Association between Traumatic Dental and Brain Injuries in U.S. Children

Objectives: The aim of this study was to investigate a possible association between traumatic injuries to the teeth and their supporting structures and traumatic injuries to the brain.
Methods: National estimates were generated using the 2010-2014 Nationwide Emergency Department Sample (NEDS). Children up to the age of 18 years with International Classification of Diseases, 9th Edition (ICD-9) codes for trauma were included. Patients who had ICD-9 codes for traumatic dental injuries (TDI) and traumatic brain injuries (TBI) were identified. Chi-Square tests were used to test the relationship between TDI and TBI.
Results: There was 6.3 million pediatric ED visits with codes for trauma, 989,473 (15.8%) patients had TBI without TDI, 85,828 had TDI without TBI (1.4%), and 6,861 had both TBI and TDI (0.1%). There was a statistically significant inverse association between TDI and TBI in this pediatric trauma population. For the age groups of 0-6, 7-12 and 13-18, the inverse association remained significant across groups except for the age group 13-18. Among 0-6 year-old patients, 5% (2,780/55,455) of patients with TDI had TBI versus 22% (454,162/2,087,421) in patients without TDI. Among 7-12 year-old patients, 8% (1,618/19,448) of patients with TDI had TBI versus 12% (203,571/1,717,856) in patients without TDI.
Conclusions: Our results showed that in population under 13, the likelihood of TBI was lower in the group with TDI compared to the group without TDI. This could be due to differences in mechanism of injury or potential role of teeth in absorbing some of the impact and protecting the brain. At the same time, this could have been resulted from missing some of the hidden brain injuries due to focus on the dental trauma which would be of great concern.