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High school athletes seem particularly predisposed to dental injury, but athletic mouthguards have an excellent track record of success in reducing the severity and incidence of dental injuries in sports. Therefore, it has been suggested that mouthguards be made mandatory for high school athletes who participate in sports with risk of injury. The National Federation of State High School Associations currently recommends that mouthguards be mandated for high school football, lacrosse, ice hockey, and field hockey players as well as for wrestlers who are wearing orthodontic appliances. Different states have tried to mandate additional sports with varying degrees of success. This article summarizes the process that leads to rule changes for high school athletes at the national level and discusses the history of 4 states--Minnesota, Maine, New Hampshire, and Massachusetts--that have tried to mandate mouthguards for different sports. Common complaints that lead to the cessation of mouthguard rules, such as speech considerations, breathing ability, and cleanliness, are discussed. [ABSTRACT FROM AUTHOR]