Prevention of Sports-Related Orofacial Injuries

Board takeaway

• Assess: Ask about organized sports and recreational activities, then recommend appropriate face protection and a properly fitted mouthguard.
• Fit: Custom guards offer superior retention, comfort, and protection; fit must accommodate eruption, exfoliation, or orthodontic movement.
• Limits: Explain that protection reduces orofacial injury risk but cannot eliminate injuries, and evidence for concussion prevention remains tentative.

Injury risk and consequences

• Falls, collisions, surfaces, and equipment create risk even without league mandates. Basketball commonly involves player-player contact; baseball, softball, and field hockey commonly involve player-object contact.
• Cited surveillance highlights boys’ basketball and girls’ field hockey; competition had approximately three times the dental injury rate of practice.
• Upper lip, maxilla, and maxillary incisors are frequent sites. Lacerations, crown fractures, and avulsions predominate overall; crown fractures predominate in permanent teeth.
• Trauma carries pain, psychological effects, lifelong treatment costs, and school/work losses, disproportionately burdening disadvantaged families.
• The policy reports AAP discouragement of recreational trampoline use; support is limited to structured, supervised training with safety precautions.

Dental risk thresholds

• Trauma frequency increases with inadequate lip coverage and overjet >3 mm in primary dentition or >5 mm in permanent dentition.
• Early- to middle-mixed-dentition orthodontic treatment for overjet >3 mm may reduce permanent-incisor injury severity; this is not an automatic treatment mandate.

Mouthguard selection and fit

• ASTM favors covering all teeth in at least one arch, usually maxillary, excluding third molars. A mandibular guard is recommended for Class III malocclusion.
• Consider anterior occlusion, vertical dimension, comfort, breathing, and sport-appropriate speech.
• Eruption, exfoliation, and orthodontic movement can quickly alter fit. Block-out methods may accommodate change and extend use across seasons; no fixed reassessment/replacement interval is specified.

Protection and evidence

• Guards cushion/distribute impact, separate teeth from soft tissues, and stabilize the mandible. Helmets/facemasks add protection; facemask benefit is clearer for player-object than player-player contact.
• Data suggest a properly fitted 3.0-mm guard might reduce concussion incidence after a jaw blow. This is neither guaranteed protection nor a universal thickness requirement.
• A cited systematic review found custom guards neither improved nor impaired athletic performance; research gaps remain.
• Literature review, surveillance, epidemiology, testing, and specialty guidance support the policy. Estimates vary by population/sport; recommendations lack formal evidence grades.

Prevention in practice

• Provide anticipatory guidance; prescribe, fabricate, or refer for guards in patients at increased risk.
• Address cost, comfort, speech, breathing, and adherence with athletes, parents, and coaches; free guards alone do not assure use.
• Continue preventive practices in football, lacrosse, field hockey, ice hockey, and wrestling with braces; advocate guards in other organized sports carrying orofacial risk.
• AAPD encourages required ASTM-certified face protectors for youth baseball/softball.
• Coaches/administrators should consult an experienced dentist before seasonal practices about immediate injury management, including avulsion.
• Promote payer access, community/legislative partnerships, student training in custom fabrication, and research on affordable, comfortable, effective guards.

Common board traps

Answer aloud

Basketball requires no guard locally—what do you advise?

Recommend a properly fitted mouthguard for basketball’s orofacial injury risk.

• A local mandate is not required for a clinical recommendation.
• Address comfort, retention, breathing, speech, and consistent use.

How do braces affect selection?

Braces and ongoing tooth movement affect mouthguard fit and the space needed for development.

• A custom guard may be feasible, but the child's orthodontic circumstances may require another appropriate design.
• Choose with the orthodontic plan in mind and reassess fit as teeth move.

Does a guard prevent concussion?

Recommend it for orofacial protection; do not promise concussion prevention.

• The policy’s concussion evidence is tentative.
• Its 3.0-mm example is not a universal thickness requirement or a guarantee of protection.