It must be possible to protect those mouths somehow. The damage produced over a full career is famously horrible. Yet it seems almost possible to protect them. We certainly protect eyes now. Even a steel cage is not impossible here.
Of course there is also the ongoing issue of simply making the sport safer. It certainly has been accomplished in the European game. That obviously has not extended to the mouth.
Hockey does not have that far to go actually. Again a cage may be good enough to tackle this. Known rule changes can also eliminate most concussion risk as well. I do think that the league will have to do this simply to avoid the economic cost of delayed legal action from all the damage.
The big problem remains American football. The implied legal cost is long since immense. i do not know how you can play and not be badly concussed as a matter of course.
The ugly, gory, bloody secret life of NHL dentists
Nov 1, 2019
David Fleming
https://www.espn.com/nhl/story/_/id/27851359/the-ugly-gory-bloody-secret-life-nhl-dentists
WHEN THE PUCK finally came to rest, it was almost entirely inside Craig MacDonald's mouth. It was Dec. 21, 2007, and with 1:51 left to play, the Tampa Bay Lightning winger, working in his own zone, stepped in front of an errant, elevated slap shot that instantly cleaved a grisly, bloody and impossibly wide swath of carnage through MacDonald's lips, gums and tongue before reducing nine of his teeth to dust. He spat out the 6 ounces of vulcanized frozen black rubber like it was a rotten MoonPie to reveal a fractured lower gum line and his half-cleaved tongue, hanging by a thread. Even in a sport synonymous with dental trauma, where the enduring image of hockey has long been the disturbing-but-endearing shot of Bobby Clarke's toothless grin reflected in the shiny silver of the Stanley Cup, MacDonald's injury was gruesome enough to earn an on-air attaboy from Don Cherry himself.
Team doctors reconnected the filleted parts of MacDonald's face with 75 sutures, then sent him home, where he sat on the couch until dawn, jolted awake by even the slightest puff of air passing over a mouthful of raw, exposed nerves.
"Worst night of my life," he says.
The next morning wasn't much better. After making his way, ever so gingerly, to the office of Gil Rivera, the Lightning's team dentist, MacDonald opened his mouth and was greeted by ... terrified silence. As a member of the gnarliest and most peculiar fraternity in sports, Rivera has seen it all during his 17 years practicing dentistry in the NHL: a Tooth Fairy teammate delivering goalie Ben Bishop's incisors to the bench for safekeeping; winger Ondrej Palat holding up half his bottom teeth with his tongue after getting lightsabered by an overeager rookie in practice; veterans, like Tomas Tatar, whom Rivera calls "Humpty Dumpties" because they have lost the same three front teeth on four separate occasions; marquee talent in need of work (and a bit of courage) hiding from him at the arena; and a notorious tough guy silently sweating through his clothes during an especially tough bicuspid extraction that Rivera compares to King Arthur pulling Excalibur out of the stone.
"It's just hockey, right?" says MacDonald, who retired in 2013 and, after studying at Harvard, is now an investment consultant in Nova Scotia. "Although I still don't recommend people blocking shots with their teeth."
Still, as MacDonald sat in Rivera's chair the next morning, the anatomy inside the player's mouth -- monstrously swollen gums, shredded tongue and Tic Tac nubs instead of teeth -- was unrecognizable. Rivera recoiled. He had no idea what he was looking at, or where to start. "His mouth was just obliterated," Rivera says. Out of instinct, he grabbed his air and water syringe and began washing away the dried brown blood and coagulate. Still unable to describe what slowly came into view next, Rivera puts his wrist against his mouth and wiggles his four fingers, like a walrus. "Four nerves just dangling there, flapping in the wind," he says. "I was like, 'OK, we need to do [six] root canals right now.' Oh, that poor guy."
Over the next four months, on off-days and between games, Rivera pieced MacDonald back together again during a dozen visits and more than 50 hours in the chair. The most hockey thing ever? MacDonald missed a grand total of one game. And the respect he earned from then-Lightning coach John Tortorella garnered him the most ice time of his 16-year pro career -- as well as a friend, and a dentist, for life.
IT MIGHT BE the gig Rivera wants now. That wasn't always the case. Rivera, who grew up in Puerto Rico, had never seen a hockey game until he attended the University of Connecticut. Three months after completing his residency, and new to Florida, he got a message from the senior partner at his dental practice telling him to report downtown to lend a hand with the Lightning. Rivera Googled "Tampa" and "Lightning" and, after briefly considering that the last thing lightning-strike victims needed was a good tooth cleaning, he realized his boss was talking about the city's NHL team.
Rivera began speed-reading as many gory case studies on extreme dental trauma as he could get his hands on. And what he quickly learned was that while tooth enamel might be the hardest biological substance on earth, it's no match for the sport of hockey. With pucks, sticks and fists flying in all directions at players who famously refuse all means of protection, tooth trauma and trips to the dentist -- most people's worst nightmare -- are as inherent to hockey as ice. Recently, after Florida's Troy Brouwer lost the same two front teeth that Calgary team dentist Kristin Yont had fixed for him when he played for the Flames, he sent her a picture of his wrecking-ball smile while sporting a T-shirt that said it all: 4 out of 5 Dentists Recommend Hockey.
The relentless assault on such a specific body part, especially one as socially and aesthetically important as teeth, has transformed NHL dentists into the unsung heroes of the sports world. Each team keeps a full-time dentist on staff, often seated a few rows behind the bench and armed with a medieval toolkit of needles, forceps, sutures and curettes. Most NHL arenas have dental chairs somewhere near the locker rooms. The work performed there is so vital to teams' health and success that dentists are often some of the few staff members to survive an ownership or coaching change, and many, including Rivera, get championship rings and their own day with the trophy after a run to the Stanley Cup. "After seeing how many lips had been on the Cup, I gave it the slightest little kiss I could ... and then I went and disinfected my mouth," Rivera says.
On his first trip to the Bolts' rink in 2002, Rivera, then a baby-faced 26-year-old, became lost inside the labyrinth of narrow, dark hallways under the arena. After the final horn blew, signaling another Lightning loss -- back then the team was, shall we say, toothless? -- Rivera looked up to see Tortorella, a notorious hothead, charging in his direction. Thinking that Rivera was a fan, a purple-faced Torts started screaming "Who the f--- let this f---ing kid back here!?"
"Somebody came running over, going, 'No-no-no, Coach, that's our dentist!'" Rivera recalls. "I love that guy; he's awesome and super sweet outside all this. But trust me, I made a mark on his mouth later on."
Indeed, Lesson No. 1 in hockey: Sooner or later, everyone answers to the dentist.
This season, it was much, much sooner for New Jersey Devils center Blake Coleman. Midway through the second period in the Devils' season opener on Oct. 4, a teammate's stick clipped Coleman in the mouth, damaging four teeth and depositing a sandwich of fiberglass splinters that had to be extracted as a prelude to an emergency root canal. After missing just four minutes of ice time, though, Coleman returned and scored on a one-handed Frisbee-flip backhand.
Last season's playoffs opened with an even crazier jaw-dropping goal by San Jose Sharks captain Joe Pavelski. Less than six minutes into Game 1 against the Vegas Golden Knights, Burns sent a shot toward the net that literally ricocheted off Pavelski's front teeth and past Vegas goalie Marc-Andre Fleury. After his crowning achievement, Pavelski returned with a new plastic chin guard and a toothless grin that fit in rather well in San Jose.
Burns, for one, lost his first tooth at 16 from a high stick to the mouth the day after getting his braces off. Knowing his mom had paid a small fortune to his orthodontist, Burns was worried she might knock out his other tooth once she found out. The game took care of that in no time, creating in his mouth an old-school look so distinctive that in 2017 the Sharks gave away Gap-Toothed Brent Burns Grills to fans as an in-game promotion. His mom, though, still kids him constantly that she wants that braces money back.
The light shined straight through to the floor.
Callahan's teeth were intact, but there was a 3-inch hole in his cheek, like he was some kind of gaffed tuna. A closer look revealed that a large portion of Callahan's exposed jawbone was covered in a strange black substance. Ochi labored over it with his curette for an excruciating 15 minutes while trying to keep his dinner down. Later, a staff member with more hockey experience informed him, with a shrug, that the substance was stick tape. "There's no manual for this stuff," Rivera says. "But for someone who always wanted to be a dentist growing up, being a part of the NHL means we're doing some crazy stuff -- and I love it."
Or consider Game 4 of the 2010 Western Conference finals, when, after getting smashed in the mouth by a shot, Chicago Blackhawks defenseman Duncan Keith spit out seven teeth like sunflower seeds on his way back to the bench. "It sounds gross and bad," Keith says, "but it happens all the time to guys."
During a game, an NHL team dentist's main priorities are triage, improvisation and speed: Stop the bleeding, yank or file down any dangerous edges and numb the pain so the player can return to the ice as quickly as possible. Restorative oral surgery -- things like root canals, crowns, bridges or removable teeth the players call "flippers" -- is saved for the fully equipped dental office. So it was that Keith left a breadcrumb trail of bicuspids all the way to the Blackhawks' training room, where at one point he counted seven needles in his mouth. He missed just six and a half minutes of the game and returned to the ice, mumbling instructions through numb chipmunk cheeks while setting up the game-tying goal. (Two and a half weeks later, Keith was drinking out of the Cup, presumably through a straw.)
"Gotta leaf it all on the eyesh," he gummed to reporters after the Sharks game.
FOR DECADES, THE pregame ritual in the NHL was for players to write their numbers on coffee cups, place their teeth inside the cups and leave them on a shelf in their lockers before taking the ice. In the 1960s and '70s, the game's giants, players like Clarke, Bobby Hull, Gordie Howe and Stan Mikita, created the enduring and strangely charming archetype of the toothless hockey warrior. For the rest of the world, the eyes might be the windows into the soul. In hockey, it's the teeth. And for half a century, the idea that hockey players would so readily sacrifice their smiles and subject themselves to a lifetime of periodontal pain, all in the singular pursuit of fleeting hockey glory, came to embody the rough, quirky charm of the sport. "Hockey players accept that being in the dental chair is just part of their job," says Yont, the Flames' dentist. "And they do seem superhuman when it comes to that."
At the very least, NHL dentists receive some rather unique (and creepy) keepsakes to decorate their offices. In Rivera's clinic, just across the street from Raymond James Stadium, there's a framed picture of his staff with the Stanley Cup and, just down the hall, a closet full of light green plaster molds of every Lightning player's teeth. All NHL dentists keep molds like these so they have something to work from when the originals inevitably go missing. But jumbled together on a counter, the collection of green jagged fangs, especially with the players' names scribbled on the backs in black Sharpie, looks like some kind of Halloween display.
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Rivera also has a framed jersey that Hall of Famer Martin St. Louis inscribed "thx for the best smile in the NHL!!" During his 13 years in Tampa, St. Louis underwent just about every dental procedure imaginable inside Rivera's office. Routine dental trauma has just always been an accepted byproduct of the sport. Hanging in Solmundson's office in Winnipeg is a picture of an old local pro team in which all but one player have holes in their smiles. Tom Long, the team dentist for the Hurricanes since the franchise moved to Raleigh in 1997, remembers a similar jack-o'-lantern look to his 1966 Dartmouth hockey team.
Yet Long, Rivera and other team dentists now say they can see major changes in the sport of hockey reflected in the improved smiles of their modern-day NHL clients. In other words, the era of tooth trauma in hockey might be down to its last bite.
For starters, fewer fights and fewer head shots mean fewer lost teeth, obviously. College players in the U.S. are required to wear full masks, so a large portion of players arrive in the NHL with all their own teeth. More players are also wearing mouthguards -- although the truth is they're little help when it comes to a direct hit. MacDonald, after all, was wearing a mouthguard. It might have prevented a concussion, which is no small thing, but as for his teeth, all it did was provide a collection tray for his shattered chiclets (and a cautionary tale for his teenage daughters, both of whom play hockey but never without a full mask).
A recent study in the journal Sociology of Health and Illness titled "Straight White Teeth as a Social Prerogative" found that spending on dental services in the U.S. has increased by more than $100 billion since the NHL's coffee cup days. Our smiles are now one of the most potent societal indicators of class, status and fitness, thanks to endless marketing campaigns bombarding us with the message that a mouth full of perfectly straight, white chompers is "linked to ... acceptance into high society, improving employment prospects, and ensuring success in career and love."
As a result, players who just a few years ago would have waited until the offseason, or retirement even, to fix a missing or cracked tooth are repairing their smiles right away.
There will always be holdouts; this is the NHL, after all. In 2016, after a high stick turned him into a "Twilight" extra, Bruins winger David Pastrnak's new look became so popular on Instagram that he decided to keep it. Others decline dental work for an entirely different reason: Some of the toughest athletes in the world are just as terrified of dentists as the rest of us.
Especially the Eastern European players. Several team dentists surmised that because of a different standard of dental care in places such as the Czech Republic and Russia -- where the use of Novocain and anesthesia is sometimes considered an indulgence, even in pediatric dentistry -- players from that part of the world are so terrified of the dentist that Long has seen them visibly shaking from fear in his chair.
"Trust me, hockey players get just as anxious, just as annoyed, just as scared as everyone else," Rivera says. "They are huge, and I am small, but I always find it interesting that, in my dental office, they are always way more afraid of me than I am of them."
LIGHTNING DEFENSEMAN Braydon Coburn understands the terror. He was in Minsk, Belarus, at the 2014 world championship when an Italian player took a wild baseball swing at a loose puck and instead cracked Coburn right across the kisser, shattering his entire top row of teeth. "A total mess," he says. "Just all nubs and blood. The teeth fell out like piano keys."
Tournament officials told him not to worry. You're going to see the top dentist in all of Belarus, they said. Then they escorted him behind the rink into a cinder-block broom closet with a bare light bulb, a dental chair and Soviet-era equipment that looked like it belonged in a Jordan Peele movie. The team chaperone and Russian translator took one look at Coburn's hamburger face and screamed "Nyet!" before running out of the room crying. Still, Coburn didn't want to fly home and miss a chance to represent Canada, so he succumbed to the chair where, using nothing more than thumbs-up and thumbs-down signals to communicate, the Belarusian dentist pummeled him with pulpectomies for nearly three hours. With Coburn on the verge of either suffering a panic attack from the less-than-ideal conditions or passing out from the hot enamel smell of his own tooth dust, the dentist stood up, waved her hands and said "Finish ... after supper, teeth ready."
Without fanfare, she leaned over the chair and pushed them into his mouth. It was a perfect fit.
Coburn was able to remain in Minsk and play in the Canadian national team sweater again.
Now, sitting in the Lightning locker room after a morning skate, the Minsk memory causes Coburn to smile, which in turn reveals his miracle Belarusian bridge, still as tight and strong as the day he got it.
"That dentist saved me," he says.
In hockey, that's just part of the drill.
As the Tampa Bay Lightning's team dentist, Gil Rivera, left, does more than just fill in the gaps between forward Ondrej Palat's pearly whites. Rivera is also on hand at every home game to tend to any on-ice tooth trauma. Edward Linsmier for ESPN
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