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Beginning in January 2000, all individuals participating in basic military training at Fort Leonard Wood, Missouri, were issued boil-and-bite mouthguards. From January 2000 to March 2001, trainees were required to wear mouthguards only for a single activity, pugil stick training. After March 2001, mouthguards were required for four activities including pugil stick training, unarmed combat, rifle/bayonet training, and the confidence/obstacle course. Dentists systematically tracked trainees who reported to the dental clinic with orofacial injuries during three periods: January 2000–March 2001 (phase 1), April–September 2001 (phase 2) and September 2002–June 2003 (phase 3). Orofacial injury rates were 3.35, 1.89 and 1.91 cases/10 000 person-years in phases 1, 2 and 3, respectively. The overall risk of an orofacial injury was 1.76 (95% confidence interval = 1.03–3.02) times higher in phase 1 compared with the combined phases 2 and 3 (P = 0.006). Thus, orofacial injury rates were lower when mouthguards were required for four training activities as opposed to one training activity. Mouthguards are now required at all five Army basic training sites when trainees are performing any of the four training activities.