A Knocked-Out Tooth Is More Dangerous Than You Think — and Mouthguards Can’t Always Save You

Nobody likes when things go sideways — especially in sports. But when they do, it’s good to be surrounded by calm, capable people — maybe a few risk-takers, and at least one person who knows what to do. That’s especially true when a tooth gets knocked out. Make no mistake: when a tooth is fully displaced from the mouth, it’s not pretty. There will be blood — and for those unfamiliar with dental trauma, it’s not for the faint of heart.

Being from Canada, and an avid fan of hockey, I remember a time when the term mouthguard wasn’t even common. Back then, losing a tooth in hockey was a badge of honor. But with the skyrocketing cost of crowns, implants, and bridges, we’ve gotten smarter. Today, the mindset is: play better — and wear the damn guard.

Still, even the best mouthguard can’t completely eliminate the risk of injury. In high-impact sports, the energy forces from impact can exceed the protective abilities of any mouthguard out there. When a tooth is completely knocked out, it’s called an avulsion. When it’s just loosened or shifted but still in the socket, it’s known as a subluxation. For now, let’s focus on what happens when a tooth is 100% gone.

If the tooth isn’t found on the field, there are three possibilities:

1. A spectator pocketed it.

2. The player swallowed it.

3. The player aspirated it (breathed it into their airway).

Aspiration is the most dangerous scenario. If there’s any suspicion, the player should get a chest X-ray immediately. Surgery may be necessary. If the tooth was swallowed, a doctor should monitor the player to ensure it passes safely. Dental treatment options can be evaluated at that point.

More commonly, the tooth ends up on the field — grass, turf, court, mat, or concrete. If found quickly, the best option is to reinsert the tooth immediately into its socket. Use the adjacent teeth as a guide to match the angle, and yes, this may mean placing it with unwashed hands and no gloves. It sounds reckless, but in many cases, the body — and a round of antibiotics — will handle any resulting bacteria. And due to the adrenaline, most players don’t even feel the tooth going back in.

Once the tooth is back in place, the player should see a dentist as soon as possible. The dentist will typically stabilize the tooth by bonding it to adjacent teeth with wire. If the body accepts it, the tooth may re-integrate. However, most cases the tooth will still require a root canal, and in some cases the tooth will eventually undergo necrosis (death), ankylosis (fusion with the bone), or resorption (breakdown of the root over time), all of which may ultimately lead to tooth loss.

In all scenarios, time is the most critical factor. Teeth that are reinserted quickly have a far better chance of long-term survival — sometimes even without further treatment.

So, Why Are Mouthguards So Important?

Because they help you avoid all of this.

A properly fitted mouthguard reduces the chance of dental avulsion, subluxation, and other traumatic injuries. According to sports dentistry data, up to 90% of dental injuries involve the upper front four teeth — the exact zone a well-designed mouthguard is meant to protect.

Mouthguards aren’t just a box to check — they’re your first line of defense. Whether you're in a cage, on a field, or on the court, wearing the right guard can mean the difference between a hard-fought victory… and an emergency trip to the dentist.

So protect your teeth. Wear the damn guard.

Written by Dr. Vesna Delic Romero, Chief Dental Officer of Damage Control Mouthguards