School of Public Health

Raquel Capote

Epidemiology of sport-related traumatic dental injury among United States High School Athletes


Participation in high school athletics is steadily increasing thus placing more youth at risk for traumatic dental injuries (TDIs). TDI is an important public health problem due to its high prevalence, challenging management, economic burden, and potential for long-lasting detrimental effects. Although TDIs cannot be completely eliminated, injury rates and severity have the potential to be reduced. Objectives: To describe dental injuries and examine the protective effect of mouthguards in sport-related dental injuries in high school athletes. 


National High School Sports-Related Surveillance Study data (2005/2006−2013/2014) were analyzed. Certified athletic trainers from a national sample of participating high schools prospectively record injury incidence and athlete exposure (AE) information for high school athletes participating in 20 sports. A case-control design was used to evaluate the effectiveness of mouthguards. Cases were all reportable dental injuries in the surveillance system during the study period. Four different control groups were used: oral soft-tissue injuries, ankle injuries, eye & nose injuries, and non-head/non-face injuries. 


The incidence rate for dental injuries was 0.63 per 100,000 AE; student-athletes required surgery with greater frequency for dental injuries (32%) as compared to oral soft-tissue, ankle, nose & eye, and non-head/non-face injury groups examined. When comparing dental injuries to the oral soft-tissue injuries, there was a persistent, though statistically non-significant, trend toward protection of mouthguard wear by approximately 20% after adjustment for athlete’s sex, level of exposure, and sport [OR=0.80, 95% CI: 0.23-2.83]; using ankle injuries and non-head/face injuries control groups, mouthguard wear was significantly associated with lower odds of dental injury after adjustment for athlete’s sex and level of exposure [OR=0.35; 95% CI: 0.22−0.55] and [OR=0.25, 95% CI: 0.16−0.39], respectively; using an eye & nose injury control group, mouthguard wear was associated with increased odds of dental injury, although the associate was not statistically significant [OR=1.56, 95% CI: 0.96-2.54]. 


We found that sport-related dental injuries were rarely reported yet often severe. The majority of players complied with the mandatory mouthguard equipment policy and there was some evidence of mouthguard protection against dental injuries.