When teeth go flying: Inside the bloody, spine-tingling rush of NHL in-game dentistry

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When teeth go flying: Inside the bloody, spine-tingling rush of NHL in-game dentistry

Playing for the Erie Otters in an overtime game, 17-year-old Ryan O’Reilly darted up the ice, looking to create a scoring chance. As the play unfolded, one of O’Reilly’s opponents on the Owen Sound Attack attempted to lift his stick.

That didn’t go as planned. The Attack player’s stick went straight into O’Reilly’s face, whamming him right in the middle front teeth.

The blast broke one of O’Reilly’s teeth high, close to the gum, and split another one down the middle. The forward skated to his bench, one tooth dangling in his mouth. There was blood everywhere.

That didn’t concern coach Robbie Ftorek as much as having O’Reilly on the ice for an overtime power play. He shoved a mouth guard in his center’s mouth, hitting the dangling tooth and sending shivers down O’Reilly’s spine. “Get back out there!” he told his player.

“The adrenaline of the game, you feel it happen, you’re not sure what’s going on,” O’Reilly said in a recent interview. “After the game, I had a nerve exposed on the one tooth. Opening my mouth, I could feel the air just coming in. It didn’t feel good.”

O’Reilly, who laughs when he tells the story, didn’t score on the power play or on his shootout attempt. After the game, he smiled at his mother and still remembers the horror on her face. He thinks he spotted a few tears in her eyes.

When it comes to hockey players, toothless mouths are an enduring and endearing stereotype — and with good reason. Just look at pictures of Alexander Ovechkin and Brent Burns. Some players don’t wear mouth guards, and the amount of sticks and pucks flying at head level leads to facial injuries. There’s a dentist at every NHL game ready at all times to jump into action.

What actually happens when a player loses a tooth (or more than one) depends on the situation. As was the case with O’Reilly, there’s normally little that can be done at the arena on game night.

“Sutures will probably be as definitive as you get,” Washington Capitals dentist Tom Lenz said. “Otherwise, if they broke a tooth, but it’s not out all the way, we’ll make sure it’s smoothed off or coated with something.”

If the player or one of his teammates finds the knocked-out tooth, the dentist at the arena can clean it off, usually with saline, and put it back into the socket by splinting it to the nearest adjacent teeth that are solidly in place. Then, in four to six weeks, the dentist removes the splint. If all goes well, the body will heal around the tooth and it will be back in place.

Plenty of teeth, though, break upon impact, and Lenz imagines many have been eaten by Zambonis over the years.

Gustav Nyquist picks up his knocked out tooth during a game. (Photo: Steph Chambers / Getty Images)

While a game is going on, Lenz sits in the Zamboni corner. If a player on either team leaves the bench with an injury, Lenz will meet him there unless it’s clearly something unrelated to the mouth. When a player has, in fact, suffered a tooth injury, Lenz’s role is to stabilize. A player will lie on a training table and receive basic repairs, be it the splinting of loose teeth or stitches on gum or lip injuries.

Sometimes players have nerves exposed, as was the case with O’Reilly. That also happened once to Avalanche forward Miles Wood when he was playing with the Devils.

“You’d squirt water in your mouth, and obviously it’s painful,” said the forward, who sports a collection of missing chompers in his top row and also has several fake teeth.

Lenz isn’t able to do full root canals at the arena, but in the case of an exposed nerve, he can essentially do a partial one. He’ll use a small barbed broach and get rid of the insides of the canal. The rest of the root canal, which removes infected and inflamed tooth pulp, will happen whenever the player goes to the dentist’s actual office, not his station at the arena.

“What I’m set up to do (at the arena) is take the nerve out of the inside of the tooth,” he said. “Those are the ones we’ll seal over with some composite at the game. It’s going to need to be made to look nice at some other point, but we’ll get it covered up so that he can breathe and cold air and stuff doesn’t bother him.”

Adrenaline and anesthetics can get a player through the night of the injury. What comes next is far less enjoyable.

“The worst part is the next day when you’ve got to sit in the chair for six hours and just hear the drill,” Wood said.

Six hours is on the long end of a dentist visit, Lenz said. A session that long likely means multiple tooth extractions, as was the case with Wood’s lengthiest trip to the chair. That came when he was playing for the Devils. Burns, with the Sharks at the time, passed a puck through the neutral zone. It hit someone’s stick and redirected into Wood’s mouth, breaking his four front teeth.

The dentist spent seven hours on Wood the next day, the forward remembered, but he returned to the Sharks game. Asked if a lost tooth ever forced him to leave a game for good, he seemed borderline offended.

“Never,” he said. “I would never do that. No.”

Added Lenz: “It has to be pretty severe (for a player to leave the game), to tell you the truth.”

Lenz said more players use mouth guards nowadays than in years past. That helps protect teeth, but it isn’t foolproof. Rangers defenseman Erik Gustafsson was recently wearing one in a game earlier this month, yet a puck still managed to knock out one of his bottom teeth. O’Reilly doesn’t wear a mouth guard because he finds it makes communicating with teammates hard, but he recommends kids play with one in.

Rangers forward Jimmy Vesey recently suffered an oral injury when a puck hit his face at a team practice. He didn’t feel a ton of pain in the moment, though there was plenty of blood. Vesey quickly left the rink and went straight to the dentist, where he got stitches. Two of his teeth were loose, so the dentist put a splint on them. That came off during an ensuing visit, during which the dentist decided one of the teeth was too loose to save and decided to pull it.

“They put some bone in the hole and they stitched it up and I was out of there,” Vesey said.

The actual tooth pull didn’t hurt much, but the pain set in that night.

If a dentist determines a tooth needs to be removed, the actual process of doing so depends on a number of variables, including the point of the season. Depending on the severity and situation, the player might be able to wait until the offseason to go through the extraction process. That way they avoid a stretch of discomfort while playing games.

If an oral injury happens to a visiting player, their team might want to wait for its own dentist to pull the tooth. In that case, Lenz’s job is to make that person as comfortable as possible until that can happen, like taking the nerve out of the tooth.

Many players have artificial teeth put into their mouths. Others, including O’Reilly, will wait until after their career ends for a permanent solution. The Predators center has a flipper tooth, which is a prosthetic he can put in and take out when he pleases. It gives him a good party trick. In 2019, when accepting a “best comeback” ESPY award on behalf of the St. Louis Blues, he pulled out his tooth mid-speech. He did the same while speaking on Zoom to a fourth-grade class in 2021, drawing gasps from the students.

“Kids find it a little crazy, but it is something that gives me a little character,” he said.

He’s needed plenty of replacement flippers over the years, though. He’s left it under restaurant plates before, only for waiters to take it away, mistaking it as a scrap of food. Some have fallen out of his pocket, only to get stepped on.

There are alternatives that are becoming more common than flippers, Lenz said. One is using Invisalign-like material and inserting an artificial tooth that lines up with where a player is missing one.

Vesey still isn’t sure what he’ll do in regard to his missing tooth. He’s likely going to leave it as is for the rest of the season then will decide what’s next. He mentioned the possibility of a flipper but assumes he’ll eventually find a more permanent option.

“If you see me in 10 years,” he joked, “I’ll have great teeth.”

(Illustration: John Bradford / The Athletic; photos courtesy of Getty Images and iStock)