Keeping Your Head—and Your Teeth—After Sports-Related Dental Injuries

Before the Boston Celtics won an NBA championship in 2024, point guard Derrick White had to lose something personal—parts of his teeth. 

When White dove for a loose ball in the second quarter of Game 5, he collided with 7-foot, 1-inch Dallas Mavericks center Dereck Lively and came up with a bloodied mouth that sent him to the locker room. 

White’s injury, a combination of displaced teeth and fractured teeth, was treated by Joey Chang, D08, DG12, a senior clinical instructor at Tufts University School of Dental Medicine and practicing oral and maxillofacial surgeon. 

Chang, who had been watching the game and was honored to treat White after the Celtics clinched the championship that night, sees injuries like these regularly in his private practice. 

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Derrick White handles the ball in a USA Basketball Showcase game against South Sudan in London on July 20, 2024. Team USA won 101-100. Photo: Courtesy of USA Basketball

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Derrick White handles the ball in a USA Basketball Showcase game against South Sudan in London on July 20, 2024. Team USA won 101-100. Photo: Courtesy of USA Basketball

Treatments for sports-related dental injuries, the most common of which are caused by teeth making contact with the lips, vary widely. When teeth are affected, treatments can include repairing chipped teeth using bonding solutions, and undergoing more involved procedures like root canals, depending on the severity.

“With injuries like Derrick’s, if the tooth is structurally sound but it is displaced within the bone, the management can range from splinting the tooth, to a root canal and a crown. If the teeth are fractured, they may need fillings or a crown. If the teeth are fractured or displaced beyond repair, then the teeth may need to be removed and replaced with an implant,” Chang said. “Protecting the teeth with athletic mouthguards is the most important thing an athlete can do.”

Mouthguards Matter

When comparing athletes who identify as mouthguard users to non-mouthguard users, a study published in Sports Med found that the latter were up to 1.9 times more likely to incur an orofacial injury while playing sports. 

“If you don’t wear a mouthguard, you’re basically twice as likely to damage your teeth,” Chang said. “It can depend on participation in contact sports versus non-contact sports, but Derrick’s injury—and he wasn’t wearing a mouthguard—was just as bad as any hockey injury.” 

Hockey dental injuries like those sustained by Team USA’s Jack Hughes, who lost two teeth in a game before scoring a goal in overtime against Canada to take home Olympic gold, are gruesome to look at but are relatively common. 

More than 30% of 169 respondents surveyed for a paper published by the Journal of the Canadian Dental Association reported a past oral injury from hockey, with the most common being an oral laceration (62%), followed by broken or chipped teeth. Forty-six percent of those surveyed never wore a mouthguard, 23% always wore a mouthguard, and 15% sometimes did—with 17% only wearing one when it was enforced. 

In certain instances, a mouthguard may still not keep an athlete from catastrophe. When Chang was a resident, he treated a hockey player who was hit with a stroke of sheer bad luck when he was struck with a puck—which went through the protective mask cage on his helmet—and broke his jaw. 

“It was the perfect storm sort of thing,” Chang said. “It perfectly fit through the cage, but the difference of just a couple of millimeters could have changed the outcome. He was wearing a mouthguard, but he ended up needing to have his jaw wired shut, and he was a pretty important player on his team.”

With a broken jaw, a player like the one Chang treated will likely be out of the rotation for six weeks. This critical period both allows the bone to fuse and prevents re-injury. 

“When I’m really considering what’s best for the patient with that type of injury, they’re going to be out of regular games for a full six weeks,” Chang said. “It’s the same as if someone broke their arm. Going to practice should be fine.”

Chang, who was an engineer before attending dental school, recently calculated how fast a puck flies coming off a slapshot and how much pressure that puck would apply to someone’s face and teeth.

“It can reach 80-something miles per hour and bring 20-40 pounds of pressure on your teeth or tooth,” Chang said. “I feel like most hockey players I’ve met think losing a tooth is almost a badge of honor, but it just makes it so much harder for us to treat them in the future.”

With repeated trauma to the jaw and the teeth, procedures like implants, which require drilling into bone to place the fixture to be successful, can be impossible. “A lot of times with those injuries, the bone is gone,” Chang said.

If an athlete, hockey player or otherwise, sustains concussed or luxated injuries, meaning bruising or shifting of the teeth respectively, the recovery period is shorter. 

“The healing time with these types of injuries isn’t as long because, especially if someone wears protective gear or a mouthguard, they can usually go back to practice after two weeks or so,” Chang said. 

Working with Young Athletes

Despite their effectiveness, Chang said young athletes can be resistant to wearing them because they’re worried that they might be a sign of weakness. 

“I’ve worked with young athletes who’ve said they don’t want to wear their mouthguards because other kids don’t wear them,” Chang said. “Wearing a mouthguard isn’t a sign of weakness; it actually protects you down the line from things like developing temporomandibular joint disorders (TMJ).”

One of the causes of TMJ disorders, Chang said, is a result of an injury deteriorating the joint that moves the jaw. 

“It’s basically arthritis of the joint due to an injury,” Chang said. “We treat the jaw the same as any other joint, so we can debride it, clean it out, and even move it into a better position. In some cases, we go as far as replacing the joint. If someone had a bad knee injury, they might require a knee replacement someday. When there are serious injuries, there are usually implications down the line.”