Pediatric and adolescent patients often experience various types of trauma during growth, with dental trauma being one of the most common types [1]. Dental trauma accounts for about 5% of all bodily injuries, and 25% of all school-aged children are reported to have experienced these injuries [2]. An increase in activity levels increases the likelihood of injury due to falls at home or school, impacts from objects, violence, or traffic accidents. Sports activities are also a significant cause of dental trauma [3,4]. According to a study conducted by Kim and Kim [5] in 2010, loss of balance leading to falls accounted for 61.13% of trauma cases among patients under the age of 15 in South Korea, with sports activities being the second most common cause at 11.55%. Lam [6] reported that sports activities and falls constitute the majority of dental trauma cases, with variations depending on the characteristics and popularity of the different sports.

Engagement in sports activities among children and adolescents can positively affect their psychological, social, and physical well-being, making them a highly recommended pursuit [7]. In South Korea, national policies are being developed to increase participation rates in sports activities among children and adolescents, leading to a continuous rise in engagement [8]. According to the 2023 Youth Health Behavior Survey by the Korea Disease Control and Prevention Agency, the percentage of boys and girls engaging in physical activity for at least 60 min per day, five days a week, increased from 19.9% and 7.7%, respectively, in 2020 - 24.6% and 9.2%, in 2023 [9].

However, participation in sports activities carries potential injury risks; moreover, injuries from such activities are becoming a significant public health concern with the increase in the number of participants [10]. A report from the Sports Safety Foundation (2020) on domestic sports safety accidents revealed that 64.3% of recreational sports participants reported injuries during exercise, with about 1% of these injuries occurring in the oro-maxillofacial region, including the mouth (0.4%), tooth (0.3%), and jaw (0.4%) [11]. These sports-related injuries contradict the fundamental purpose of sports, which is to promote and maintain health, highlighting the need for appropriate preparation to ensure safe exercise and prevent injuries [12].

The proportion and characteristics of dental trauma resulting from sports vary significantly depending on factors such as the sample size, geographical location, age of the subjects, and characteristics of the sports [13]. The prevalence of sports-related dental trauma ranges from 8% to 45%, depending on the type of sport [14]. It can vary according to the mandatory protective gear regulations and specific sports with the highest incidence of trauma, which differ by country [15], thus indicating the need for studies tailored to the specific conditions of each country. Although a study on sports-related dental trauma in South Korea has been conducted by Park et al. [16], it encompassed all age groups and did not specifically focus on pediatric and adolescent populations. Therefore, this study aimed to identify the distribution and characteristics of sports-related dental trauma in pediatric patients in order to provide fundamental data for preventing such trauma in the future.

This study aimed to analyze the characteristics of sports-related dental trauma in pediatric and adolescent patients in order to identify trends in injury occurrence during sports activities and explore preventive and management strategies. Over the past six years, sports-related dental injuries accounted for 12.9% of all dental trauma cases among patients < 18 years of age at the Chosun University Dental Hospital (Table 4). This proportion is consistent with the findings of Kim and Kim [5] and Choi et al. [24], which reported that sports activities are a major cause of trauma. However, these results differ from those of international studies, such as the 10-year retrospective study by Gassner et al. [25], which reported a 31.8% incidence of sports-related maxillofacial injuries among pediatric patients in the United States. According to Welch et al. [26], the proportion of sports-related dental injuries in New Zealand ranged from 20.6% to 26.2%. These discrepancies may be attributed to the varying rates of sports participation across different countries. Given the continuous increase in physical activity rates in South Korea, the proportion of sports-related dental injuries is expected to rise in the future [9,27].

In terms of gender distribution, males accounted for 74.4% of the injuries, while females accounted for 25.6% in this study (Table 4). This finding is consistent with other studies on dental trauma, which reported a higher incidence of injuries among males compared to females [5,24]. However, while these studies typically reported a male-to-female ratio of approximately 1.7 : 1, the ratio in the present study was 2.9 : 1 [28]. Schneider et al. [29] also noted that males were more likely to experience sports-related injuries than females, suggesting that greater attention should be given to preventing sportsrelated trauma in male adolescents.

Significant differences in the distribution of the sports types based on the age group were observed in this study (Fig. 2). Kickboard-related injuries were most common in the preschool age group (3 - 6 years), and this trend continued into the elementary school years as the second most common cause of injury. This finding aligns with those of other studies that highlighted the high incidence of injuries related to nonmotorized kickboards in young children [21]. This age group is characterized by a lack of fear toward equipment, a high level of curiosity, and limited access to various sports activities, which may explain the high incidence of kickboard-related injuries [30,31]. Consistent with reports that soccer is associated with the highest risk of injury across all age groups [11], contact group sports were the most frequent cause of injury among high school students in the current study. Con-tact sports inherently carry a higher risk of injury due to continuous physical interactions between participants, emphasizing the need for preventive measures [32].

Cycling was the most common cause of injury among elementary and middle school students and accounted for the highest proportion of injuries across all sports types in the present study. In the study by Park et al. [16], cycling was identified as the leading cause of oro-maxillofacial injuries in children and adults. Similarly, Cetinbas et al. [33] reported that cycling resulted in a higher incidence of crown fractures than other sports. Stewart et al. [34] also identified bicycles as one of the consumer products most strongly associated with dental trauma. Cycling is a common and easily accessible daily activity, particularly outside of dedicated facilities (e.g., mountains, roads, parks), and it ranks as the third most popular recreational sport in South Korea [11,16]. Additionally, like kickboard, the range of sports that younger children can participate in is limited, which may explain the high incidence of injuries associated with these activities [31]. However, in the present study, cycling was associated with the highest number of teeth involved in a single trauma event across all sports types, with most cases involving injuries to three or more teeth, a statistically significant finding (Table 7). Although this study is a retrospective analysis based on medical records and does not allow for the estimation of the specific risk associated with each sport [7], it clearly indicates a strong correlation between cycling and dental trauma, highlighting the need for increased attention to preventing dental injuries during cycling activities among children.

Tooth injuries were the most prevalent among the three types of injuries in the present study (Table 6). Jaw injuries were rare, accounting for only 4.9% of cases, while soft tissue injuries were more common, accounting for about 32%. These findings are consistent with those in the literature review by Werlich et al. [32]; however, they differ from the results of the study by Park et al. [16], where different injury patterns were observed among all age groups. The focus on pediatric outpatients in the current study may have influenced the results.

In the detailed analysis of tooth injuries, the maxillary anterior region was the most commonly affected, accounting for 77.3% of all tooth injuries, with the upper right central incisor being the most frequently injured (31.5%). The most common types of tooth injuries were subluxation and uncomplicated crown fractures (Figs. 3 and 4). These findings are consistent with previous research on dental trauma and sports-related dental injuries [14,19,24,25,35,36]. Arraj et al. [37] reported that children with a large overjet (greater than 5 mm) are at greater risk of dental injuries; the American Academy of Pediatric Dentistry recommends that dentists monitor these patients closely, especially during sports activities [13]. Thus, dentists must educate parents and patients about the risk of injuries in the maxillary anterior region during sports participation.

This study aims to provide foundational data for improving the environments of places where children’s physical activities frequently take place. Specifically, it seeks to investigate whether the presence of nearby adults was helpful in providing proper and timely guidance for follow-up care when a child experienced dental trauma. This is crucial because delayed treatment can lead to poor prognoses [38]. It found that the presence of a supervisor at the location where the injury occurred was associated with a shorter time to initial management (Table 9), indicating that the presence of a supervisor who understands the importance of prompt initial care can make a significant difference in treatment outcomes.

However, since the present study simply categorized the presence or absence of a supervisor based on the location, it did not include the level of knowledge that supervisors possessed regarding dental trauma. The Sports Safety Foundation reported that awareness of first aid protocols for injuries caused by impacts (e.g., concussions, dental injuries, and cranial injuries) is generally low [11]. Tewari et al. [39] reported that the level of knowledge about dental injuries among sports participants and coaches is often insufficient. Besides, in this study, more than half of the patients visited more than one medical facility, with some visiting up to four facilities (Table 4). If they had prior knowledge of hospitals capable of providing proper treatment, they would not have visited multiple hospitals. Thus, sports participants may lack awareness of the complexity of treating dental trauma, which may not be adequately managed at all private dental clinics or emergency rooms [38,40].

Raising awareness will be necessary to ensure that supervisors properly fulfill their important roles. Dental injuries sustained during sports activities can lead to pain and aesthetic concerns, which in pediatric and adolescent patients can result in decreased self-esteem, reduced practice or playtime, and fear of reinjury [39]. In the meantime, these injuries are predictable, and outcomes can be significantly improved with appropriate and timely intervention [39,40]. Enhancing education for professional supervisors, such as teachers and sports coaches who are familiar with children’s physical activities, is critical in managing dental injuries. Improving their awareness of dental injuries could make a difference in the fate of injured teeth. Establishing first aid protocols for injuries, posting safety notices, providing brochures, and identifying hospitals capable of providing appropriate treatment in advance can help prevent severe outcomes from dental injuries. In addition to these supervisors, it would also be beneficial to increase the awareness of dental trauma among caregivers, such as parents who often act as supervisors in activities like cycling and kickboard outside of dedicated facilities. Public awareness campaigns about dental trauma management guidelines should be effectively promoted to the general population.

Furthermore, the use of protective equipment, such as mouthguards, would substantially reduce the incidence of injuries. Mouthguards are recommended for use in any sport involving body contact or contact with objects [41]. They can play an effective role in preventing trauma in contact team sports such as soccer and basketball, where “blow/kick from another player” and “blow from the ball” are the major causes of trauma (Table 8). Mouthguards should also be encouraged in activities such as cycling and kickboard to prevent injuries [13].

This study represents the first domestic research to focus exclusively on an in-depth analysis of sports-related dental injuries in pediatric patients. Due to its reliance on medical records, it offers more accurate data than survey-based studies commonly used in sports injury research. However, the study’s limitations include the lack of an objective definition for classifying the causative sports, which leads to a disunified sample size, the limited sample size due to the single-institution nature of the study, and the absence of data on the exposure levels to specific sports. Future national studies could help estimate the risk of dental injuries in specific sports, aiding in the development of mandatory protective equipment policies. Additional research evaluating the awareness of dental injuries among sports participants, parents, and trainers would also be beneficial.

In this retrospective study, the sports-related dental injuries among pediatric and adolescent patients who visited Chosun University Dental Hospital were assessed by analyzing their electronic medical records. Sportsrelated dental trauma was most common among male elementary school students during cycling activities, and the injuries frequently affected the maxillary anterior teeth due to falls. Furthermore, the presence of an appropriate supervisor during sports activities reduced the time to treatment among these patients.