Does my teenager need a sports mouthguard, and how do I know whether it fits and protects well?

Which sports call for a mouthguard

Mouthguards are usually associated with football, hockey and boxing, but the American Dental Association recommends one for any activity with a risk of a blow to the face or a fall. In practice that includes sports such as basketball, soccer, lacrosse, skateboarding, biking, gymnastics and martial arts. The American Academy of Pediatric Dentistry makes the same point from the other direction: every sport carries some risk of injury to the mouth and face from falls, collisions and contact with hard surfaces, and a mouthguard works by spreading the force of an impact so that less of it lands on any one tooth.

The evidence behind the recommendation is reasonably consistent. A 2019 systematic review that pooled observational studies found that athletes who did not wear a mouthguard had more than twice the risk of an injury to the mouth, teeth or face (an orofacial injury) compared with those who did. The studies differed in design and in how they defined injury, so the exact figure should be read loosely, but the direction is clear.

The practical point for a parent is that the question is less "does my teen need one" than "is the one we have doing its job." A guard in a gym bag protects nothing, and a guard that has to be held in by clenching is one a teen will spit out at the first water break.

The three types, and what fit really means

Stock guards

Sold ready to wear in a few sizes. They are the least expensive and the least adaptable: nothing about the shape can be changed, so they tend to be bulky, which makes breathing and talking harder, and they are often held in by biting down rather than by gripping the teeth.

Boil-and-bite guards

Softened in hot water, placed in the mouth and shaped by biting and pressing with the fingers and tongue. The fit is usually better than a stock guard and the price is modest. The result depends heavily on how carefully the guard was molded; one that was overheated or bitten through may end up thinner over the front teeth, where cover matters most.

Custom-made guards

Made by a dentist from an impression or a digital scan of the teen's teeth. The ADA describes a custom guard as the best-fitting option: it grips the teeth so it stays in place without clenching, and its thickness is controlled during manufacture. It costs more than the other two, and because a teenager's mouth is still changing it may need remaking as the teeth move. If a custom guard is not an option, the ADA's position is that a stock or boil-and-bite guard is still better than none.

Whatever the type, the ADA's description of an effective guard is a useful checklist: comfortable, tear-resistant, durable, easy to clean, and not restrictive of breathing or speech. Most guards cover only the upper teeth; a dentist may suggest a lower guard as well when there are braces or another fixed appliance on the lower jaw.

What changes the answer for your teen

• Braces. Brackets and wires can cut the lips and cheeks in a collision. Ask the orthodontist for a guard designed to fit over braces, wear it at practice as well as games, have it refitted or remade as the teeth move, and replace it when it is damaged or no longer fits well.
• Clear aligners. Aligners are removable trays that only work when worn for most of the day. Ask the orthodontist or dentist whether the guard goes over the aligner or the aligner comes out for the sport, and how the missed hours are handled.
• Growth and new teeth. Children and teens often need new guards more often than adults because their mouths are still growing and teeth are still coming through. A guard that fit in September can be loose by spring.
• Crowns, bonding, veneers or an implant. Mention these at the fitting visit so that coverage and thickness over that area can be considered.
• Grinding. A sports guard and a night guard are different devices for different jobs; a dentist who sees grinding wear may suggest a separate night appliance. See custom night guard or store-bought guard for that decision.
• Breathing and speech. A teen who cannot call for a pass or breathe hard through the mouth will not keep the guard in. Comfort is a protection issue, not a luxury.

What a mouthguard does and does not protect

A well-fitting guard cushions blows that would otherwise chip or break teeth, drive teeth into the gum or knock them out, and it keeps the lips, cheeks and tongue from being cut against the teeth. That is where the evidence is strongest.

Concussion is a different matter. The same 2019 review that found a clear benefit for mouth and facial injury found only a small, statistically uncertain difference in concussion rates between players who wore guards and those who did not. A concussion is a brain injury caused by a blow to the head or a jolt that moves the brain inside the skull; a guard on the teeth does not change that physics in any proven way. The honest summary is that a mouthguard has not been shown to prevent concussion, and a teen wearing one should be treated after a head impact exactly as a teen without one would be.

A fit check you can do at home

Have your teen put the guard in and then open the mouth without biting down. It should stay on the upper teeth on its own. Ask them to speak a sentence and to breathe hard through the mouth; a little muffling is normal, gagging or gasping is not. Look at the edges: the guard should cover the upper teeth from front to back, including the molars, with no bare front edge where a tooth could take a direct hit; a dentist can confirm whether the edges and thickness are adequate. Then look at the thickness over the front teeth and the biting surfaces; a boil-and-bite guard that has been chewed through is no longer doing its job there. Finally, ask about sore spots after a session. Pain is a reason to adjust or replace, not to persevere.

Caring for the guard and knowing when to replace it

The ADA's care advice is short. Rinse the guard before and after each use, or brush it with a toothbrush and toothpaste, and occasionally wash it in cool, soapy water and rinse well. Carry it in a sturdy case with vents so it can dry and bacteria are less likely to grow. Keep it out of the sun and away from hot water, including the dishwasher and a hot car, because heat distorts the plastic. Check it regularly for tears, thin spots and loosening, and bring it to each dental visit so the dentist can inspect the fit.

Replace it right away if it is worn, damaged or no longer fits snugly, and expect a growing teen to need a new one more often than an adult. Ask the dentist how often makes sense for your teen's age, sport and mouth.

If an injury still happens

Emergency care comes first. Breathing or swallowing difficulty, bleeding that will not stop with firm pressure, severe facial trauma, loss of consciousness, or a suspected concussion (one pupil larger than the other, drowsiness or trouble waking, a headache that gets worse, slurred speech, weakness, numbness or loss of coordination, repeated vomiting, seizures or increasing confusion) mean calling 911 or going to the nearest emergency department. Those situations are not for an online appointment request. Dental care follows once the teen is medically safe.

A knocked-out permanent tooth is time-sensitive. Pick it up by the crown (the white part), not the root. If it is dirty, rinse it briefly in milk, saline or the teen's own saliva; do not scrub it, use soap or wrap it in tissue. If the teen is alert and the tooth is a permanent one, put it back in the socket facing the right way and have them bite gently on gauze or a clean cloth. If that is not possible, keep it moist in cold milk or tucked inside the cheek, never in water or dry, and get to a dentist immediately, ideally within 30 minutes. The full first-steps guide is at a knocked-out adult tooth, with local versions for families near Carpinteria or Summerland and for UCSB students.

A chipped or broken tooth should be rinsed with warm water, with a cold compress on the face for swelling and any pieces saved; see a dentist promptly. A cut lip, cheek or tongue is cleaned gently, held with pressure and a cold compress; if the bleeding does not stop, that is an emergency department visit. Bring the mouthguard too, since a guard that was in during an impact may itself be damaged.

The next step

Bring the guard to your teen's next check-up and ask for the fit to be checked against their current teeth and any orthodontic appliance. Occlusal guards (night guards for grinding) are among the services listed at Loul Dental Studio; whether the office makes custom sports mouthguards, or refers out for them, is something to ask when you call or request an appointment. A request is not a confirmed appointment, and it is never the route for an injury that is bleeding, swelling or involved the head.