with the team and keep their mouths shut.

I have always shared the team dentist duties with other dentists. It is possible to do it all yourself, but having a group to cover the games makes it a lot easier. I mentioned my partner Ron Foeldi in addition other team dentists who have included: Rick Lawson, Rick Landgren and Byron Larson. Together, we try to keep the players’ teeth off the ice and in their mouths where they belong.

hockey cartoonNote from the Managing Editor:

Sitting with Dr. Emmott during a recent Phoenix Coyotes game, what struck me about him wasn’t his thorough knowledge of the game (although he provided my wife and I with a concise and impressive synopsis of the rules); it was his enthusiasm for it. He cheers for the Coyotes both as their doctor and as a fan. Dr. Emmott may have over 20 years of experience as a professional hockey dentist, which is more than enough time to grow weary of hockey, but he still loves the game.

As someone who played hockey for years I couldn’t resist asking Dr. Emmott a couple of questions between wrist shots, poke checks and kick saves, starting with, ““What’s the worst injury you’ve had to treat?” Pausing for a second, he responded, “Well I wasn’t covering the game that day, but I’d have to say the jaw injury to then Phoenix Coyote forward, Jeremy Roenick.” In 1999, during a game vs. the Dallas Stars, Roenick was crushed into the boards by Stars defenseman Derian Hatcher. The force of the hit broke Roenick’s jaw and left him out of the first few playoff games.”

The other question I was able to squeeze in was, “What has been the most challenging aspect of treating professional hockey players?” “Not being able to follow up on treatment in many cases,” he quickly replied. “Players are on the road a lot, they’re busy, and they often get traded or move from farm teams to the professionals, so it’s difficult to get them in. When it comes to treating the visitor’s players, we often just numb them up so they can continue playing (the cold air going in and out of the mouth with a missing tooth is extremely painful). In most cases they’ll receive treatment from their own doctor when they return home.”

A special thanks to Dr. Emmott for allowing me special access to his professional life; I thoroughly enjoyed the Coyotes game and his hospitality.