Front teeth take the damage in sport. Upper central incisors, usually, in someone between eight and fifteen, usually from an elbow, a stray boot, a ball at close range or the ground. Rugby league and union, AFL, hockey, basketball, cricket, skateboarding and scooters account for most of what we see across the Tweed Valley.
What happens in the first few minutes at the ground makes a real difference to the outcome, and most sideline first aid kits are not set up for it. This is worth reading before the season rather than during it.
The first few minutes
Stop play and check more than the mouth. A blow hard enough to damage teeth can also cause concussion or a jaw injury. Confusion, a headache, nausea, or trouble opening and closing the mouth normally all take priority over the tooth. If there is any suspicion of concussion, follow your sport’s protocol and see a doctor.
Control the bleeding. Clean gauze or a clean cloth, firm pressure, sitting upright and leaning slightly forward. Mouth injuries bleed impressively because the tissue is well supplied with blood, and it usually looks worse than it is.
Find the tooth or the fragment. Look on the ground and check the mouth, including under the tongue and inside the lips. A missing fragment that is not on the ground may be embedded in the lip, which needs a doctor to look at it.
If a whole adult tooth is out, this is the urgent one. Hold it by the crown, not the root. If dirty, rinse briefly in milk. Reseat it in the socket if you reasonably can and have the player bite gently on gauze. If not, put it in milk. Then straight to a dentist. The full first-30-minutes guide covers this in detail, including why a knocked-out baby tooth must never be put back.
If a tooth is loose or pushed out of position, do not force it back. Get it looked at the same day.
If a tooth is chipped, keep the piece in milk. A chip that shows a pink spot in the middle has exposed the nerve and needs seeing that day.
Cold on the outside of the face, never heat. Fifteen minutes at a time for swelling and bruising.
The thing missing from most first aid kits
A small carton of long-life milk.
It costs a couple of dollars, sits in the kit all season, and is the difference between a tooth that can be replanted and one that cannot. Water destroys the cells on the root surface within minutes. Milk keeps them viable long enough to get to a dentist.
Add clean gauze, a cold pack and a small sealable container, and the kit is genuinely equipped for a dental injury. Most are not, which is why so many teeth arrive wrapped in a dry tissue.
Mouthguards, honestly
A mouthguard is the only piece of the puzzle you control in advance.
Custom-fitted guards are made from an impression or scan of the teeth. They fit closely, stay put without being clenched, allow reasonably normal speech and breathing, and can be made in team colours, which matters more for compliance than adults expect.
Boil-and-bite guards from a sports shop are considerably better than nothing and are a reasonable stopgap. The trade-off is fit. They tend to be bulkier, they loosen as they age, and many players end up holding them in place by biting, which is why they get spat out and left in a bag.
The honest summary: the best mouthguard is the one that gets worn every session. A fitted guard wins mostly because it is comfortable enough that wearing it is not a decision each week.
Two practical notes. Children’s guards need remaking regularly because their teeth are still coming through, so a guard fitted at nine will not fit properly at eleven. And if your child is in braces, a guard matters more, not less, because a lip driven into brackets tears. A guard made to fit over the appliances is the right one, and it will need replacing as treatment progresses.
Some health fund extras policies contribute toward a custom mouthguard. Worth checking your cover before the season starts, since it is a planned purchase rather than an emergency one.
After the injury, what follows
A tooth that has taken a significant knock needs following up even when it settles down, and this is the part people skip once the drama passes.
The blood supply to the nerve can be damaged by the impact without the tooth moving at all. Sometimes the nerve recovers. Sometimes it dies quietly over the following months, and the first sign is the tooth darkening, or an abscess appearing a year later. Neither is an emergency in the week after the game, which is exactly why the follow-up appointment gets missed.
We generally want to see an injured tooth again at intervals over the following year, with a check of how it responds to cold and an X-ray to compare against the original. Catching a dying nerve early usually means straightforward root canal treatment rather than dealing with an abscess later.
If your child took a knock last season and the tooth has since changed colour, that is worth an appointment even though it does not hurt.
Getting seen
We are open Monday to Friday, 8:00am to 5:00pm, at Level 1, Tweed Arcade, 2 Queen Street in Murwillumbah. Ring (02) 6672 1980 as early in the day as you can.
You do not need to be an existing patient. We look after families from Murwillumbah, Uki, Pottsville, Kingscliff and across the border, including visiting teams.
If an injury happens outside our hours and there is a facial injury, a suspected broken jaw, or bleeding that will not stop with firm pressure, go to a hospital emergency department. For everything else, see our emergency dentistry page for what to do first.
Frequently asked questions
What should be in a team first aid kit for dental injuries? +
A small carton of long-life milk, clean gauze, a cold pack, and a sealable container. Milk is the single most useful item, because it keeps a knocked-out tooth viable far longer than water or a dry tissue does.
Is a boil-and-bite mouthguard good enough? +
It is much better than nothing. A custom-fitted guard made from an impression fits closer, is less bulky, does not need to be held in place by clenching, and is therefore worn more consistently. Consistency is most of the protection.
Can you play with a knocked-out tooth reimplanted? +
No. Once a tooth has been reimplanted it needs to be splinted and left alone. Finishing the game risks losing it permanently, and there may be other injuries that have not shown themselves yet.
Do mouthguards protect against concussion? +
The evidence for that is not settled and it should not be the reason you wear one. What a mouthguard clearly does is protect teeth, lips and the jaw from direct impact, which is reason enough.
My child wears braces. Can they still wear a mouthguard? +
Yes, and it matters more, not less. Braces turn a lip impact into a laceration against the brackets. A guard designed to fit over orthodontic appliances is the right choice, and it will need remaking as the teeth move.