A fastball to the face. An elbow during a rebound. A collision on the soccer field. A fall from a bike. These moments happen in an instant. The result can be a cracked tooth, a knocked-out tooth, a fractured jaw, or lacerated lips and gums. The athlete spends the rest of the season in pain instead of on the field.
Most of these injuries are preventable. A properly fitted mouthguard absorbs and disperses impact forces, protecting not just the teeth but the jaw, the temporomandibular joint (TMJ), and even the brain by reducing the force transmitted to the skull. This guide explains what mouthguards do, which athletes need them, and how to choose the right type. For a broader understanding of all dental emergencies, review our guide on Emergency Dentistry: When to Seek Immediate Dental Care. For comprehensive dental care information, see our Complete Guide to Comprehensive Dental Care.
Table of Contents
Key Takeaways (TL;DR)
- Dental injuries are the most common orofacial sports injury. The CDC reports that mouthguards prevent over 200,000 oral injuries each year in the United States.
- Not all mouthguards are equal. Boil-and-bite mouthguards from sporting goods stores are better than nothing. Custom-fitted mouthguards from a dentist provide superior protection, comfort, and fit.
- Mouthguards protect more than teeth. They reduce the risk of jaw fractures, concussions, lip lacerations, and TMJ injuries by absorbing and dispersing impact forces.
- Mouthguards are required in football, hockey, lacrosse, boxing, and rugby. But athletes in basketball, soccer, baseball, wrestling, and martial arts are also at high risk and should wear them.
- Athletes with braces need special mouthguards. Standard mouthguards do not fit over orthodontic brackets. Sports dentists can fabricate mouthguards that accommodate braces and protect the lips from bracket cuts.
The Scope of Sports-Related Dental Injuries
Dental trauma is a hidden epidemic in youth and adult sports. Unlike a sprained ankle or a pulled muscle, a knocked-out tooth or a fractured jaw can have lifelong consequences. The financial cost of replacing a single tooth with a dental implant can exceed $5,000. The emotional cost of losing a front tooth is immeasurable for a young athlete.
According to the CDC, sports-related injuries account for approximately 20% of all dental trauma in the United States. The American Dental Association reports that athletes who do not wear mouthguards are 60 times more likely to suffer dental injuries than those who do. Yet compliance remains low, especially in non-contact sports where athletes mistakenly believe they are not at risk.
How Mouthguards Work: Physics of Protection
A mouthguard is not a brick wall. It does not stop impact completely. Instead, it changes how force is transmitted. Without a mouthguard, a direct blow to the chin or mouth transfers energy directly to the teeth. The teeth slam together. The upper teeth drive into the lower teeth. The result can be cracked teeth, displaced teeth, or fractures of the jawbone.
A properly fitted mouthguard works through three mechanisms. First, it creates distance between the upper and lower teeth. This gap prevents the teeth from slamming directly into each other. Second, the mouthguard material absorbs impact energy by compressing. Third, the mouthguard spreads the remaining force over a larger surface area, reducing pressure at any single point.
Research also suggests mouthguards may reduce concussion risk. When the jaw is struck, the impact forces travel through the mandible to the skull base. A mouthguard that cushions the jaw may reduce the force transmitted to the brain. While more research is needed, the potential concussion protection is an additional benefit for athletes in high-impact sports.
Three Types of Mouthguards: Stock, Boil-and-Bite, and Custom
Not all mouthguards provide the same level of protection. The three main types differ in cost, fit, comfort, and effectiveness. Understanding the trade-offs helps athletes and parents make informed decisions.
Stock Mouthguards (Pre-formed)
These are ready-to-wear mouthguards purchased at sporting goods stores. They come in standard sizes (small, medium, large). They are the least expensive option, often costing $5 to $20. However, they provide the worst fit. Stock mouthguards are bulky, uncomfortable, and often do not stay in place. They can make breathing and speaking difficult. Many athletes spit them out or stop wearing them. The ADA does not recommend stock mouthguards except as a temporary emergency measure.
Boil-and-Bite Mouthguards (Shell-Liners)
These are the most common mouthguards in youth sports. The athlete boils the mouthguard in water to soften the thermoplastic material, then bites down to mold it to their teeth. They cost $15 to $50. Boil-and-bite mouthguards provide better fit than stock mouthguards but are still inferior to custom devices. The molding process is imprecise. The material thickness varies. Over time, they lose their shape and need replacement. They are acceptable for recreational athletes but not ideal for competitive sports.
Custom-Fitted Mouthguards (Dentist-Fabricated)
These are the gold standard. The dentist takes an impression of the athlete’s teeth. A dental laboratory fabricates a mouthguard from the impression using vacuum-formed or pressure-laminated materials. The result is a precise fit that follows every contour of the teeth and gums. Custom mouthguards are thinner, more comfortable, and provide superior protection. They do not interfere with breathing or speaking. They cost $200 to $500. For serious athletes, this is the best investment in dental protection.
Which Sports Require Mouthguards? The Full List
Many people mistakenly believe mouthguards are only for football and hockey. In reality, dental injuries occur in almost every sport. The ADA and the International Academy of Sports Dentistry recommend mouthguards for 29 sports and recreational activities.
High-Risk Sports (Mouthguards Required or Strongly Recommended)
- Football: Required by most leagues at all levels. The National Federation of State High School Associations mandates mouthguards for football.
- Hockey (ice and field): Required. Dental injuries are common due to sticks, pucks, and physical contact.
- Lacrosse (men’s and women’s): Required in men’s lacrosse. Strongly recommended in women’s lacrosse despite lower contact rules.
- Boxing and MMA: Required. Mouthguards are essential for combat sports.
- Rugby: Required at most competitive levels.
- Basketball: Not required but highly recommended. Basketball has one of the highest rates of dental injury because of elbows, falls, and ball impacts.
- Soccer: Not required but strongly recommended. Headers, collisions, and falls cause frequent dental trauma.
- Baseball and softball: Recommended for catchers, infielders, and batters. A wild pitch or line drive can cause severe dental injury.
- Wrestling: Recommended. Close contact and takedowns can cause dental trauma.
- Martial arts (karate, taekwondo, judo, jiu-jitsu): Required in many competitions. Contact with hands, feet, and the mat poses risks.
- Skateboarding, rollerblading, and scooters: Recommended. Falls onto concrete are common.
- Bicycling (mountain biking, BMX, road cycling): Recommended. Falls at speed can cause severe dental and facial injuries.
- Equestrian sports: Recommended. A fall from a horse can cause serious dental trauma.
- Skiing and snowboarding: Recommended. Falls and collisions with trees or other skiers pose risks.
Lower-Risk Sports (Mouthguards Optional but Not Harmful)
Sports like swimming, track and field, gymnastics, tennis, and golf have lower but not zero dental injury risk. A gymnast falling off the balance beam can hit their mouth. A tennis player can take a racquet to the face. A swimmer can slip on the pool deck. The decision to wear a mouthguard in these sports depends on individual risk tolerance and specific activities.
Special Considerations: Braces, Young Children, and Breathing Problems
Athletes with Braces or Orthodontic Appliances
Athletes with braces face two problems. First, standard mouthguards do not fit over brackets and wires. Second, a blow to the mouth can drive the brackets into the lips and cheeks, causing deep lacerations that may require stitches. Special orthodontic mouthguards are available. These are larger to accommodate the braces and have a softer inner layer to protect the lips. Some are double-layer designs that allow the mouthguard to be remolded as the teeth move during orthodontic treatment. Custom-fabricated orthodontic mouthguards from a dentist provide the best protection and comfort.
Young Children and Primary Teeth
A knocked-out baby tooth is not reimplanted. But the injury can damage the developing permanent tooth underneath. Children in organized sports should wear mouthguards as soon as they have enough permanent teeth to hold the device in place, typically around age 7 or 8. For younger children, a boil-and-bite mouthguard or a custom mouthguard from a pediatric dentist can protect both primary and developing permanent teeth.
Athletes with Asthma or Breathing Difficulties
Some athletes worry that a mouthguard will make breathing harder, especially during intense exercise. A properly fitted custom mouthguard does not significantly impair breathing. The mouthguard sits on the teeth, not in the airway. Athletes can breathe around it. If a stock or poorly fitted boil-and-bite mouthguard causes breathing difficulty, upgrade to a custom device. Some custom mouthguards can be fabricated with breathing channels for athletes with severe asthma or anxiety about breathing restriction.
How to Care for and When to Replace a Mouthguard
A mouthguard only works if it is clean, intact, and properly fitted. Poorly maintained mouthguards can harbor bacteria and fungus, including Candida (yeast) and Staphylococcus. They can also lose their protective properties as the material degrades.
Mouthguard Care and Maintenance Protocol
Cleaning:
Rinse with cold water before and after each use. Brush gently with a soft toothbrush and mild soap (not toothpaste, which is abrasive). Soak weekly in a denture cleaner or mouthguard cleaning solution. Air dry completely before storing. Do not leave in direct sunlight or a hot car.
Storage:
Store in a rigid, vented plastic case. Do not store in a closed container while wet, as this promotes bacterial growth. Keep the case away from heat sources.
When to Replace:
Replace a mouthguard when any of the following occur:
- The material becomes thin, torn, or perforated
- The fit becomes loose or the mouthguard falls out
- The athlete has had orthodontic treatment (braces removed)
- The athlete has had new restorations (crowns, bridges, fillings) that change tooth shape
- A boil-and-bite mouthguard has lost its shape (typically after one season)
- A custom mouthguard shows signs of wear (typically after 2-5 years)
Frequently Asked Questions About Sports Mouthguards
People Also Ask
At what age should a child start wearing a mouthguard for sports?
Children should wear mouthguards as soon as they have enough permanent teeth to hold the device in place, typically around age 7 or 8. For younger children in sports like soccer or martial arts, a pediatric dentist can fabricate a smaller mouthguard that fits over mixed primary and permanent dentition. Do not wait until all permanent teeth have erupted. The risk of dental injury exists as soon as a child participates in organized sports.
Does insurance cover custom mouthguards?
Many dental insurance plans cover custom mouthguards, often at 50% to 100% depending on the plan. Some medical insurance plans also cover mouthguards for sports participation, especially for children. Check with your insurance provider. The dental office can usually verify benefits before fabrication. Even without insurance, the out-of-pocket cost of a custom mouthguard ($200-$500) is far less than the cost of treating a single dental injury ($1,500-$5,000 for a root canal or implant).
Sources
The information in this guide draws from the following authoritative organizations and clinical resources:
- American Dental Association (ADA) — Mouthguards for Sports
- Centers for Disease Control and Prevention (CDC) — Dental Trauma Prevention
- American Academy of Pediatric Dentistry (AAPD) — Mouthguards for Children
- International Academy of Sports Dentistry (IASD)
Last reviewed: May 2026
About the Author
Dr. Eli Jackson, DMD is a general dentist who works with youth, high school, and adult athletes to prevent sports-related dental injuries. Dr. Jackson fabricates custom-fitted mouthguards for athletes in Bowling Green and the surrounding region.
At Chandler Park Dental Care, Dr. Jackson offers custom sports mouthguards in a variety of colors and thickness levels to match team colors and sport requirements. The practice serves athletes throughout Bowling Green, Alvaton, Rockfield, Smiths Grove, and Scottsville.
