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Bicycle helmets — does the dental profession have a role in promoting their use? H. R. Chapman and A. L. M. Curran Br Dent J 2004; 196: 555–559

Comment

Arguably, dentists have not engaged in injury prevention campaigns as much as might be expected, which makes this article very welcome. Few could argue against cycle helmet and other injury prevention initiatives by the dental team.

However, there are gaps in the evidence which must be addressed before the profession can argue that cycle helmets prevent dental and oral injury. In these days of evidence based public health it is not enough to state that '... it might be reasonable to surmise that a helmet that confers protection to the nose and maxilla is likely to confer some degree of protection to the upper dentition'. In fact, this seems unlikely since in the 1996 JAMA study cited no evidence of lower face (which included the upper lip) protection was found. Furthermore, a principal author has stated that the study included 121 cases with fractured teeth: 4.3% of those who were helmeted and 4.8% of those who were unhelmeted. The (non significant) odds ratio was 0.90 for helmet use (95% CI 0.63-1.30) in this regard.1

In our study, also cited in the paper, of 104 cyclists treated for dental and face injury treated in South Wales A&E departments, injury was progressively more common from upper, through middle, to lower thirds of the face. Half of the patients sustained central facial injury (the nose, upper lip and upper anterior dentition).2

Our ex vivo studies include laboratory testing of all cycle helmet designs available in 1995 with regard to face protection. It was concluded that the dimensions of cycle helmets in relation to face coverage are crucial in influencing the extent to which facial protection is conferred, but that no current helmet designs were likely to prevent dental and oral injury. Downward projection of helmet design below the inferior limit for testing stipulated by British Standard 6863 was remarkably variable.3

Both epidemiologic and laboratory investigations suggest that the incorporation of a lower face bar, similar to Formula One helmet design, has the potential to prevent dental and lower third injuries. Such a helmet, the FaceSaver helmet has now been patented and is currently available.4 It remains to be seen however, whether such helmets are actually effective in terms of dental injury and whether there are unintended outcomes.

As for legislation, powerful injury prevention arguments are ranged against the arguments of civil libertarians. But arguments about legislation should not be allowed to undermine a main point of this paper which is relevant to all of us, that as health professionals, we should be committed to prevention beyond the confines of the mouth.