THE FIGHT DOCTOR
upon the severity, the jaw should be supported by hand or a cloth wrapped under the jaw and over the head to provide stability. It’s equally important to diagnose a dislocated jaw. The TMJ is the sliding hinge that connects the jawbone to the skull’s temporal bone. It allows you to speak, chew and swallow and has a shock-absorbing disc that sits between the two bones. The right and left sides move together to open and close the mouth, push the jaw
the hand.” All sports where there is significant contact should use well-made mouthguards. I’ve always been amazed seeing pro American football players like Patrick Mahomes hang a simple mouthguard on the side of their mouth between plays. If it really fits, this should be impossible. If a boxer’s mouthguard is well-made, it must be manually removed – not spit out. Dr. Kevin Jones, a Pennsylvania prosthodontist known to many as the
Victor Ortiz succumbed to a broken jaw after nine rounds against Josesito Lopez.
forward and back and slide the jaw side- to-side. A dislocated TMJ needs immediate medical attention to guide the jaw back into its socket – just like replacing a dislocated shoulder. Diagnosis using x-rays or a computed tomography (CT) scan can provide a three- dimensional view of the jaw, and MRI can show the extent of soft-tissue injury. Minor fractures can be treated with a sling to keep the jaw in place. Typically, a soft diet, no smoking (that can increase infection risk), good oral care and avoiding further trauma will help recovery. If a fracture occurred, treatments vary depending on the fracture location. According to multiple recent studies by the Journal of Cranio-Maxillofacial Surgery comparing recovery time following lower facial injuries sustained in soccer and rugby, at least six weeks are required using protective face masks. Some found at least three months of rest were required. In boxing, a fighter has often needed more than six months for adequate healing before considering fighting again or sparring. In 2010, the Journal of Emergencies, Trauma, and Shock examined the prevalence and patterns of combat sport-related maxillofacial injuries. They studied 120 males engaging in four disciplines – including boxing – who had sustained some injury to the face requiring treatment. Almost 60% sustained some kind of dental trauma, including 46.7% of boxers. Eighteen boxers sustained some maxillofacial fractures. While kickboxers
“mouthpiece guy,” has been making custom-fit mouthguards for boxers for more than 20 years. “It needs to fit correctly so the fighter can breathe and opens the bite 2-3 millimeters, so it reduces TMJ pressure, pressure on the buccal area and provides cushioning.” He also stresses that the mouthguard should be 2-3 millimeters in thickness. Although some studies show mouthguard thickness can vary inside the mouth, all agree that too much thickness will not provide extra protection. Jones is against a double mouthpiece and notes that his mouthguards are so secure they won’t fall out even if the fighter is knocked out. He also believes it’s crucial to keep them clean and recommends the boxer be fitted for a new one approximately every two years. Similar to knockouts, each fighter has inherent susceptibility to jaw, TMJ and dental injury. Some things can’t be controlled. But nothing can replace a well- made mouthguard produced and custom- fitted by an experienced dentist. And if such injuries occur, a boxer can’t train them away. Instead, they should closely follow their surgeon’s treatment and recommendations for a complete recovery – otherwise reinjury is almost certain. Dr. Margaret Goodman is the former chief ringside physician for the Nevada State Athletic Commission and is the founder/president of the Voluntary Anti-Doping Association. She co-hosts the Fighter Health Podcast.
suffered serious maxillofacial injuries more often than boxers, all were related to the use of less protective gear. How do boxers prevent TMJ, dental or jaw fractures? The American Dental Association estimates that up to 200,000 injuries are prevented yearly in high school and collegiate athletes by wearing a mouthguard. Mouthguards mitigate oral, dental and maxillofacial injury by acting as a shock absorber but are also believed to lessen the severity of brain injury and even a knockout. Boxing was the pioneer in using mouthguards, dating back to the late 1800s. They were made out of cotton, tape, sponge or even wood and were clenched between the upper and lower teeth. In the 1930s, custom-made mouthguards were made using dental impressions, wax and rubber to provide additional shock absorption. Modern-era mouthguards are now crafted with ethylene-vinyl acetate, polyurethane and silicone, all of which improve the fit and comfort. Respected professional boxing trainer Stephen Edwards notes, “Mouthguards are important because they secure the jaw, and the jaw takes the brunt of most head shots. A good-fitting mouthguard to the jaw is equivalent to a good, secure handwrap for
T he foremost concern regarding head shots in boxing is brain injury. However, we can’t dismiss the acute and long-term damage to facial structures – especially the mandible (jaw), the temporomandibular joint (TMJ) and teeth. Jaw fractures – a break in the upper or lower jawbone – are infrequent in boxing but can interfere with the fighter’s career if inadequately managed. Fighters like Muhammad Ali, Tyrell Biggs and Victor Ortiz each lost with a broken jaw. Ali fractured his jaw during his March 31, 1973, loss against Ken Norton, which he avenged a little over five months later. Jake Paul sustained bilateral jaw fractures when he fought Anthony Joshua in December 2025 and was still under observation five months later. As Paul told The Guardian in May LOWER FACIAL INJURIES IN BOXING AND HOW TO PREVENT THEM By Dr. Margaret Goodman
Jai Opetaia suffered a double jaw fracture against Mairis Briedis in 2022.
2026, “Most definitely [my boxing career could be over].” He has yet to schedule another bout. It’s not always simple to diagnose a jaw fracture. The jawbone can be broken in several locations requiring different treatment and recovery time. A fighter might have difficulty chewing or talking, trouble breathing or even ear pain. There can be bruising and swelling along the jaw line – although that can take time to develop. The easiest way for the fighter to recognize a fractured jaw is that their teeth no longer align and they have trouble closing their mouth, along with pain. Other symptoms can be tingling or numbness along the lower lip or tongue, loose/chipped teeth and bleeding from the lip or gums. When a jaw fracture is suspected in a bout, immediate medical attention is required by the ring physician. Depending
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