Bicycle helmets and facial injuries

Get on your bikes kids!

While cycling is a popular health activity with benefits for both the individual and society it Is not without its risks. The use of cycle lanes, high visibility clothing and bicycle helmets are all considered to reduce risk. In some countries cycle helmets are compulsory.  Bicycle accidents and falls  can cause a range of injuries from minor to permanent disability or fatality.

The aim of this review was to investigate the effect of bicycle helmet use on facial injuries.


Searches were conducted in the PubMed/MEDLINE, Google Scholar, and Cochrane Library databases. Observational Studies involving patients >16years compared helmet users to non-helmet users were considered. Studies were excluded if they examined the effects of helmet legislation, reported facial injuries with other injuries, compared different types of helmet, or were wholly paediatric studies. Two reviewers independently selected the studies, abstracted data and assessed risk of bias. Selection, reporting, attrition, and detection bias were assessed.


  • 9 studies involving 23,461 patients were included.
  • 4 were considered to be at low risk of bias and 5 at medium risk
  • Participants wearing helmets were less likely to sustain a facial injury (OR = 0.69, 95% confidence interval 0.63– 0.75, P < 0.0001). [9 studies]
  • 5 studies reported on facial fractures find helmets to be protective (OR = 0.79 95% CI 0.70–0.90, P = 0.0003).


The authors concluded: –

The results of the present analyses suggest that bicycle helmets may offer a protective benefit against facial fractures. However, it is noted that previous analyses have shown that this protection is not uniform across the face and that the upper and middle face may be protected.

The analyses also suggest that bicycle helmets may protect against facial injuries other than fractures. However, the number of studies available was reasonably small and there was a high degree of heterogeneity for this particular analysis.


There have been a number of reviews of the effect of bicycle helmets on head and facial injuries since a 1999 Cochrane review by Thompson et al concluded that,

Helmets reduce bicycle-related head and facial injuries for bicyclists of all ages involved in all types of crashes including those involving motor vehicles.

However, an underlying concern is the quality of the available observational studies which has given rise to some debate about helmet use. A nice summary is available in the science based medicine blog, Do Helmets prevent head injuries.

This current review restricts itself to just facial injuries while two other recent reviews (Høye, 2018 )  and ( Olivier et al, 2017) are broader.  These two larger reviews also report on facial injuries finding reductions of 23% (Høye, 2018)  and 33%  [OR=0.67, 95% CI;  0.56–0.81] ( Olivier et al)


Primary Paper

Fitzpatrick DG, Goh M, Howlett DC, Williams M. Bicycle helmets are protective against facial injuries, including facial fractures: a meta-analysis. Int J Oral Maxillofac Surg. 2018 Apr 2. pii: S0901-5027(18)30077-8. doi:10.1016/j.ijom.2018.03.005. [Epub ahead of print] PubMed PMID: 29622478.

Other references

Thompson DC, Rivara F, Thompson R. Helmets for preventing head and facial injuries in bicyclists. Cochrane Database of Systematic Reviews 1999, Issue 4. Art. No.: CD001855. DOI: 10.1002/14651858.CD001855.

Høye A. Bicycle helmets – To wear or not to wear? A meta-analyses of the effects of bicycle helmets on injuries. Accid Anal Prev. 2018 Aug;117:85-97. doi:10.1016/j.aap.2018.03.026. Epub 2018 Apr 17. PubMed PMID: 29677686.

Olivier J, Creighton P. Bicycle injuries and helmet use: a systematic review and meta-analysis. Int J Epidemiol. 2017 Feb 1;46(1):278-292. doi: 10.1093/ije/dyw153. Review. Erratum in: Int J Epidemiol. 2017 Feb 1;46(1):372.PubMed PMID: 27450862.




Share on Facebook Tweet this on Twitter Share on LinkedIn Share on Google+
Mark as read
Create a personal elf note about this blog
Profile photo of Derek Richards

Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

More posts - Website

Follow me here –