Risk factors for severe traumatic dental injuries in Japanese school children: A nationwide database analysis

Objective: Traumatic dental injuries represent a significant public health concern among school-aged children, with substantial economic burden and long-term impact on quality of life. This study aimed to identify high-risk factors associated with severe traumatic dental injuries requiring prosthetic treatment in Japanese school children. Methods: Data from a nationwide school injury compensation database covering 2005–2023 were analyzed. Variables included sex, school level, injury location, and injury occasion. Severe traumatic dental injury was defined based on the Japan Sport Council compensation criteria as injuries requiring prosthetic treatment for three or more teeth or causing masticatory dysfunction. Risk factors for severe injuries were identified using univariate and multivariate logistic regression, adjusting for sex and school level. Results: Traumatic dental injuries occurred most frequently during recess in elementary school students and during physical education and sports club activities in secondary school students. High risk sports for severe injuries included baseball, basketball, and soccer in males and volleyball, soft football, and basketball in females. Injuries occurring outside school buildings on campus and off school grounds showed significantly higher odds of severity than occurring inside school buildings. Commuting exhibited the highest risk of severe injury, followed by sports club activities and recess. Conclusions: Severe traumatic dental injuries occur across all school levels, with patterns varying by age, location, and activity. The elevated risk associated with commuting, outdoor locations, and sports highlights the need for targeted prevention strategies, including mandatory mouthguard use in high-risk sports, enhanced emergency protocols, and improved safety in outdoor school environments.