Frequency of dentoalveolar trauma in high-performance athletes: a systematic review in multi-sport events in Latin America

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We aimed to determine the prevalence of dentoalveolar trauma in high-performance athlete participating in multi-sport events in Latin American countries. Methods A comprehensive search was performed between December 15–22, 2024 in 12 databases including following the PRISMA guidelines and Robvis for bias assessment. The inclusion criteria encompassed original articles, correspondences, scientific letters, prevalence studies, and studies on dentoalveolar trauma in athletes during multi-sport events in Latin America. Results The initial literature search yielded a total of 798 articles. The remaining articles underwent full-text review, leading to the inclusion of one article for analysis. The selected study was authored by Enrique Amy, a researcher from the University of Puerto Rico School of Medi-cine. Published in the Dental Traumatology Journal in 2005, the study aimed to investigate the incidence of dental and orofacial trauma among athletes participating in the Central American and Caribbean Games across six different editions. The main reasons for seeking dental care among the 279 athletes included mouthguard fabrication, resolution of acute dental and orofacial conditions, restorations, and dental evaluations. Detailed information on the specific injuries and sports associated with the athletes is provided, including 18 cases of treated acute dental conditions, which primarily occurred during sport-related activities and accounted for 6% of all dental consultations during the games. Conclusions This systematic review provides valuable insights into the prevalence of dentoalveolar trauma in high-performance athletes participating in multi-sport events in Latin America. The findings highlight the importance of preventive measures, such as mouthguard use, to mitigate the risk of dental and orofacial injuries in this population. " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/15-554", "name": "Frequency of dentoalveolar trauma in high-performance athletes: a..." } } ] } Home Browse Frequency of dentoalveolar trauma in high-performance athletes: a... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Avendaño F, Opazo-García C, Moya-Salazar J et al. Frequency of dentoalveolar trauma in high-performance athletes: a systematic review in multi-sport events in Latin America [version 1; peer review: 1 approved with reservations] . F1000Research 2026, 15 :554 ( https://doi.org/10.12688/f1000research.169394.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Frequency of dentoalveolar trauma in high-performance athletes: a systematic review in multi-sport events in Latin America [version 1; peer review: 1 approved with reservations] Felipe Avendaño 1 , Catalina Opazo-García 1,2 , Jeel Moya-Salazar 3 , Juan Pablo Morales 1 , Bárbara Salgado 1 , Hans Contreras-Pulache https://orcid.org/0000-0003-2450-9349 4 Felipe Avendaño 1 , Catalina Opazo-García 1,2 , [...] Jeel Moya-Salazar 3 , Juan Pablo Morales 1 , Bárbara Salgado 1 , Hans Contreras-Pulache https://orcid.org/0000-0003-2450-9349 4 PUBLISHED 18 Apr 2026 Author details Author details 1 Sports Dentistry Association of Chile (AODCh), Santiago, Chile 2 Faculty of Medicine, Universidad del Desarrollo, Santiago, Chile 3 Faculty of Medicine, Universidad Señor de Sipan, Chiclayo, Peru 4 Universidad Norbert Wiener, Lima, Peru Felipe Avendaño Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing Catalina Opazo-García Roles: Conceptualization, Formal Analysis, Methodology, Project Administration, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Jeel Moya-Salazar Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Software, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Juan Pablo Morales Roles: Data Curation, Investigation, Methodology, Resources, Software, Writing – Original Draft Preparation, Writing – Review & Editing Bárbara Salgado Roles: Conceptualization, Formal Analysis, Methodology, Software, Writing – Original Draft Preparation, Writing – Review & Editing Hans Contreras-Pulache Roles: Formal Analysis, Investigation, Methodology, Software, Validation, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Abstract* Introduction Severe damage to teeth or the periodontium can significantly affect oral functions of athletes during sport games reducing their performance and participation. We aimed to determine the prevalence of dentoalveolar trauma in high-performance athlete participating in multi-sport events in Latin American countries. Methods A comprehensive search was performed between December 15–22, 2024 in 12 databases including following the PRISMA guidelines and Robvis for bias assessment. The inclusion criteria encompassed original articles, correspondences, scientific letters, prevalence studies, and studies on dentoalveolar trauma in athletes during multi-sport events in Latin America. Results The initial literature search yielded a total of 798 articles. The remaining articles underwent full-text review, leading to the inclusion of one article for analysis. The selected study was authored by Enrique Amy, a researcher from the University of Puerto Rico School of Medi-cine. Published in the Dental Traumatology Journal in 2005, the study aimed to investigate the incidence of dental and orofacial trauma among athletes participating in the Central American and Caribbean Games across six different editions. The main reasons for seeking dental care among the 279 athletes included mouthguard fabrication, resolution of acute dental and orofacial conditions, restorations, and dental evaluations. Detailed information on the specific injuries and sports associated with the athletes is provided, including 18 cases of treated acute dental conditions, which primarily occurred during sport-related activities and accounted for 6% of all dental consultations during the games. Conclusions This systematic review provides valuable insights into the prevalence of dentoalveolar trauma in high-performance athletes participating in multi-sport events in Latin America. The findings highlight the importance of preventive measures, such as mouthguard use, to mitigate the risk of dental and orofacial injuries in this population. READ ALL READ LESS Keywords Dentoalveolar trauma, athletes, prevalence, multi-sport events, tooth injuries, Latin America. Corresponding Author(s) Jeel Moya-Salazar ( [email protected] ) Close Corresponding author: Jeel Moya-Salazar Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2026 Avendaño F et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Avendaño F, Opazo-García C, Moya-Salazar J et al. Frequency of dentoalveolar trauma in high-performance athletes: a systematic review in multi-sport events in Latin America [version 1; peer review: 1 approved with reservations] . F1000Research 2026, 15 :554 ( https://doi.org/10.12688/f1000research.169394.1 ) First published: 18 Apr 2026, 15 :554 ( https://doi.org/10.12688/f1000research.169394.1 ) Latest published: 18 Apr 2026, 15 :554 ( https://doi.org/10.12688/f1000research.169394.1 ) Introduction The recent increase in the standard of living and leisure time has resulted in a rise in sports participation among the population. 1 While sports involvement is associated with numerous health benefits, there is also a risk of injuries. 2 Traumatic injuries are a significant health problem in populations worldwide. With the growing number of new athletes and the popularity of sports, the incidence of sports-related injuries continues to rise. 3 Although the incidence of such injuries is widely reported, there are differences among studies in terms of case definitions, 4 and the prevalence of dental injuries also varies depending on the type of sport practiced. 5 Prevalence rates of dental traumas previously reported 6 range from 8% to 45%, and men are two to three times more likely to suffer dental traumas in permanent teeth (12% to 33%) compared to women (4% to 11%). 7 Injuries arising from sports activities have the potential to impact both soft and hard tissues, their severity contingent on the anatomical site and force application direction, as documented in a prior investigation. 3 Various contributing factors, including falls, physical altercations, sports-related incidents, vehicular accidents, and epileptic episodes, can precipitate sports-related injuries. 6 Given the often-accidental nature of these injuries, prompt emergency dental intervention becomes imperative. Among adults, crown fractures affecting the permanent maxillary anterior teeth emerge as the most prevalent form of dental trauma, encompassing nearly 79% of cases. 6 Such fractures may entail damage limited to enamel, extend to both enamel and dentin, or involve enamel, dentin, and pulp. 7 Severe damage to teeth and/or the periodontium can significantly affect oral functions, including speech and chewing, in addition to having a negative impact on psychosocial development due to aesthetic issues. 8 Baiju et al. further emphasized that oral health problems can have a variety of negative impacts on overall well-being, reduce the quality of life, and hinder athletic performance. 9 Traumas to the oral and maxillofacial region can also result in problems such as reduced participation in sports games, 1 making it crucial to consider them during sports competitions. 10 Diverse classification systems have been employed to characterize traumatic injuries, leading to inconsistent outcomes in some prevalence studies. 6 Retrospective questionnaires are commonly used in studies examining oral trauma, 5 and accurately estimating the prevalence and patterns of dental injuries, as well as identifying associated factors, can inform public health policies and strategies in this area. 11 The occurrence of dental trauma in elite athletes highlights the importance of conducting epidemiological research within this population to better understand the nature and extent of such injuries. 12 Examining the prevalence of dental trauma in specific geographic regions is pivotal for recognizing the occurrence of these injuries in distinct populations. 11 Despite extensive research on traumatic dental injuries in various contexts, including sports, no known study has specifically investigated the prevalence of dental traumas among athletes participating in the Pan American Games. 6 In this study, we conducted a systematic review to determine the prevalence of dentoalveolar trauma in high-performance athletes. Another objective of the review was to describe the frequency of injuries according to the country of origin of athletes participating in multi-sport events held in Latin American countries. Methods Study design and database We designed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 recommendations and pre-registered it in PROSPERO (CRD 451763, on August 21, 2023). The research question was formulated using the PIO acronym. 13 The population was high-performance athletes, the intervention was dentoalveolar trauma, and the outcomes were the prevalence of dentoalveolar trauma. The review was conducted in the following databases: Pubmed (MEDLINE), Scielo, Scopus, Wiley, ScienceDirect, EBSCO, Cochrane Library, Web of Science, and Lilacs. Additionally, we used Sportxiv, Dimensions, and Google Scholar. The identification of studies and their flow can be observed in Figure 1 . Figure 1. PRISMA 2020 Flowchart for the selection of studies. Search strategy and inclusion criteria For the search, we used the following Boolean descriptors and keywords (MESH terms): ((dental trauma OR oral trauma OR tooth injury OR tooth fractures OR orofacial injuries) AND (athletes OR elite athletes OR professional athletes OR high-performance) AND (Latin America OR Pan American AND (multi-sport event)). The manual search was conducted between December 15–22, 2022, and in two languages (English and Spanish). The inclusion criteria were the following: (i) original articles, correspondence articles, and scientific letters, (ii) prevalence studies, (iii) dentoalveolar trauma studies in athletes during multi-sport events in Latin America between 1980 and 2022. We did not apply a time filter to limit the years of publication to a specific period. Moreover, in regard to exclusion criteria, we did not include the following: (i) studies from other continents, (ii) incidence or exploratory studies, (iii) dentoalveolar traumas in non-multi-sport events, and (iv) systematic reviews, meta-analyses, reflection articles, editorials, clinical cases, history articles, and method papers. Data extraction and quality assessment Two authors (F.A. and J.P.M.) independently evaluated the abstracts of each article and excluded those that did not meet the inclusion criteria. Subsequently, the full text of each selected article was reviewed according to the predetermined protocol, and any disagreements between the authors were resolved through consensus at each stage of the review. Cohen’s Kappa correlation test was used to assess the overall agreement between the reviewers, revealing a good level of agreement in the search process (k = 0.811). Data Extraction Process involved retrieving relevant information from the included studies using the CASPe (Critical Appraisal Skills Program) template of a database in MS-Excel 2013 (Microsoft Corp., Redmond, WA, USA). 14 The possible bias of identified documents was evaluated using the Cochrane risk of bias tool (Robvis 2.0). The studies that were considered to have a high risk of bias were those that did not include at least one outcome in their analysis. Data analysis We used the IBM SPSS version 23.0 (Armonk, NY, USA) for the data analysis. A descriptive analysis of the included studies was performed to estimate their respective frequencies. Due to heterogeneity among the identified documents, it was not possible to conduct a meta-analysis, and instead, a narrative analysis of the research, focused on the primary findings of each included study, was presented. Results Search results Initially, an extensive literature search was conducted using several databases, including PubMed (n = 4), Scopus (n = 43), Wiley (n = 67), EBSCO (n = 11), Web of Science (n = 5), LILACS (n = 7), ScienceDirect (n = 20), Dimensions (n = 498), and Google Scholar (n = 160), resulting in a total of 798 articles. After eliminating 58 duplicates and articles in languages other than English or Spanish, the remaining articles were reviewed based on their titles and abstracts, excluding those irrelevant to the research question. Subsequently, the full texts of the remaining articles were carefully reviewed, leading to the exclusion of 53 studies and leaving only one article for analysis. Characteristics of the included study The selected article for this study was written by Enrique Amy, 15 a member of the Department of Physical Medicine, Rehabilitation, and Sports Medicine at the University of Puerto Rico School of Medicine. Published in the Dental Traumatology Journal in 2005, the main objective of the study was to investigate the incidence of dental and orofacial trauma in athletes participating in the Central American and Caribbean Games in six different editions: Cuba (1982), Dominican Republic (1986), Mexico (1990), Puerto Rico (1993), Venezuela (1998), and El Salvador (2002). Among the 2107 athletes across six delegations in various editions of these games, our study specifically examined 279 athletes seeking dental treatment and evaluation at the Medical Center of the Puerto Rico delegation. The selection of athletes was randomized. Registration details for each athlete encompassed personal information like name, age, gender, sports type, medical and dental history, along with the reason for their dental consultation. Finally, Amy’s study 15 presented an unclear bias, as described in Figure 2 . Figure 2. Bias assessment of the study included in this review. Main findings The main reasons for seeking dental care were the fabrication of mouthguards, resolution of acute dental and orofacial conditions, the need for restoration, and dental evaluations. Out of the total 279 athletes who received dental care, 133 (47.7%) were assessed for mouthguard fabrication, 18 (6.4%) for acute condition resolution, 52 (18.6%) for restorations, and 76 (27.2%) for dental evaluations. A detailed breakdown of the consultation reasons for each edition of the multi-sport event is provided in Table 1 . Table 1. Number of interventions in the different game events. Data in N (%). Country (year) Patients Mouthguard Acute condition Rehabilitation Evaluation Cuba (1982) 48 (17.2) 0 (0) 5 (27.8) 30 (57.7) 13 (17.1) Dominican Republic (1986) 21 (7.5) 0 (0) 0 (0) 5 (9.6) 16 (21.0) Mexico (1990) 89 (31.9) 54 (40.6) 5 (27.8) 6 (11.5) 24 (31.6) Puerto Rico (1993) 44 (15.8) 33 (24.8) 3 (16.7) 3 (5.8) 5 (6.6) Venezuela (1998) 52 (18.6) 34 (25.6) 5 (27.8) 6 (11.5) 7 (9.2) El Salvador (2002) 25 (8.9) 12 (9.0) 0 (0) 2 (3.8) 11 (14.5) Total 279 (100) 133 (100) 18 (100) 52 (100) 76 (100) Among the 18 instances of acute dental conditions treated, the majority (6% of all dental consultations during the games) were associated with sports activities. Dental fractures were the predominant form of dentoalveolar trauma, with specific details of injuries and the corresponding sports outlined below: - Four instances of lip contusions occurred in karate and boxing (two each). - Three cases of periapical injuries were reported in baseball, basketball, and athletics. - Dental fractures were observed in two cases, one in field hockey and another in athletics. - Two cases of lip lacerations in wrestling and basketball. - Fractured jaws occurred in two cases, one each in basketball and baseball. - Periapical abscesses were reported in three cases, associated with athletics, rifle shooting, and parade. - One case of avulsion of teeth in boxing. Discussion This systematic review based on Latin American studies revealed that few studies addressed the main objective. Only one study in the last four decades summarized the available published literature on the prevalence of dentoalveolar trauma in high-performance athletes. This analysis of six sports events demonstrated that mouthguard fabrication and resolution of acute dental and orofacial conditions were the primary dental care events. Additionally, the majority of cases of treated acute dental conditions were related to sports activities such as boxing, karate, and basketball. Our results reveal an area of research that requires detailed regional-wide study on dentoalveolar trauma in athletes, given its social, sporting, and economic impact. Strengths First, the study begins by highlighting a comprehensive literature search, using multiple accredited databases, grey literature, and thesis collections, showcasing a thorough strategy for data acquisition. Another strength of the study, to the best of our knowledge, is that it is the first review in Latin America that addresses dental issues in athletes. The results effectively communicate the reasons for seeking dental care, the breakdown of athletes’ visits for various purposes, and a detailed description of acute dental conditions and trauma treated during sporting events. Main findings The prevalence of dentoalveolar traumas varies mainly in relation to the type of sport practiced, finding very dissimilar prevalence among them, resulting in a great heterogeneity in the types of results found in relation to the variable under study. The World Dental Federation (FDI) classified sports into two categories based on the risk of dentoalveolar trauma: High risk (such as American Football, field hockey, ice hockey, lacrosse, martial arts, rugby, skates, skateboards, and mountain biking) and moderate risk (such as basketball, soccer, handball, diving, squash, gymnastics, parachuting, and water polo). 16 For example, in non-contact sports like volleyball, a lower prevalence of dental trauma has been reported compared to contact sports such as taekwondo and ice hockey. 17 , 18 Similar studies have found that men are two to three times more likely to suffer some type of dental and orofacial trauma than female athletes. 19 On the other hand, amateur athletes tend to suffer maxillofacial injuries more frequently than professional athletes. One study demonstrated that only 10% of patients who experienced this type of injury were professional athletes. 20 In Amy’s study, 15 sports events in Cuba (1982), Dominican Republic (1986), Mexico (1990), Puerto Rico (1993), Venezuela (1998), and El Salvador (2002) were included. However, there are other sports events for which no reports on this topic have been made. As we approach the hosting of the upcoming Pan American Games in Chile 2023, there are aspects that have not been addressed in previous editions, as reviewed in the limited existing literature. The low incidence of dentoalveolar traumas found in this study may be due to the fact that the majority of “sporting hours” are spent during the practice and training of professional athletes. Unlike this study, as we analyze this variable during a short period of a multi-sport event. For example, according to a study conducted at the Lima 2019 Pan American Games, 21 the prevalence rate of dentoalveolar traumas was so low that it was considered one of the problems that arose during the sporting event, along with acute pain, malar bone fracture, and adjustment of orthodontic appliances, representing only 9.2% of the issues consulted during the sporting event, demonstrating that the majority of oral problems faced by athletes already existed before the start of the event. The prevalence of dental trauma has been shown to be related to predictive factors such as the intensity and speed of the sport, the level of contact among participants, and the use and type of sports protective equipment, including mouthguards. 22 Several prevalence studies on dental trauma worldwide, such as the one conducted by Andrade 6 at the Pan American Games in Rio de Janeiro 2017, have demonstrated variation in results due to different methodologies used. Most of these studies rely on retrospective self-reporting approaches, which do not reflect the incidence at the time of the multi-sport event, making it difficult to quantitatively and qualitatively determine the variable being analyzed in this systematic review. Moreover, self-reports do not accurately qualify these sports-related injuries, introducing bias because of the absence of a competent clinician to diagnose them. Therefore, the importance of generating epidemiological research protocols regarding the variable in question during multi-sport events in Latin America becomes crucial for creating public policies aimed at prevention and treatment of these injuries related to professional athletes. Among these public policies, the creation of an assessment and action protocol aimed at the multidisciplinary management of dentoalveolar trauma is essential. It is important to consider these differences in the prevalence and risk of dentoalveolar traumas according to the sport and level of competition. These findings can be useful in informing orodental prevention and protection strategies in athletes in order to reduce the incidence of injuries and promote oral health in this population group. Moreover, further research is required to better understand risk factors and develop sport-specific interventions. Limitations In this systematic review, we have identified some limitations related to epidemiological research and management protocols regarding dentoalveolar traumas in Latin American multi-sport events. Firstly, we found limitations in the collection of specific epidemiological data and management protocols for these traumas. For instance, while dental fractures were reported as the most common type of dentoalveolar trauma, it was not specified whether these were enamel, enamel-dentin, or enamel-dentin-pulp fractures. This lack of detail hinders a precise understanding of the magnitude and severity of the traumas. Secondly, although we used meta-search engines and preprints to expand the number of evaluated studies, 23 we might have not included all relevant gray literature. This could mean that part of the available evidence was not taken into account in this review, which could have improved the results. Thirdly, we observed that sports events have not implemented a surveillance system that allows standardized registration and reporting of sports injuries, including dentoalveolar traumas. A Surveillance System for Injuries and Diseases (SVLE) has proven successful in recent Pan American sports events 24 and could be a valuable tool for registering and tracking dentoalveolar traumas in future events. These limitations highlight the need for improved data collection and management protocols related to dentoalveolar traumas in multi-sport events. Furthermore, greater awareness is needed regarding the importance of implementing adequate surveillance systems to obtain accurate and comparable data between events. These improvements would allow a better understanding of the incidence, severity, and risk factors associated with dentoalveolar traumas, which in turn would facilitate the implementation of more effective preventive and management strategies for the benefit of athletes. Conclusion the available evidence to date does not provide a definitive conclusion regarding dentoalveolar trauma in high-performance athletes in Latin American multi-sport events. The only study included in our analysis showed that most oral problems during the competition were not traumas but rather pre-existing diseases or issues. This highlights the importance of the role of sports dentists in competitions and sports teams. However, the low number of studies focused on this topic reveals a research gap and the need to address the field of sports dentistry in the Latin American region. Data availability Underlying data No data are associated with this article. Reporting guidelines Figshare: PRISMA 2020 Check list - Frequency of dentoalveolar trauma in high-performance athletes: a systematic review in multi-sport events in Latin America, https://doi.org/10.6084/m9.figshare.31875943 . 25 Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). References 1. Park HK, Park JY, Choi NR, et al. : Sports-Related Oral and Maxillofacial Injuries: A 5-Year Retrospective Study, Pusan National University Dental Hospital. J. Oral Maxillofac. Surg. 2021; 79 (1): 203.e1–203.e8. Publisher Full Text 2. Black AM, Eliason PH, Patton DA, et al. : Epidemiology of Facial Injuries in Sport. Clin. Sports Med. 2017; 36 (2): 237–255. Publisher Full Text 3. de Oliveira JM , Pauletto P, Werlich MO, et al. : Prevalence of orofacial injuries in wheeled non-motor sports athletes: A systematic review and meta-analysis. Dent. Traumatol. 2021; 37 (4): 546–556. Publisher Full Text 4. Burt CW, Overpeck MD: Emergency visits for sports-related injuries. Ann. Emerg. Med. 2001; 37 (3): 301–308. Publisher Full Text 5. Ferrari CH, Ferreira de Mederios JM: Dental trauma and level of information: mouthguard use in different contact sports. Dent. Traumatol. 2002; 18 (3): 144–147. Publisher Full Text 6. Andrade RA, Evans PL, Almeida AL, et al. : Prevalence of dental trauma in Pan American games athletes. Dent. Traumatol. 2010; 26 (3): 248–253. Publisher Full Text 7. Inouye J, McGrew C: Dental problems in athletes. Curr. Sports Med. Rep. 2015; 14 (1): 27–33. Publisher Full Text 8. Tsuchiya S, Tsuchiya M, Momma H, et al. : Factors associated with sports-related dental injuries among young athletes: a cross-sectional study in Miyagi prefecture. BMC Oral Health. 2017; 17 (1): 168. PubMed Abstract | Publisher Full Text | Free Full Text 9. Baiju RM, Peter E, Varghese NO, et al. : Oral health and quality of life: current concepts. J. Clin. Diagn. Res. 2017; 11 (6): ZE21–ZE26. Publisher Full Text 10. Frontera WR, Micheo WF, Amy E, et al. : Patterns of injuries in athletes evaluated in an interdisciplinary clinic. P. R. Health Sci. J. 1994; 13 (3): 165–170. 11. Aldrigui JM, Jabbar NS, Bonecker M, et al. : Trends and associated factors in prevalence of dental trauma in Latin America and Caribbean: a systematic review and meta-analysis. Community Dent. Oral Epidemiol. 2014; 42 (1): 30–42. PubMed Abstract | Publisher Full Text 12. Ranalli DN: Sports dentistry and dental traumatology. Dent. Traumatol. 2002; 18 (5): 231–236. Publisher Full Text 13. Huang X, Lin J, Demner-Fushman D: Evaluation of PICO as a knowledge representation for clinical questions. AMIA Annu. Symp. Proc. 2006; 2006 : 359–363. 14. Critical Appraisal Skills Programme Español: Instrumentos para la lectura crítica.2023. Accessed January 12, 2023. Reference Source 15. Amy E: Oro-facial injuries in Central American and Caribbean sports games: a 20-year experience. Dent. Traumatol. 2005; 21 (3): 127–130. Publisher Full Text 16. Federation Dentaire International (FDI): Commission on dental products, Working Party No. 7:1990. 17. Caglar E, Kargul B, Tanboga I: Dental trauma and mouthguard usage among ice hockey players in Turkey premier league. Dent. Traumatol. 2005; 21 (1): 29–31. PubMed Abstract | Publisher Full Text 18. Tulunoglu I, Ozbek M: Oral trauma, mouthguard awareness, and use in two contact sports in Turkey. Dent. Traumatol. 2006; 22 (5): 242–246. Publisher Full Text 19. Castaldi CR: Sports-related oral and facial injuries in the young athlete: a new challenge for the pediatric dentist. Pediatr. Dent. 1986; 8 (4): 311–316. PubMed Abstract 20. Mourouzis C, Koumoura F: Sports-related maxillofacial fractures: a retrospective study of 125 patients. Int. J. Oral Maxillofac. Surg. 2005; 34 (6): 635–638. PubMed Abstract | Publisher Full Text 21. Opazo-García C, Moya-Salazar J, Chicoma-Flores K, et al. : Oral health problems in high-performance athletes at 2019 Pan American Games in Lima: a descriptive study. BDJ Open. 2021; 7 : 21. PubMed Abstract | Publisher Full Text | Free Full Text 22. Gardiner DM, Ranalli DN: Attitudinal factors influencing mouthguard utilization. Dent. Clin. N. Am. 2000; 44 (1): 53–65. PubMed Abstract | Publisher Full Text 23. Kwon D: How swamped preprint servers are blocking bad coronavirus research. Nature. 2020; 581 : 130–131. Publisher Full Text 24. Moya-Salazar J, Rodriguez-Papini H, Opazo-Zamora A, et al. : Revisión del sistema de vigilancia de lesiones y enfermedades durante juegos multideportivos (Review of the injury and illnesses surveillance system during multi-sport games). Retos. 2022; 44 : 1–9. Publisher Full Text 25. Moya-Salazar J: Frequency of dentoalveolar trauma in high-performance athletes: a systematic review in multi-sport events in Latin America. figshare. 2025. Accessed March 27, 2026. Reference Source Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 18 Apr 2026 ADD YOUR COMMENT Comment Author details Author details 1 Sports Dentistry Association of Chile (AODCh), Santiago, Chile 2 Faculty of Medicine, Universidad del Desarrollo, Santiago, Chile 3 Faculty of Medicine, Universidad Señor de Sipan, Chiclayo, Peru 4 Universidad Norbert Wiener, Lima, Peru Felipe Avendaño Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing Catalina Opazo-García Roles: Conceptualization, Formal Analysis, Methodology, Project Administration, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Jeel Moya-Salazar Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Software, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Juan Pablo Morales Roles: Data Curation, Investigation, Methodology, Resources, Software, Writing – Original Draft Preparation, Writing – Review & Editing Bárbara Salgado Roles: Conceptualization, Formal Analysis, Methodology, Software, Writing – Original Draft Preparation, Writing – Review & Editing Hans Contreras-Pulache Roles: Formal Analysis, Investigation, Methodology, Software, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 18 Apr 2026, 15:554 https://doi.org/10.12688/f1000research.169394.1 Copyright © 2026 Avendaño F et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Avendaño F, Opazo-García C, Moya-Salazar J et al. Frequency of dentoalveolar trauma in high-performance athletes: a systematic review in multi-sport events in Latin America [version 1; peer review: 1 approved with reservations] . F1000Research 2026, 15 :554 ( https://doi.org/10.12688/f1000research.169394.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 18 Apr 2026 Views 0 Cite How to cite this report: Okubo R. Reviewer Report For: Frequency of dentoalveolar trauma in high-performance athletes: a systematic review in multi-sport events in Latin America [version 1; peer review: 1 approved with reservations] . F1000Research 2026, 15 :554 ( https://doi.org/10.5256/f1000research.186734.r477053 ) The direct URL for this report is: https://f1000research.com/articles/15-554/v1#referee-response-477053 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 05 May 2026 Rodrigo Okubo , Santa Catarina State University, Florianopolis, Brazil Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.186734.r477053 Overall assessment The article addresses a relevant and underexplored topic: the frequency of dentoalveolar trauma among high-performance athletes participating in multi-sport events in Latin America. The review is potentially useful because oral and maxillofacial injuries may affect athletes’ health, ... Continue reading READ ALL Overall assessment The article addresses a relevant and underexplored topic: the frequency of dentoalveolar trauma among high-performance athletes participating in multi-sport events in Latin America. The review is potentially useful because oral and maxillofacial injuries may affect athletes’ health, participation, performance, and the planning of preventive strategies during sports events. The manuscript also has some strengths, including the attempt to search multiple databases and grey literature sources, the use of a PRISMA flow diagram, and a clear recognition that the available evidence in this specific field is scarce. However, I have several methodological and reporting concerns that should be addressed before the article can be considered scientifically sound. Major points that must be addressed 1. The manuscript states that the aim was to determine the prevalence of dentoalveolar trauma in high-performance athletes participating in multi-sport events in Latin America. However, the only included study appears to report dental consultations and acute dental/orofacial conditions among athletes seeking dental care, rather than prevalence in the entire athlete population. Therefore, the authors should clarify whether the review is estimating prevalence, incidence, frequency of consultations, or frequency of trauma among dental-service users. If the available evidence does not allow prevalence to be estimated, this should be explicitly stated in the title, abstract, results, discussion, and conclusion. 2. There are important inconsistencies in the manuscript. The abstract states that the search was conducted between December 15–22, 2024, whereas the Methods section reports December 15–22, 2022. The Methods also state that studies from 1980 to 2022 were eligible, while also saying that no time filter was applied. These inconsistencies make it difficult to understand the actual search period and eligibility window. The authors should provide a single, consistent account of the search date, eligible publication period, and whether any date restriction was applied. 3. The review reports that 12 databases/sources were searched, but the exact search strategies for each database are not fully provided. The Boolean expression also appears incomplete or ambiguous, particularly regarding the use of “Latin America OR Pan American AND multi-sport event”. The authors should provide the complete search strings for all databases, including Spanish terms if the search was performed in English and Spanish, as well as the date of each search, filters used, and the number of records retrieved from each source. For Google Scholar, the authors should state how many pages or results were screened. 4. The flow diagram reports 815 records identified, whereas the Results section reports 798 articles. This discrepancy should be corrected. In addition, because only one article was included, the authors should provide a supplementary table listing the studies excluded after full-text assessment and the specific reason for exclusion. This is particularly important because some cited studies appear highly relevant to the topic, such as studies on dental trauma or oral health problems during Pan American Games. The authors should explain why these studies were excluded or whether the eligibility criteria should be reconsidered. 4. The use of the Cochrane risk-of-bias tool/Robvis appears inappropriate for the included study design. The domains shown in the figure, such as random sequence generation, allocation concealment, and blinding, are designed for randomized trials and do not fit observational prevalence or service-utilization studies. The authors should replace this assessment with an instrument suitable for prevalence or observational studies, such as the JBI checklist for prevalence studies, the AXIS tool, or another justified tool. The risk-of-bias judgments should then be reinterpreted accordingly. 5. The manuscript reports that the included study involved 279 athletes seeking dental treatment and evaluation among 2107 athletes across six delegations. This is an important distinction: the denominator for trauma prevalence should be the population at risk, not only those seeking dental care. The authors should clearly distinguish between: a) all athletes participating in the events; b) athletes from the Puerto Rico delegation; c) athletes who sought dental care; and d) athletes with acute dental/orofacial conditions. The current wording risks overinterpreting dental-service data as population prevalence. 6.The manuscript reports using SPSS and descriptive analysis. Given that only one study was included and no meta-analysis was performed, the statistical analysis is minimal. This is not necessarily a problem, but the authors should avoid implying that statistical procedures beyond descriptive summaries were conducted. The analysis should be presented transparently as a narrative synthesis with descriptive extraction of frequencies. 7. The abstract conclusion states that the review provides valuable insights into the prevalence of dentoalveolar trauma and highlights preventive measures such as mouthguard use. However, with only one included study, and with data based on dental consultations rather than population-based prevalence, the conclusions should be more cautious. The final conclusion is more balanced than the abstract, but both should be harmonized. The authors should emphasize that the evidence is insufficient to estimate prevalence and that the main finding is the lack of robust epidemiological data in Latin American multi-sport events. Minor points The PIO framework is not ideal as written because “dentoalveolar trauma” is not an intervention. The authors may consider using PECO/PEO or simply defining Population, Exposure/Condition, and Outcome. The manuscript should be carefully edited for grammar and consistency. For example, “high-performance athlete participating” should be revised to “high-performance athletes participating”. The term “dentoalveolar trauma” should be consistently defined, including whether soft-tissue injuries, jaw fractures, periapical abscesses, and orthodontic appliance issues are included or excluded. The manuscript should avoid statements such as “first review in Latin America” unless this claim is fully supported by the search and eligibility criteria. The reference to the Pan American Games in Rio de Janeiro should be checked, as the cited study appears to refer to the 2007 Pan American Games rather than 2017. The table title “Number of interventions” could be clearer, for example: “Reasons for dental consultations across different editions of the Central American and Caribbean Games”. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Sports injury epidemiology; sports physiotherapy and rehabilitation; musculoskeletal health; clinical research methodology; systematic reviews and evidence synthesis. My assessment focuses mainly on the methodological quality of the review, reporting transparency, interpretation of sports injury data, and whether the conclusions are supported by the results. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Okubo R. Reviewer Report For: Frequency of dentoalveolar trauma in high-performance athletes: a systematic review in multi-sport events in Latin America [version 1; peer review: 1 approved with reservations] . F1000Research 2026, 15 :554 ( https://doi.org/10.5256/f1000research.186734.r477053 ) The direct URL for this report is: https://f1000research.com/articles/15-554/v1#referee-response-477053 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 18 Apr 2026 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 1 18 Apr 26 read Rodrigo Okubo , Santa Catarina State University, Florianopolis, Brazil Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Okubo R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 05 May 2026 | for Version 1 Rodrigo Okubo , Santa Catarina State University, Florianopolis, Brazil 0 Views copyright © 2026 Okubo R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Overall assessment The article addresses a relevant and underexplored topic: the frequency of dentoalveolar trauma among high-performance athletes participating in multi-sport events in Latin America. The review is potentially useful because oral and maxillofacial injuries may affect athletes’ health, participation, performance, and the planning of preventive strategies during sports events. The manuscript also has some strengths, including the attempt to search multiple databases and grey literature sources, the use of a PRISMA flow diagram, and a clear recognition that the available evidence in this specific field is scarce. However, I have several methodological and reporting concerns that should be addressed before the article can be considered scientifically sound. Major points that must be addressed 1. The manuscript states that the aim was to determine the prevalence of dentoalveolar trauma in high-performance athletes participating in multi-sport events in Latin America. However, the only included study appears to report dental consultations and acute dental/orofacial conditions among athletes seeking dental care, rather than prevalence in the entire athlete population. Therefore, the authors should clarify whether the review is estimating prevalence, incidence, frequency of consultations, or frequency of trauma among dental-service users. If the available evidence does not allow prevalence to be estimated, this should be explicitly stated in the title, abstract, results, discussion, and conclusion. 2. There are important inconsistencies in the manuscript. The abstract states that the search was conducted between December 15–22, 2024, whereas the Methods section reports December 15–22, 2022. The Methods also state that studies from 1980 to 2022 were eligible, while also saying that no time filter was applied. These inconsistencies make it difficult to understand the actual search period and eligibility window. The authors should provide a single, consistent account of the search date, eligible publication period, and whether any date restriction was applied. 3. The review reports that 12 databases/sources were searched, but the exact search strategies for each database are not fully provided. The Boolean expression also appears incomplete or ambiguous, particularly regarding the use of “Latin America OR Pan American AND multi-sport event”. The authors should provide the complete search strings for all databases, including Spanish terms if the search was performed in English and Spanish, as well as the date of each search, filters used, and the number of records retrieved from each source. For Google Scholar, the authors should state how many pages or results were screened. 4. The flow diagram reports 815 records identified, whereas the Results section reports 798 articles. This discrepancy should be corrected. In addition, because only one article was included, the authors should provide a supplementary table listing the studies excluded after full-text assessment and the specific reason for exclusion. This is particularly important because some cited studies appear highly relevant to the topic, such as studies on dental trauma or oral health problems during Pan American Games. The authors should explain why these studies were excluded or whether the eligibility criteria should be reconsidered. 4. The use of the Cochrane risk-of-bias tool/Robvis appears inappropriate for the included study design. The domains shown in the figure, such as random sequence generation, allocation concealment, and blinding, are designed for randomized trials and do not fit observational prevalence or service-utilization studies. The authors should replace this assessment with an instrument suitable for prevalence or observational studies, such as the JBI checklist for prevalence studies, the AXIS tool, or another justified tool. The risk-of-bias judgments should then be reinterpreted accordingly. 5. The manuscript reports that the included study involved 279 athletes seeking dental treatment and evaluation among 2107 athletes across six delegations. This is an important distinction: the denominator for trauma prevalence should be the population at risk, not only those seeking dental care. The authors should clearly distinguish between: a) all athletes participating in the events; b) athletes from the Puerto Rico delegation; c) athletes who sought dental care; and d) athletes with acute dental/orofacial conditions. The current wording risks overinterpreting dental-service data as population prevalence. 6.The manuscript reports using SPSS and descriptive analysis. Given that only one study was included and no meta-analysis was performed, the statistical analysis is minimal. This is not necessarily a problem, but the authors should avoid implying that statistical procedures beyond descriptive summaries were conducted. The analysis should be presented transparently as a narrative synthesis with descriptive extraction of frequencies. 7. The abstract conclusion states that the review provides valuable insights into the prevalence of dentoalveolar trauma and highlights preventive measures such as mouthguard use. However, with only one included study, and with data based on dental consultations rather than population-based prevalence, the conclusions should be more cautious. The final conclusion is more balanced than the abstract, but both should be harmonized. The authors should emphasize that the evidence is insufficient to estimate prevalence and that the main finding is the lack of robust epidemiological data in Latin American multi-sport events. Minor points The PIO framework is not ideal as written because “dentoalveolar trauma” is not an intervention. The authors may consider using PECO/PEO or simply defining Population, Exposure/Condition, and Outcome. The manuscript should be carefully edited for grammar and consistency. For example, “high-performance athlete participating” should be revised to “high-performance athletes participating”. The term “dentoalveolar trauma” should be consistently defined, including whether soft-tissue injuries, jaw fractures, periapical abscesses, and orthodontic appliance issues are included or excluded. The manuscript should avoid statements such as “first review in Latin America” unless this claim is fully supported by the search and eligibility criteria. The reference to the Pan American Games in Rio de Janeiro should be checked, as the cited study appears to refer to the 2007 Pan American Games rather than 2017. The table title “Number of interventions” could be clearer, for example: “Reasons for dental consultations across different editions of the Central American and Caribbean Games”. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Sports injury epidemiology; sports physiotherapy and rehabilitation; musculoskeletal health; clinical research methodology; systematic reviews and evidence synthesis. My assessment focuses mainly on the methodological quality of the review, reporting transparency, interpretation of sports injury data, and whether the conclusions are supported by the results. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Okubo R. Peer Review Report For: Frequency of dentoalveolar trauma in high-performance athletes: a systematic review in multi-sport events in Latin America [version 1; peer review: 1 approved with reservations] . F1000Research 2026, 15 :554 ( https://doi.org/10.5256/f1000research.186734.r477053) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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