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

Original Article: Prevention of Unintentional Childhood Injury

Issue Date: October 1, 2020

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 (

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

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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