Dental Injuries In Sports: Prevention and First-Aid Treatment

Injury prevention

Wearing a mouth guard has been proven to help prevent dental injuries, which is why they are required in a number of college and high school sports, including football, lacrosse, field hockey and ice hockey. 

Baseball and basketball are two sports in which dental injuries are common, but few players wear mouth guards.

The American Dental Association and the International Academy of Sports Dentistry recommend using mouth protection for 30 activities. While some athletes claim mouth guards are uncomfortable and affect breathing and communication, there is no conclusive evidence that breathing or adequate oxygen levels are compromised, even during strenuous physical activity.


Knocked out (e.g. avulsed) tooth

  • Primary ("baby") teeth should never be replanted; replanting should only be attempted for intact, permanent teeth.
  • Every athlete must be evaluated immediately for airway obstruction and then the injured area washed with sterile water and dabbed with guaze. 
  • Ideally, replantation of a knocked out tooth should occur with 5 to 10 minutes. Successful replantation is much less likely after 20 minutes of "extraoral dry time" and highly unlikely after 60 minutes.
  • If unable to replant immediately, the intact tooth or tooth remnants should be kept in a storage media such as (in order of preference):
    • Hank's Balanced Salt Solution
    • Cold milk (skim milk, preferably)
    • Saliva (inside the athlete's cheek)
    • Saline, or
    • Water.
  •  If the intact tooth has debris, then it should be held by its crown, rinsed with water or normal saline, properly oriented by observing the adjacent teeth, and replanted in the socket.
  • Return to play is individual to each athlete. For completely avulsed teeth with no chance of replantation, the player could return within 48 hours with mouth guard protection if no bone fractures are evident.
  • Players who have replantation and splinting of avulsed teeth should wait at least 2 to 4 weeks to return and only with mouth guard and face mask protection.
  • Tetanus status should be determined and consideration given for booster vaccinations if indicated. 

Displaced tooth

  • Move displaced tooth to its normal position, especially if it is interfering with bite.
  • If the pulp is exposed, the tooth may have blood at the fracture site and will be sensitive to temperature and pressure. Capping the tooth with a readily available calcium hydroxide resin from a dental emergency kit is recommended until definitive dental care is provided;
  • With successful treatment the player may return to play with mouth guard protection within 24 to 48 hours (there are no firmly established return-to-play guidelines)

TMJ dislocation 

  • TMJ dislocation can be difficult to differentiate from a displaced mandibular jaw fracture.
  • Moving the jaw back and forth side to side may reduce the dislocation.  Urgent referral to a dentist or oral surgeon should be made if reduction does not occur because swelling or muscle trismus (limited ability to open mouth)
  • Player may return with protection (mouth guard and/or face mask) between 2 and 4 weeks, depending on severity.
  • The risk of another dislocation may be increased with a previous dislocation. 

Tooth-saving kit recommended

  • Proper treatment can improve outcomes.  
  • Prompt referral for complicated crown fractures and TMJ dislocations is "paramount."
  • A tooth-saving kit is useful on the sports sideline. If not available, an avulsed tooth can be transported in milk or saliva. 

1. Young E, Macias R, Stephens L.  Common Dental Injury Management in Athletes. Sports Health: A Multidisciplinary Approach. 2013;20(10):1-6.