Wednesday, August 5, 2020

Sticks, pucks and teeth

Ever wonder what it’s like to be a dentist in the National Hockey League? Where your patient pool consists of professional athletes who crash into boards at speeds of up to 45 mph, all while leaving their mouths exposed to the unpredictable trauma that can present in the blink of an eye. Sounds like a practice builder. 

Some people might feel that having a team dentist is a little excessive. A hockey game is 60 minutes, and you would think that a simple toothache could wait until a more appropriate time than, perhaps, in the middle of a must-win playoff clinching showdown between the division rival. But anyone who has witnessed a live hockey game knows that it is one of the most vicious, bloody contact sports in the world. The gloves are dropped, faces get smashed, bones are broken and, more importantly to us, teeth are lost. 

Dating back to the early days of the game, losing teeth has been rather symbolic and embraced. It was rather commonplace for a hockey player to have a partial denture appliance of some sort at some point in his career. Usually worn off the ice, each player would have a paper cup with his name written on it to drop off their teeth on the way out of the locker room. To a hockey player, it is a symbol of toughness and grit, and they take pride in it. 

More recently, players have somewhat exhausted this mindset, as the societal demand for esthetics has become more prominent. Unfortunately, players still lose teeth every day, but they have become more receptive and willing to take on new means of protection to prevent the loss of their pearly whites after a hard day’s work.

This past November, I sat down with the former Colorado Avalanche team dentist, Dr. Steve Barker of Stonebridge Dentistry in Lakewood, Colorado. For 14 years, he served as the sole provider for the Av’s and even found a way to integrate organized dentistry into the NHL. Dr. Barker and his team currently represent the Denver Nuggets, University of Denver athletics and the Colorado Rapids soccer club. He shared with me a wealth of knowledge and some great stories about what it was like to take a career like dentistry and connect it to his passion for professional sports.

Aaron Buban: Walk me through a typical day in your life as a team dentist.

Dr. Steve Barker: I was working in private practice during the day, and if there was a home game, I would go straight to the arena afterwards. They wanted all the medical staff there an hour before the game because our services could be needed at any time. It could be coaches from the opposing team, the refs — anybody who wants or needs our attention. During the game, if there were incidents, you’re getting down to the locker room. We’ve got emergency kits there to do dentistry, and the other docs have what they need. It’s a pretty effective medical facility in the bowels of the arena. 

Afterwards, we would stick around to see if anyone needed attention or treatment. There were times when something happened during the game, and [afterwards, we] would write referrals, set up appointments or contact dentists in other cities.

I’m sure you’ve had to deal with a variety of incidents.

Everything you could ever imagine.

Is there a case that sticks in your head?

There was an incident right before the All-Star break in 2004. Seconds after the puck dropped, one of our guys came up and wiped out an opposing player’s complete anterior dentition with the blade of his stick. He came down to the locker room, and we took out the remaining root tips, which was all we could really do in that setting. I sutured him up, and he smiles at me with a swollen jaw and eight missing teeth and says, “It’s all part of the game.” 

Was there anything that surprised you when you first started dealing with hockey players and their decisions to wear or to not wear face masks?

When I started with Denver University, it was and still is required by the NCAA that all athletes wear complete facemasks. However, when those same athletes get to the NHL, they get a choice. Historically, most of the pro guys would lose the facemask on day one, and that was a tough pill for a dentist to swallow. Back in the Gretzky days, losing teeth was a symbol of pride. Toward the end of my time with the Av’s, it seemed that a lot of the younger guys were leaning toward more protection. Whether that was a half shield visor or a full mask, it was a surprise to say the least.

With esthetics becoming more popular these days, have you noticed more hockey players paying attention to this?

The players have become much more conscious of esthetics. When I started, there were players who had partials or removable appliances, and they would take them out for games and practices, place them in a paper cup and head out to the rink without a care in the world. As my tenure continued, toward the end of 2009, you would see the transition of players becoming very conscientious of their teeth and playing their whole career with a full dentition without any sort of dental procedure, which is phenomenal. A lot of them are wearing mouth guards, along with the face protection, which [shows] they care.

How do you determine whether a player is healthy enough to return to a game after a visit with you?

Most of the time, a lot of it is up to the players. Their main goal is to get back in the game to be there for their team. I’ve seen people play with broken ankles, broken hands, broken arms, broken teeth, broken jaws. Although its usually ill-advised to send them out there, it’s truly amazing how tough professional hockey players are.

When it comes to needles and surgery, does the toughness translate to the dental chair?

You know, guys would show up with broken jaws from getting punched in a fight or a puck to the face. I’d say nine times out of 10, the toughness pretty much just translates right over — “let’s just do it, doc. Do whatever you need to do to get me on the ice.” However, there’s always that one 250-lb 6-foot-8 defensemen who couldn’t take a shot of lidocaine to save his life. 

What happens when players are under the care of multiple dentists?

After a few years, we created an organization with all the team dentists. We created forms that we filled out that described who got injured, what the injury was, what happened, how many stitches were put in and recommended follow-up treatment, and we would give a copy to the trainer of the opposing team.

This group changed our operation. There could now be a transition from one city to the next, where players could encounter trauma in one city and receive all of the necessary follow-up care throughout the remainder of the trip without having to leave the team. The group was further recognized by the NHL and sanctioned as the NHL Team Dentists Association. 

During my time, I served as president of the organization for a year, but I must say, we put together a solid team that changed the dynamic of team dentistry in the NHL. It’s no different from you being involved in ASDA. Right now, you’re a student advocate, and you’re there to represent students’ viewpoint to do what’s right for your people. We based our principles off of the best interests of the athletes. It was great for the NHL.

Do have any advice for dental students who aspire to become a team dentist?

You have to put yourself out there. I graduated from the University of Minnesota in 1982 and moved to Denver shortly after. When I got here, I was a big hockey fan and quickly became a season ticket holder for the Denver University hockey team and had seats for about 14 years with no affiliation with the team. Year after year, my seats got closer and closer to the rink, and by that time, people were starting to get to know me. I got to know the coaches, the staff, the medical team, and one thing lead to another and I kind of just got lucky. 

[A good starting place is at] the high school level, providing mouth guards for high school athletes, spending time with youth sports teams and just being a volunteer. As a student, that can cost you a lot of time, but the rewards are great because looking at the big picture, you’re preventing trauma, you’re helping people out in a great way. And if something happens on the field, at least you’re there for a consult. Most of the high school teams will have their own medical staff, but I can almost guarantee you that they won’t have a dentist on site, and that’s a fantastic place to start. The experience working with athletes at any level is invaluable.

~Aaron Buban, Colorado ’22, Chapter President, ASDA Council on Membership Associate Chair

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