A Retrospective Study of Dental Trauma in Israeli Military Personnelin the Swords of Iron War

INTRODUCTION: Traumatic dental injuries (TDIs) are common but understudied consequences of combat-related craniofacial trauma. The Swords of Iron (SOI) War exposed Israel Defense Forces (IDF) personnel to high-velocity injuries in extreme battlefield conditions. This study aims to characterize the prevalence, anatomical distribution, and associated complications of TDIs among IDF soldiers during the SOI war, and to explore their operational and clinical implications. METHODS: A retrospective cohort study using the IDF Trauma Registry (IDF-TR) from October 2023 to February 2025 was conducted. Soldiers with head and neck trauma who underwent dental evaluations were included. Dental injuries were categorized by type (fracture, avulsion, periodontal ligament [PDL] injury), tooth location, and associated comorbidities, including temporomandibular disorders (TMDs) and sensory deficits. RESULTS: Of 1542 soldiers with head and neck trauma, 259 underwent dental evaluation, and 67 (25.9%) sustained at least one TDI. Tooth fractures (n = 73, 28.2%) and avulsions (n = 68, 26.2%) were the most common, predominantly affecting the maxillary central incisors. Penetrating trauma and endotracheal intubation were associated with higher avulsion rates, although the difference was not statistically significant. TMDs were diagnosed in 27 (10.4%) of the patients and were significantly associated with avulsed teeth (mean 1.41 vs. 0.15; p = 0.013). Soldiers with sensory deficits also trended toward higher avulsion rates. DISCUSSION: Combat-related TDIs during the SOI war showed a high incidence of anterior tooth trauma, especially avulsions and fractures, with strong associations with TMDs. These findings underscore the need for targeted prevention strategies, early dental and TMJ assessments, and long-term rehabilitation planning to preserve the functional and operational readiness of military personnel.