Helmet use and maxillofacial injuries due to bicycle and scooter accidents


Bicycles and scooters are popular modes of transport, and their use is being encouraged in many cities and countries to improve sustainability. The development of e-bikes and e-scooters has further increased use with e-bikes proving popular with older people. However, accidents are non-uncommon with the incidence. of maxillofacial fractures in cycling accidents reported to be 3% to 20%.  While helmets are effective in preventing traumatic brain injuries their effectiveness in preventing maxillofacial injuries is less clear.

The aim of this review was to assess the effect of helmet use on the incidence of maxillofacial injuries due to cycling, e-bike, scooter, and e- scooter accidents.


Searches were conducted in the Medline, Embase, Cochrane Central, Web of Science Core Collection, and Google Scholar databases. Studies with sample sizes of 10 or more reporting data on helmet use and maxillofacial injuries due to cycling, e-bike, scooter, and e- scooter accidents in patients age < 18 published after 1st January 2009 were considered. Only Dutch or English publications were included. Two reviewers independently screened and selected studies and data abstracted. The Newcastle–Ottawa Scale (NOS) was used to assess study quality and a meta-analysis conducted.


  • 14 studies (11 retrospective, 2 prospective cohorts, 1 case-control) reporting 177,351 cases were included.
  • 5 studies were conducted in the USA, 2 each in Sweden and the UK and one each in Australia, Germany, France, Taiwan, and Poland.
  • 5 studies were considered to be good quality, one of moderate quality and 8 of poor quality.
  • 8 studies reported that helmets reduced the incidence of maxillofacial injuries, 2 reported they did not with 4 not reporting on maxillofacial injuries separately.
  • 11 studies contributed to the meta-analysis which showed a significant reduction in the risk of maxillofacial injury with helmet use; Odds ratio = 0.682 (95%CI; 0.565 to 0.822), a reduction of 32%.
  • As the studies did not distinguish between motorised and non-motorised vehicles no sub-group analysis was performed.


The authors concluded: –

…..wearing a helmet had a significant protective effect against the risk of maxillofacial injury in cyclists, indicating the need for strict legislation on helmet use. Future prospective research studies are needed because of the increasing use of e-bikes, shared e-scooters, and other new vehicles (e.g. speed pedelecs) and the continuously changing demographics and infrastructure, with increased risks for preventable maxillofacial trauma.


The authors have searched a number of major databases although restricting the inclusions to publications in Dutch and English may have excluded some relevant studies. Only 5 of the included studies were considered to be of high quality with the majority being of a retrospective design. In addition, maxillofacial injuries were included in most studies as a secondary outcome rather than a primary outcome restricting analysis of different types of injury. With the increasing use of e-bikes and scooters it would have been interesting to see if there were any trends in injury time. However, data on different types of bikes and scooters were not available in the primary studies. The findings indicate a reduction in risk of maxillofacial injury of about 32% (95%CI; 28% to 43%) with helmet use which is similar to an earlier review (Dental Elf – 15th Jun 2018). Future well conducted and reported prospective studies would be helpful to improve the quality of the available evidence and assess the impact of any changes in use or legislation. While bicycle helmet wearing is not mandatory in the UK it is in a small number of  countries.


Primary Paper

Stassen HS, Atalik T, Haagsma JA, Wolvius EB, Verdonschot RJCG, Rozeboom AVJ. Effect of helmet use on maxillofacial injuries due to bicycle and scooter accidents: a systematic literature review and meta-analysis. Int J Oral Maxillofac Surg. 2023 Apr 6:S0901-5027(23)00014-0. doi: 10.1016/j.ijom.2023.01.013. Epub ahead of print. PMID: 37031014.

Other references

Bicycle helmet wearing laws by country – from Wikipedia

Dental Elf – 15th Jun 2018

Bicycle helmets and facial injuries

Picture Credits

Photo by Coen van de Broek on Unsplash



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