Sports-Related Dental Injuries in the Pediatric Patient: A Retrospective Study

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J Korean Acad Pediatr Dent. 2025;52(2):129-141

Publication date (electronic) : 2025 May 20

doi : https://doi.org/10.5933/JKAPD.2025.52.2.129

Suhyun Park, Myeongkwan Jih, Somin Lim, Nanyoung Lee

Department of Pediatric Dentistry, School of Dentistry, Chosun University, Gwangju, Republic of Korea

Corresponding author: Nanyoung Lee Department of Pediatric Dentistry, School of Dentistry, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju, 61452, Republic of Korea Tel: +82-62-616-3860 / Fax: +82-62-616-3700 / E-mail: nandent@chosun.ac.kr

Received 2024 September 23; Revised 2024 November 3; Accepted 2024 November 11.

Trans Abstract

Introduction

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.

Materials and Methods

2. Study subjects

1) Study population

Electronic medical records of 2,382 patients aged 3 – 18 who visited Chosun University Dental Hospital between January 2018 and January 2024 and were diagnosed with a condition coded under the Korean Classification of Diseases S-codes were reviewed in this retrospective study. Cases with sports-related trauma were included in the study, whereas those involving physical activities not explicitly classified as sports or where the injury occurred during a sports activity but was not related to the actual participation in the sport were excluded.

2) Data collection

Data pertaining to gender, age, participating sport, final diagnosis, cause of injury, time of trauma, location of trauma, hospital routed, initial management, and time elapsed until initial management were collected from the medical records. Incomplete or inaccurate records were excluded from the analysis. The collected data were entered into Excel 2016 (Microsoft, Redmond, WA, USA).

3) Classification of patients based on age

The patients were classified into the following categories based on their age: preschool (3 – 6 years), elementary school (7 – 12 years), middle school (13 – 15 years), and high school (16 – 18 years).

4) Classification of participating sports

The types of sports were classifiesd into 10 groups, as shown in Table 1 [16-19].

Table 1.

Classification of sports activity

5) Types of injuries

The injuries were classified into three categories: jaw, soft tissue, and tooth. The included diagnoses and corresponding codes are listed in Table 2. If a patient had multiple types of injuries, all were included in the analysis.

Table 2.

Type of injury classification

The tooth number and the number of teeth affected by each injury were collected for patients categorized under tooth injuries. In addition, the diagnoses were collected again for each individual tooth and categorized according to IADT guidelines as follows; crown infraction, uncomplicated crown fracture, complicated crown fracture, crown-root fracture, root fracture, alveolar fracture, subluxation, lateral luxation, intrusion, extrusion, and avulsion [2]. If a tooth had multiple diagnoses, each diagnosis was included in the analysis. Primary teeth were excluded from the statistical analysis.

6) Classification of the causes of injury

The causes of injury were categorized as follows: slipdown, blow from the ball/puck, blow from a stick, blow/kick from another player, and collision/tackle [19].

7) Classification of trauma time and location

The time of injury was classified according to time periods by referencing previous studies [20]. The time periods of day was divided into morning (7 AM – 12 PM), afternoon (12 PM – 6 PM), and night (6 PM – 7 AM).

The location was classified based on whether a supervisor was present (Table 3). An individual stationed at the area and capable of managing safety protocols was considered as the supervisor. Examples of locations with supervisors include educational institutions, such as schools and sport-specific facilities.

Table 3.

Location classification by supervisor presence

8) Classification of hospitals routed, initial management, and time to management

In order to ascertain the number of medical facilities that patients visited prior to receiving initial management (including private dental clinics, general hospital emergency departments, university hospital emergency departments, and general practitioners), the relevant data was collected. Initial management was classified into Resin Wire Splinting, Suturing, Intermaxillary Fixation, Pulpotomy, Pulp Capping, and Restoration. The time to initial management was recorded as the difference between the time of injury (as reported by the patient) and the time the patient arrived at the hospital [21-23].

Results

1. General characteristics

Among 2,382 trauma patients surveyed, 308 (229 [74.4%] males and 79 [25.6%] females) experienced sports-related injuries, accounting for 12.9% of all trauma cases (Table 4). The gender distribution across different age groups generally showed a higher number of males, except in the cases of 7- and 8-year-olds, where females were more prevalent compared to males (Fig. 1). Based on the age groups, trauma was most commonly encountered among the elementary school students with 154 cases (50.0%), followed by high school students with 61 cases (19.8%), middle school students with 49 cases (15.9%), and preschool children with 44 cases (14.3%).

Table 4.

The distribution of the number of genders, sports, age, time of occurrence, and number of medical facilities visited before emergency care

Fig 1.

Distribution of age and gender. The chi-square test was performed (x² = 40.872, p < 0.0001).

Cycling was the most common sport involved with trauma cases (65 cases, 21.0%), followed by contact group sports with 50 cases (16.2%), and kickboard activities with 48 cases (15.5%). The most common time for injuries to occur was the afternoon (145 cases, 47.1%), followed by the morning (72 cases, 23.4%), and the night (54 cases, 17.5%). Most patients (174 cases, 56.5%) visited one facility before receiving emergency care, while 90 patients (29.2%) arrived immediately without visiting other facilities, and 40 patients (13.0%) visited two facilities. In total, the patients visited up to four facilities before receiving treatment (Table 4).

2. Distribution of sports based on the age group

The distribution of the sports types varied significantly with the age group (Table 5, p < 0.0001). Kickboard injuries were the most frequent, with 20 cases (45.5%) in the preschool age group. Cycling was the most common, with 35 cases (22.7%) among the elementary school students, while the middle school students presented with an equal number of cases (12 each, 24.5%) for both cycling and contact group sports. Among the high school students, contact group sports were the most common, with 21 cases (34.4%).

Table 5.

Distribution of sports and age group

3. Distribution of the sports and types of injury

Among the three types of injuries, tooth injuries were the most prevalent, with 244 cases (63.6%), followed by soft tissue injuries with 124 cases (32.0%), and jaw injuries with 19 cases (4.9%; Table 6). Tooth injuries were the most common in all sports categories, except for combat sports, where soft tissue injuries were the most frequent, with 13 cases (56.5%). In the swimming group, only tooth injuries were observed, with no cases of jaw or soft tissue injuries. No statistically significant differences were observed between the type of sport and type of injury (p= 0.703).

Table 6.

Distribution of sports and type of injury

4. Distribution of tooth injuries

1) Distribution of diagnoses of tooth injuries

Out of 308 patients, 244 had tooth injuries, and 543 teeth were affected. Of these, 486 teeth (89.5%) were permanent, and 57 (10.5%) were primary. As shown in Fig. 2, the most common type of injury was subluxation, affecting 204 teeth (42.0%), followed by uncomplicated crown fractures (n = 106, 21.8%), crown infractions (n = 43, 8.8%), and avulsions (n = 37, 7.6%). The teeth most frequently affected were the upper right central incisors (n = 153, 31.5%), followed by the upper left central incisors (n = 141, 29.0%), upper right lateral incisors (n = 42, 8.6%), and upper left lateral incisors (n = 40, 8.2%; Fig. 3).

Fig 2.

Distribution of diagnoses of tooth injury.

Fig 3.

Distribution of tooth numbers. Tooth numbers were recorded multiple times if they represented multiple diagnoses.

2) Distribution of sports and number of teeth injured

The number of teeth injured per incident was determined to assess the severity of tooth injuries based on the sport (Table 7). Out of 244 incidents, 89 patients (36.5%) had one tooth injury, 87 patients (35.7%) had two teeth injuries, and 68 patients (27.9%) had three or more teeth injuries. A statistically significant difference in the number of teeth injured depending on the type of sport was observed (p= 0.004). The overall average number of injured teeth was 1.91, with the highest average in the cycling group (2.18 teeth), followed by the kickboard group (2.02 teeth), combat sports group (2.00 teeth), and stickusing group sports (2.00 teeth).

Table 7.

Distribution of sports and number of teeth injured

5. Distribution of sports and causes of injury

The most common cause of injury was slipdown (n = 288, 54.0%), followed by collision/tackle (n = 122, 22.9%), blow from the ball/puck (n = 63, 11.8%), blow/kick from another player (n = 37, 6.9%), and blow from a stick (n = 23, 4.3%; Fig. 4, Table 8). A statistically significant difference between the type of sport and the cause of injury was observed in this study (x² = 473.512, p < 0.0001). Blow from the ball/puck was the most common cause for contact group sports, limited-contact group sports, and stickusing group sports. Blow/kick from another player was most common for combat sports, and collisions or tackles were the leading causes of trauma while swimming.

Fig 4.

Distribution of cause of injury.

Table 8.

Distribution of sports and cause of injury

6. Relationship between the presence of a supervisor and the time to initial management

An independent sample t-test was conducted to examine the impact of the presence of a supervisor on the time taken to receive initial management. Only injuries within the Gwangju area were included to reduce regional differences, and those that occurred at night were excluded (Table 9). Among 87 patients, the average time to initial management was 1.27 hours when a supervisor was present and 1.90 hours when a supervisor was absent (t = -2.718, p= 0.008).

Table 9.

Difference in initial management by a presence of supervisor

Discussion

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.

Conclusion

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.

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