Letters to the Editor

Oral and Dental Injury Prevention in Children and Adolescents


Am Fam Physician. 2021 Mar 15;103(6):328.

Original Article: Prevention of Unintentional Childhood Injury

Issue Date: October 1, 2020

Available at: https://www.aafp.org/afp/2020/1001/p411.html

I applaud Drs. DeGeorge, Neltner, and Neltner for their thoughtful coverage of the important topic of preventing unintentional childhood injury. One important preventable injury topic was not included: oral and dental injuries. In children younger than six years, oral injuries are the second most common injury, accounting for approximately 20% of all injuries.1 The greatest incidence of trauma to the primary teeth occurs at two to three years, when motor coordination is developing.2 By age 14, one-third of all children will have experienced a dental trauma,3 with 11,000 emergency department visits annually for sports-related dental injuries in children and teens.4 The American Dental Association (ADA) recommends the use of mouth guards in 29 sports and exercise activities.

Oral trauma prevention can easily be worked into other injury-prevention messages during well-child visits, much in the way the authors promoted discussing the use of bicycle helmets and wrist and elbow pads. According to the ADA, athletes are 60 times more likely to suffer harm to their teeth when not wearing a mouth guard. Individuals who wear mouth guards are between 82% and 93% less likely to incur dental injuries.5 A mouth guard can cost as little as a few dollars for a “boil and bite” style and more for custom-fitted guards (which are covered by public dental insurance in many states). This messaging is consistent with the 2018 American Academy of Family Physicians policy that encourages its members to be aware of the serious disparities surrounding oral health, and to advocate for and engage in strategies that address the underlying social determinants of oral health (https://www.aafp.org/about/policies/all/oral-health.html).

Editor's Note: This letter was sent to the authors of “Prevention of Unintentional Childhood Injury,” who declined to reply.

Author disclosure: No relevant financial affiliations.


show all references

1. Malmgren B, Andreasen JO, Flores MT, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition. Dent Traumatol. 2012;28(3):174–182....

2. Flores MT. Traumatic injuries in the primary dentition. Dent Traumatol. 2002;18(6):287–298.

3. Andreasen JO, Andreasen FM, Andersson L. Textbook and Color Atlas of Traumatic Injuries to the Teeth. 4th ed. Munksgaard; 2007:224–225.

4. Montero E, Kistamgari S, Chounthirath T, et al. Pediatric sports- and recreation-related dental injuries treated in US emergency departments. Clin Pediatr (Phila). 2019;58(11–12):1262–1270.

5. Fernandes LM, Neto JCL, Lima TFR, et al. The use of mouthguards and prevalence of dentoalveolar trauma among athletes: a systematic review and meta-analysis. Dent Traumatol. 2019;35(1):54–72.

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This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.



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