Study Examines Link Between Orocraniofacial Trauma and Dental Injuries

A Quarter of Severe Facial-Trauma Patients Suffer Dental Injuries, Global Review Finds

When doctors assess a patient after a serious blow to the face or head, broken bones, brain injury and bleeding usually command immediate attention. Teeth can become an afterthought. A new international analysis suggests that omission may be costly: nearly one in four people with orocraniofacial trauma also sustain dental injuries, making the mouth an important but frequently overlooked part of both emergency care and forensic investigation. The study, published in the International Journal of Legal Medicine, estimates that dental injuries occur in 24.3 percent of orocraniofacial-trauma cases, although the researchers caution that the true burden may be obscured by inconsistent reporting and differences among patient populations. Their findings point to the teeth as more than casualties of impact. Dental damage can preserve evidence about how an injury occurred, help identify victims and, in some circumstances, contribute to reconstructing violence or determining the cause of death.

Orocraniofacial trauma is a broad medical category encompassing damage to the oral cavity, facial bones and cranial structures. It can result from road traffic collisions, falls, interpersonal violence and other high-energy events. The forces involved may act directly on the mouth or transmit through the facial skeleton, causing fractures, displacement, loosening or loss of teeth. The front teeth of the upper jaw are particularly exposed because of their position at the leading edge of the face. Unlike many soft tissues, teeth are composed largely of mineralized structures, including enamel and dentine, that can survive severe environmental conditions and retain distinctive anatomical features. Those properties give them clinical importance in treatment and forensic value after death. Yet trauma assessments may focus so heavily on life-threatening injuries that a damaged tooth is documented incompletely, or not at all, especially when a patient is unconscious, intubated or unable to communicate.

To measure the association systematically, Linda Yuliati, Mindya Yuniastuti, Oskar Nowak and colleagues conducted a systematic review and meta-analysis under the PRISMA 2020 reporting framework. The researchers searched PubMed, Scopus, Web of Science, ProQuest and the Cochrane Library from the beginning of each database through March 2026, without restricting the search by language. From 1,860 records initially identified, 18 studies met the inclusion criteria. Together, those studies represented 46,247 participants in 12 countries, giving the analysis a substantially broader base than any single hospital or regional investigation. The team assessed study quality with the Newcastle–Ottawa Scale for nonrandomized research and the RoB 2 tool for randomized trials, then combined results using a random-effects model. That statistical approach allows the underlying effect to vary among studies rather than assuming that every population, healthcare system and injury mechanism is identical.

The pooled estimate of 24.3 percent came with a 95 percent confidence interval of 19.8 to 29.1 percent. In practical terms, the analysis suggests that, across the populations represented in the evidence, approximately one out of every four people experiencing orocraniofacial trauma had an associated dental injury. The relatively broad interval reflects uncertainty in the estimate, while the high heterogeneity—an I² value of 81.2 percent—signals that the studies differed considerably in their results. In meta-analysis, I² describes the proportion of variation between observed study estimates that cannot readily be attributed to sampling error. A value above 75 percent is commonly interpreted as substantial heterogeneity. It does not invalidate the overall result, but it means the pooled percentage should not be treated as a universal rate for every emergency department, age group or mechanism of injury. Differences in definitions, examination practices, injury severity and access to dental specialists may all influence the numbers.

The most frequently reported pattern involved fractures of the dental crown, the visible portion of a tooth above the gum line. The analysis found an odds ratio of 2.09 for crown fractures, with a 95 percent confidence interval from 1.74 to 2.51. An odds ratio compares the odds of an outcome between groups; an estimate of 2.09 indicates that crown fractures were more than twice as prominent in the relevant trauma comparisons, although the precise comparison depends on how individual studies defined their control or reference groups. Crown fractures can range from small chips involving enamel to deeper breaks extending through dentine and toward the pulp, the living tissue containing nerves and blood vessels. More extensive fractures can expose the pulp, increase pain and infection risk, and threaten the long-term survival of the tooth. Clinically, identifying the fracture pattern quickly can therefore affect whether a tooth is restored, stabilized, monitored or extracted.

Among the mechanisms examined, interpersonal violence showed the strongest association with dental injury, with an odds ratio of 2.61 and a 95 percent confidence interval of 1.98 to 3.44. The result does not prove that violence causes a particular dental injury in every case, nor can a tooth alone establish the identity of an assailant. It does, however, underline why oral examination can be important when clinicians and forensic specialists document suspected assaults. A blow directed at the mouth may produce a combination of lip lacerations, bruising, tooth fractures and injuries to supporting bone. The location and orientation of damage can be recorded alongside photographs, radiographs and other medical findings. In forensic contexts, dental records, restorations, missing teeth and distinctive anatomical characteristics may also be compared with available information to assist victim identification. Such evidence is strongest when collected promptly and documented using consistent terminology.

The review identified demographic patterns as well. Male patients showed a recurring association with dental injuries, with an odds ratio of 1.58, while people younger than 18 had an odds ratio of 1.45. These figures describe associations observed across the included studies, not biological destinies. Exposure to traffic collisions, sports, falls, physical aggression and other hazards may differ by age and social setting, while children and adolescents also have developing dentitions and facial structures that alter injury risk. The researchers reported that the maxillary anterior teeth—the upper front teeth—accounted for 82.7 percent of injuries. Their vulnerability has a straightforward mechanical explanation: these teeth project forward and are often the first dental structures to meet an external force. Their position also means that inadequate lip coverage, facial geometry and the direction of impact can influence the likelihood and severity of damage.

The forensic implications extend beyond identifying victims. Teeth can help establish whether an injury occurred before or around the time of death, distinguish damage caused by trauma from changes produced after death, and contribute to the interpretation of events when other evidence is incomplete. Dental injuries may also document violence that would otherwise be underestimated, particularly when external facial wounds are subtle or when the patient’s account is unavailable. But forensic interpretation requires caution. A fractured tooth is not a unique fingerprint of a particular event, and conclusions must be integrated with medical histories, imaging, witness accounts and other physical evidence. Previous dental treatment can complicate interpretation because fillings, crowns and root-canal procedures may change the appearance and strength of teeth. The new review’s central message is therefore not that dentistry can solve every trauma investigation, but that dental findings should be preserved as part of a complete record.

The authors argue that routine dental examination should be integrated into trauma assessment and forensic investigations, especially for patients with injuries to the face, mouth or skull. A structured examination could include inspection of every visible tooth, assessment of mobility and displacement, evaluation of the gums and oral soft tissues, and radiographic imaging when fractures or root injuries are suspected. Clinicians must balance this examination against airway protection, bleeding control and other urgent interventions, but a brief initial record can prevent valuable information from disappearing as swelling, treatment or healing changes the injury. Photographs, dental charts and imaging can also support communication between emergency physicians, dentists, oral and maxillofacial surgeons, pathologists and forensic odontologists. Standardized documentation would make cases easier to compare and could reduce the underreporting that the researchers identify as a persistent problem.

The study also exposes a major weakness in the existing evidence: researchers do not always classify dental trauma in the same way. One study may count only crown fractures, another may include tooth loosening or avulsion, and a third may use a broader category of oral injury. Differences in age, injury mechanism, hospital referral patterns and examination timing can further distort comparisons. The high I² value is a statistical warning that these variations matter. Yuliati and colleagues call for standardized classification systems and multicenter prospective studies that follow patients using common definitions from the moment of injury. Prospective research could clarify how dental damage varies by force, facial fracture pattern, age and mechanism, while also recording treatment, complications and long-term outcomes. Until that evidence is available, the most defensible conclusion is both simple and consequential: in major facial trauma, the mouth is often part of the injury, and overlooking the teeth can mean overlooking medical information and forensic evidence that may never be recoverable.