“While there are several good commercially available mouthguard products, all of them require self-adjustment by the athlete and certain amount of practice to achieve good fit,” Dr. Trenton E. Gould from The University of Southern Mississippi in Hattiesburg told Reuters Health by email.

“Custom fabricated mouthguards, properly fitted by a dentist, can often help optimize fit and comfort, both of which contribute to enhanced compliant usage,” he added.

The National Federation of State High School Associations requires mouthguards in only five sports, and the National Collegiate Athletic Association mandates them in only four sports – but oral and dental injuries account for up to 38 percent of all sport-specific injuries, according to NATA.

In a new position statement, the organization makes 31 recommendations for preventing and managing sport-related dental and oral injuries. While most of advice applies to athletic trainers and other healthcare professionals, several of the recommendations are relevant for coaches, athletes and parents, too.

The most important have to do with the wear and care of mouthguards, which as Gould said should be properly fitted and worn consistently.

Athletes should examine their mouthguards daily for fit and for any damage, and the mouthguard should be replaced if it is loose or damaged. Especially for younger athletes, the mouthguard should be routinely inspected for fit and retention to accommodate new teeth and growth.

In addition, said Gould, who is one of the authors of the position statement, “Clinicians, athletic trainers, coaches, and parents should have a plan for how to deal with dental trauma.” At minimum, he added, an appropriate oral health care specialist should be identified in advance for emergencies.

“Most of the dental injury classifications (including tooth and root fractures) covered in the position statement do not represent a dental emergency,” Gould said. “As such, the athlete can be allowed to return to play immediately as pain permits, often with a mouthguard in place to prevent further injury. No additional time loss is warranted, but the athlete should be referred to a trauma-ready dentist within 24 hours.”

In contrast, significant displacement of teeth and tooth loss require immediate removal from participation and referral to a trauma-ready dentist or emergency facility.

While the athletic trainer should know how to handle tooth loss, it’s useful for athletes and parents to know what to do with those teeth. Since the single most important factor for optimal healing is putting the tooth back where it came from, this should be the first objective. The tooth might need to be rinsed gently in cold water, milk, or IV salt solution. After it is replanted, the athlete should bite down on a sterile gauze pad to keep the tooth in place until the dentist can take care of it.

If the tooth can’t be replanted immediately, it should be submerged in a special salt solution – or, if that’s not available, in cold low-fat milk – for transport. It should not be wrapped in dry gauze or a dry paper towel.

Especially for these more serious injuries, it’s up to the dentist to determine when it’s safe for the athlete to return to participation.

“It is critical to have the right sports medicine team including athletic trainers in place to address dental injuries should they occur,” Gould said. “Proper prevention and treatment can ensure the right sports safety protocols are in place so that the athlete can return to activity safely and effectively.”

The complete set of recommendations and the evidence supporting them appear in the Journal of Athletic Training.