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Craniofacial Injuries: Community-Based Interventions to Encourage Use of Helmets, Facemasks, and Mouthguards in Contact Sports


What the CPSTF Found

About The Systematic Review

The Task Force finding is based on evidence from a systematic review of 8 studies (search period 1946-November 2012). The systematic review was conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice, and policy related to oral health. This finding updates and replaces the 2000 Task Force finding on Population-Based Interventions to Encourage Use of Helmets, Facemasks, and Mouthguards in Contact Sports to Prevent Oral and Facial Injuries [PDF - 223 kB].


There is evidence to support the efficacy of mouthguards and facemasks in preventing craniofacial injuries in contact sports (Knapik et al., 2007; Benson et al, 2009; Asplund et al, 2009). There is also a large body of evidence to support the efficacy of helmets in non-contact sports such as cycling and skiing (Thompson et al, 2009; Benson et al, 2009).

Summary of Results

Eight studies were included in the review.

  • Study results were inconsistent.
  • The diversity in sports, potential injuries, and population characteristics across the studies limited the ability to pool data and draw any general conclusions about intervention effectiveness.

Summary of Economic Evidence

An economic review of this intervention was not conducted because the Task Force did not have enough information to determine if the intervention works.


Applicability of this intervention across different settings and populations was not assessed because the Task Force did not have enough information to determine if the intervention works.

Evidence Gaps

Each Community Preventive Services Task Force (Task Force) review identifies critical evidence gaps—areas where information is lacking. Evidence gaps can exist whether or not a recommendation is made. In cases when the Task Force finds insufficient evidence to determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more effectiveness studies. When the Task Force recommends an intervention, evidence gaps highlight missing information that would help users determine if the intervention could meet their particular needs. For example, evidence may be needed to determine where the intervention will work, with which populations, how much it will cost to implement, whether it will provide adequate return on investment, or how users should structure or deliver the intervention to ensure effectiveness. Finally, evidence may be missing for outcomes different from those on which the Task Force recommendation is based.

Identified Evidence Gaps

  • More research is needed on the efficacy of various protective equipment devices in preventing injuries in different contact sports.
  • Further research is required to establish the effectiveness of community-based interventions that provide and promote the use of protective equipment. Ideally, researchers will use consistent outcome measures and definitions.
  • Finally, research should examine potential harms of the intervention, especially with regard to risk compensation behavior.

Study Characteristics

  • Included studies were associated with six different contact sports.
  • Studies evaluated three broad categories of interventions including legislative mandates, provision of safety equipment, and health promotion and education.
    • Legislative mandates attempt to ensure compliance by removing choice.
    • Provision of equipment attempts to improve access, empower, and provide additional choice.
    • Health promotion and education interventions aim to educate and raise awareness of the benefits of sports safety equipment.
  • Seven of the included studies were conducted in high-income countries.