The association between traumatic dental and brain injuries in American children

Dent Traumatol. 2021 Feb;37(1):114-122. doi: 10.1111/edt.12611. Epub 2020 Nov 18.


Background/aim: It is crucial that dentists who treat traumatic dental injuries rule out concomitant brain injuries. Despite anatomic proximity, controversy exists regarding association between facial trauma and head injury. The aim of this study was to examine the association between dento-alveolar trauma (DAT) and traumatic brain injuries (TBI) using a national dataset of emergency department (ED) visits.

Material and methods: Nationwide Emergency Department Sample (NEDS) data, one of the Healthcare Cost and Utilization Project (HCUP) datasets, were analyzed. Encounters of patients age 0-18 years with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes associated with DAT and TBI in the 2010-2014 NEDS were identified. Data were analyzed using descriptive statistics, chi-square test, and logistic regression models to investigate the association between DAT and TBI and factors associated with TBI in DAT-positive patients.

Results: During the study period, 6 281 658 ED visits were associated with traumatic injuries. DAT was recorded in 93 408 (1.5%) and TBI was recorded in 996 334 (15.9%) of these traumatic injury visits. Within the group of DAT-positive encounters, 7035 (7.5%) had codes associated with TBI. Of trauma encounters where a DAT was not involved (6 188 250 encounters), 989 299 (16%) had an associated TBI code. Patients with DAT had 0.20 odds of having TBI (95% CI, 0.19-0.20, P < .0001) compared with patients who did not have DAT when all other confounding variables were kept constant. Having multiple injuries, being involved in motor vehicle crashes, and injuries due to assault were associated with higher odds of concomitant TBI in patients who sustained DAT.

Conclusions: There was an inverse association between DAT and TBI in this study population.

Keywords: brain injury; children; dental injury; dental trauma; dento-alveolar injury; head injury.

MeSH terms

  • Adolescent
  • Brain Injuries*
  • Brain Injuries, Traumatic* / epidemiology
  • Child
  • Child, Preschool
  • Craniocerebral Trauma*
  • Databases, Factual
  • Emergency Service, Hospital
  • Humans
  • Infant
  • Infant, Newborn
  • United States / epidemiology