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| CASE REPORT |
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| Year : 2017 | Volume
: 49
| Issue : 1 | Page : 31-33 |
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Traumatic dental injury during yoga practice
Anjali Deshpande, Purva Chaudhari
Department of Pedodontics, VSPM's Dental College and Research Centre, Nagpur, Maharashtra, India
| Date of Web Publication | 16-Jun-2017 |
Correspondence Address:
Anjali Deshpande
Row House Number 26, Jayanti Nagari 3, New Manish Nagar, Nagpur, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ym.ym_17_16
With increasing popularity of yoga as a preventive health practice and therapeutic modality, issues regarding its safety have been analyzed in the scientific literature. Overuse, injury or strain, and sprain are some adverse effects that may be attributed to faulty yoga practice. However, traumatic dental injury as a result of fall during yoga practice is rare and unusual. This article presents a case of an 11-year-old female who fractured her permanent central incisor while practicing yoga posture Kukkutasana (cockerel pose), the arm-balancing posture. She underwent root canal treatment for the fractured tooth followed by restoration with post and core crown buildup. Yoga is known as a source of healing since ancient time, which should not cause any harm. It is recommended to adopt appropriate safety measures while performing yoga practices so that the detrimental physical, psychological, and financial consequences of preventable traumatic injuries can be avoided.
Keywords: Cockerel pose, dental trauma, Kukkutasana, yoga practice
How to cite this article:
Deshpande A, Chaudhari P. Traumatic dental injury during yoga practice. Yoga Mimamsa 2017;49:31-3 |
| Introduction | |  |
Yoga, the spiritual and cultural heritage of India, is practiced as a way of healthy living from the ancient time. Yoga is a means of harmonizing and balancing the body, mind, and soul. With increasing popularity of yoga as a preventive health practice and therapeutic modality, issues regarding its safety have been analyzed in the scientific literature.
Overuse, injury or strain, and sprain are some of the adverse effects that may be attributed to faulty yoga practice. Traumatic injuries such as bone fracture; muscle sprain and torn ligament and tendons may result when yoga postures are practiced beyond the capacity or as a result of injury during practice of balancing poses.
However, traumatic dental injury as a result of fall during yoga practice is rare and unusual. To the best of our knowledge, this is the only case of traumatic dental injury attributed to yoga practice which required emergency care.
| Case Report | | |
This article presents a case of a patient who fractured her permanent central incisor while practicing yoga posture Kukkutasana (cockerel pose). An 11-year-old female [Figure 1] presented to the department of pediatric and preventive dentistry of a private dental college with the chief complaint of fractured and discolored tooth with occasional pain associated with it.
She had trauma 6 months back when she lost her balance while performing arm-balancing yoga posture Kukkutasana [Figure 2] and fractured her permanent maxillary right central incisor. She also had lacerations on the labial mucosa with bleeding. No other types of injuries were recorded. The patient received emergency treatment and medications from a nearby dental surgeon. The patient did not report for her follow-up dental treatment. | Figure 2: The patient performing Kukkutasan Yoga – arm-balancing posture
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However, she reported to a private dental college and hospital after 6 months with the complaint of pain in the fractured tooth. On examination, she was of average height and weight and was in good physical condition with no significant medical history.
The fractured incisor tooth was discolored. It was Ellis Class IV fracture [Figure 3] (tooth turned nonvital due to trauma) according to Ellis and Davey (1960) classification of traumatic dental injuries. | Figure 3: Ellis and Davey's Class IV fracture of maxillary right central incisor
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Radiographic investigations showed no injuries to periodontal tissues and supporting bone [Figure 4]. | Figure 4: Radiograph of maxillary right central incisor showing radiolucency of fracture involving enamel, dentin, and pulp chamber
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Her overjet (protrusion of teeth) and overbite (vertical distance covered by upper incisors over lower incisors when teeth are in occlusion) were normal with adequate lip seal with competent lips. She presented with normal occlusion of Angle's Class 1 molar relationship on both sides and did not have accident prone profile.
Root canal treatment for the fractured central incisor followed by post and core buildup with esthetic restoration was advised.
She practiced yoga regularly for 2 years and was expert in performing many yoga postures that require considerable flexibility. She had participated in district-level yoga competitions.
Arm-balancing yoga postures in yoga require considerable flexibility and are advanced level of yoga practice. In Kukkutasana, the body is lifted off the ground, on the support of both hands, making the form of the practitioner look like a cockerel standing on its legs, hence the name.
Benefits of this posture include strengthening of the arms, shoulders, elbows and wrists, and abdominal muscles. It also stretches chest muscles. The entire body weight is suspended on the arms, hence imbalance is possible even with slightest mistake.
| Discussion | | |
Traumatic dental injuries have impact on oral health-related quality of life. Children with fractured incisors are dissatisfied with the appearance of their teeth. Difficulty with eating food is also frequently experienced by children with fractured teeth (Cortes, Marcenes, & Sheiham, 2002).
Traumatic dental injuries in children and adolescents are a common problem, and several studies have analyzed the prevalence of these injuries in relation to different etiological factors. Falls and sports are the most common causes of trauma (Ain et al., 2016). However, our literature search showed no reported case of dental injury due to fall while performing yoga practice.
A case was reported with an unusual etiology of dental erosion, a 38-year-old patient who was practicing yoga (Kunjal kriya) for over 12 years (Meshramkar, Patil, & Patil, 2007).
In a study carried out in Canada, it was observed that sprain was the most common injury and the most common body region injured was the lower extremity (Russell, Gushue, Richmond, & McFaull, 2015). Poor technique or alignment, previous injury, excess effort, and improper or inadequate instruction were the most commonly cited causes of yoga injuries. Individual asanas were linked with particular injuries in a highly specific way (Fishman, Saltonstall, & Genis, 2009).
Headstand (Shirshasana) was the most often cited yoga posture, and Pranayama and Bikram Yoga were the yoga practices that were most often associated with adverse events (Krucoff, 2007).
Advanced postures that were most commonly associated with injuries as reported by Penman, Cohen, Stevens, & Jackson, (2012) were headstand, shoulder stand (Sarvangasana), and lotus (Padmasana). However, there are no reported evidences of injury resulting from Kukkutasana, the arm-balancing yoga posture.
Injury due to yoga is an infrequent barrier to continued practice, and severe injury due to yoga is rare (Holton & Barry, 2014). In the present case study, the patient resumed with the yoga practice within few days after injury and is continuing very regularly.
This case illustrates that adverse side effects in the form of traumatic injuries can occur when body is pushed to physiologic extremes and when postural balance is not controlled during yoga practice.
Implications for yoga teachers and practitioners
Identifying etiologic factors makes it possible to establish preventive measures to reduce the incidence of trauma while practicing yoga. Yoga should be practiced carefully under the guidance of a qualified instructor. Yoga should not be practiced as a competition.
Beginners should avoid extreme practices. Overlooking the warning signals of pain and discomfort while performing yoga practice may result in serious injury. Yoga practitioners should never push themselves beyond the physical capacity. Use of good quality yoga mats on nonslippery firm surface while practicing balancing yoga postures may avoid traumatic injuries to the practitioners. Protective mouthguard devices to prevent dental injuries may also be considered. Impact-absorbing surfaces around the items on which children are most likely to fall may be provided (Ain et al., 2016)
| Conclusion | | |
Across the world, millions of people have embraced yoga because of its benefits. Although scientific research has proven the efficacy of yoga on health, yoga is not without risk. Relatively few serious adverse events attributed to yoga practice have been reported. It is recommended to adopt appropriate safety measures while performing yoga techniques. Known as a source of healing since ancient time, yoga practice should not cause harm. Yoga practitioners should be warned about the benefits and risks of yoga practices. Adequate precautions must be advised by the yoga instructors so that the detrimental physical, psychological, and financial consequences of preventable traumatic injuries can be avoided.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Ain, T. S., Telgi, R. L., Sultan, S., Tangade, P., Telgi, C. R., & Tirth, A., … Tandon, V. (2016). Prevalence of traumatic dental injuries to anterior teeth of 12-year-old school children in Kashmir, India. Archives of Trauma Research, 5 (1), e24596.  |
| 2. | Cortes, M. I., Marcenes, W., & Sheiham, A. (2002). Impact of traumatic injuries to the permanent teeth on the oral health-related quality of life in 12-14-year-old children. Community Dentistry and Oral Epidemiology, 30 (3), 193-198. |
| 3. | Fishman, L., Saltonstall, E., & Genis, S. (2009). Understanding and preventing yoga injuries. International Journal of Yoga Therapy, 19 (1), 47-53. |
| 4. | Holton, M. K., & Barry, A. E. (2014). Do side-effects/injuries from yoga practice result in discontinued use? Results of a national survey. International Journal of Yoga, 7 (2), 152-154. |
| 5. | |
| 6. | Meshramkar, R., Patil, S. B., & Patil, N. P. (2007). A case report of patient practicing yoga leading to dental erosion. International Dental Journal, 57 (3), 184-186. |
| 7. | Penman, S., Cohen, M., Stevens, P., & Jackson, S. (2012). Yoga in Australia: Results of a national survey. International Journal of Yoga, 5 (2), 92-101. |
| 8. | Russell, K., Gushue, S., Richmond, S., & McFaull, S. (2015). Epidemiology of yoga-related injuries in Canada from 1991 to 2010: A case series study. International Journal of Injury Control and Safety Promotion, 23 (3), 284-290. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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