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Electric Two-Wheelers and Orofacial Trauma: What the New Evidence Means for Dental Practice in India

Introduction

Electric two-wheelers (e-bikes and e-scooters) are increasingly used on Indian city roads, including by delivery riders, and electric two-wheeler dental injuries are an emerging concern in dental trauma care. A cross-sectional study by Talwar and colleagues, published in Dental Traumatology in October 2026, compared dental and craniofacial injury patterns in conventional and electric two-wheeler riders in an urban setting [PMID 42902488]. Its findings are directly relevant to general dental practitioners, who are often the first clinicians to see a rider with a fractured or displaced tooth after a road traffic accident (RTA).

What the study did

The investigators examined and interviewed 652 riders (340 conventional two-wheeler riders and 312 e-bike/e-scooter riders) using a structured questionnaire covering demographics, vehicle type, protective gear compliance, riding behaviour, accident characteristics and orofacial injury profile [PMID 42902488]. Chi-square and Fisher's exact tests were applied, and a supplementary binary logistic regression adjusted for vehicle type, helmet compliance, commercial rider status, age group, usual speed and pre-ride training [PMID 42902488].

Key findings

  • Accident involvement: RTA involvement was significantly more prevalent among e-bike riders than conventional riders (70.8% vs 47.1%; RR 1.51; p < 0.001) [PMID 42902488].
  • Orofacial injury: Among those who had an accident, facial or oral injuries were more frequent in e-bike riders (72.9%) than in conventional riders (39.4%; OR 4.13; p < 0.001). The association persisted after multivariable adjustment (aOR 4.213; p < 0.001) [PMID 42902488].
  • Injury spectrum: Lacerations were most common (39.3%), followed by chipped or broken teeth (21.0%), jaw or facial bone fractures (14.7%), tooth avulsion (9.8%) and displacement/luxation injuries (7.1%). No individual injury category differed significantly between groups [PMID 42902488].
  • Protective behaviour: Consistent protective gear use was reported by 72.6% of conventional riders but only 5.8% of e-bike riders (p < 0.001); pre-ride training was reported by 63.8% and 14.7% respectively [PMID 42902488].
  • Commercial use: Accident rates were similar between commercial and personal use within each vehicle group [PMID 42902488].

Interpreting the evidence

The authors caution that correlated behavioural predictors such as helmet use and pre-ride training could not be reliably disentangled, and they identify low helmet compliance and urgency-driven riding among quick-commerce delivery riders as characteristics warranting further investigation [PMID 42902488]. In our reading, further limitations apply: as a cross-sectional, survey-based study from a single urban setting, it can demonstrate association but not causation, and self-reported exposures and accident histories may be subject to recall bias. Nonetheless, its findings are consistent with international reports. In Dallas, no e-scooter rider admitted with trauma reported wearing a helmet, and head and face injuries were common among admissions [PMID 31454504]. In Korea, crown-root fractures and avulsions occurred significantly more often in e-scooter-related accidents than in other causes of dental trauma, and only 1 of 33 e-scooter patients wore a helmet [PMID 37956616]. A German study has also compared dentoalveolar trauma patterns between e-scooter and bicycle accidents [PMID 41002682].

Clinical takeaways for the dental practitioner

1. Assessment: rule out the serious first

A rider presenting with dental injuries after an RTA may have sustained more than dental trauma. In the Dallas series, craniofacial injuries ranged from lacerations and concussions to intracranial haemorrhage and Le Fort II and III fractures [PMID 31454504]; in an Israeli series of e-bike and powered-scooter patients with oral and maxillofacial injuries, 32.2% also had head injuries [PMID 34470621]. Before focusing on the dentition, screen for signs warranting medical referral (altered consciousness, suspected facial fractures, airway compromise), and refer to an emergency department or oral and maxillofacial surgeon when these are present.

Once the patient is stable, examine soft tissues, the facial skeleton, occlusion and each tooth systematically. Because the Korean data showed posterior teeth were affected significantly more often in e-scooter trauma, and that minor injuries such as concussion and subluxation frequently occurred in combination with other injuries [PMID 37956616], the examination should not stop at the obviously damaged anterior tooth.

2. Emergency management of e-bike dental trauma

The International Association of Dental Traumatology (IADT) 2020 guidelines remain the reference standard for urgent care. They emphasise that proper diagnosis, treatment planning and follow-up are important for a favourable outcome after crown fractures and luxations, the most common dental injuries in permanent teeth [PMID 32475015]. Avulsion of a permanent tooth is described as one of the most serious dental injuries, for which prompt and correct emergency management is essential [PMID 32460393]. Where riders are children or adolescents with primary teeth, a separate IADT guideline applies [PMID 32458553]. Practitioners should consult the full guideline texts for injury-specific protocols on repositioning, splinting and follow-up.

D4dent's free Clinical Resources library, including chair-side Medical Emergency Protocols for Dental Clinics, and the LA dose calculator in the doctor workspace can support safe chairside care when a trauma patient also requires local anaesthesia.

3. Documentation

RTA-related injuries may carry medico-legal and insurance implications. Contemporaneous, structured records of the mechanism of injury, vehicle type, helmet use, examination findings, radiographs, clinical photographs and treatment provided are good practice, and they also make follow-up review against IADT recommendations easier [PMID 32475015]. Within D4dent, patients & appointments keep these records and scheduled reviews together, lab orders can be raised for splints or provisional restorations, and teleconsultation or the dentist community can be used to seek a second opinion on complex cases.

4. Prevention counselling

Helmet counselling is perhaps the most practical preventive contribution a dentist can make. Among e-bike and powered-scooter riders with oral and maxillofacial injuries, helmet users had lower rates of bone fractures (18.2% vs 68.8%) and dentoalveolar injuries (23.7% vs 37.3%), although helmets showed no protective effect on soft-tissue injuries [PMID 34470621]. A Cochrane review of motorcycle riders found helmets reduced the risk of death by 42% and head injury by 69%, with lower-quality evidence suggesting protection against facial injury [PMID 18254047]. For bicyclists, a Cochrane review reported a 65% reduction in upper and mid-facial injuries with helmet use [PMID 10796827].

Practical opportunities include:

  • Asking every adolescent and adult patient whether they ride a two-wheeler, and whether it is electric.
  • Recommending consistent helmet use, given the 5.8% protective-gear compliance among e-bike riders in the Talwar study [PMID 42902488].
  • Paying particular attention to delivery riders, a group the authors highlight for urgency-driven riding behaviour [PMID 42902488].
  • Using WhatsApp patient messaging to share helmet-safety reminders and post-trauma review appointments.

Conclusion

The Talwar study adds Indian urban data to a growing international literature: electric two-wheeler riders in this sample had more accidents, more orofacial injuries and markedly lower protective-gear use than conventional riders [PMID 42902488]. For the practising dentist, this translates into three duties: careful assessment that does not miss associated head and facial injuries, guideline-based emergency care, and consistent prevention counselling.

Manage trauma cases, records and follow-ups in one place. Join D4dent as a dentist: https://d4dent.org/register?role=DOCTOR

References

  1. PMID 42902488: Comparative Evaluation of Dental and Craniofacial Injury Patterns in Conventional and Electric Two-Wheeler Riders in Urban Settings: A Cross-Sectional Survey-Based Study. Dent Traumatol 2026.
  2. PMID 31454504: Craniofacial Injuries Seen With the Introduction of Bicycle-Share Electric Scooters in an Urban Setting. J Oral Maxillofac Surg 2019.
  3. PMID 37956616: Analysis of dental traumatic patterns in standing electric scooter-related accidents. Injury 2024.
  4. PMID 41002682: Comparison of Dentoalveolar Trauma Patterns Between E-Scooter and Bicycle Accidents in a German Urban Area: A Retrospective Study. Dent J (Basel) 2025.
  5. PMID 34470621: The impact of helmet use on oral and maxillofacial injuries associated with electric-powered bikes or powered scooter: a retrospective cross-sectional study. Head Face Med 2021.
  6. PMID 32475015: International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations. Dent Traumatol 2020.
  7. PMID 32460393: International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dent Traumatol 2020.
  8. PMID 32458553: International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition. Dent Traumatol 2020.
  9. PMID 18254047: Helmets for preventing injury in motorcycle riders. Cochrane Database Syst Rev 2008.
  10. PMID 10796827: Helmets for preventing head and facial injuries in bicyclists. Cochrane Database Syst Rev 2000.