This study used data from the 20th Youth Health Behavior Survey (2024) to examine the relationships among risk behaviors, physical activity, injury experiences, safety awareness, and tooth fracture in Korean adolescents. The analysis produced the following conclusions.

First, Risk behaviors such as violence-related medical treatment (OR=1.70) and heavy intoxication episodes (OR=2.09) are significantly linked to tooth fracture. Jung [13] reported a 1.67-fold increase in tooth fracture among individuals treated for violencerelated injuries. Jeong and Jang [14] found that 58.2% of adolescent drinkers had a high prevalence of oral symptoms, indicating a strong correlation between risk behaviors and oral injuries. Min and Kim [15] observed a 13.0% prevalence of tooth fracture among drinkers, with heavy intoxication increasing risk by 1.33 to 2.09 times [16], consistent with our findings. Together, these studies confirm that alcohol consumption and heavy intoxication significantly raise tooth fracture risk. Preventive strategies should therefore address not only physical safety but also lifestyle modification and delinquency prevention.

Second, This study found that the risk of tooth fracture was 1.36 times higher (OR=1.36) among individuals engaging in physical activity sessions lasting 60 minutes or more, at least four times per week. Similar elevated risks were noted for participants involved in high-intensity physical activity (OR=1.34) and strength training (OR=1.46) with the same frequency. While physical activity benefits adolescents’ cardiopulmonary function and muscle development, it also increases trauma risk due to greater physical contact, falls, and sports equipment use. Supporting this, Petti and Glendor [5] reported higher tooth fracture risk among more active adolescents. Min and Kim [15] found that 12.3% of adolescents active four or more days weekly experienced tooth fractures. Kim et al. [10] showed the highest tooth fracture prevalence (15.1%) among students with at least 60 minutes of daily activity, with similarly high rates for high-intensity and strength training five or more days per week (13.6%). These findings align with prior research linking increased activity frequency and intensity to greater tooth fracture risk. Thus, alongside promoting physical activity, protective measures-such as mouthguards, safety protocols, and trauma prevention education-are essential to preserve health benefits while reducing dental injuries. Shortened: This study found that tooth fracture risk increased by 1.34 to 1.46 times among adolescents engaging in frequent (≥4 times/week), prolonged (≥60 minutes), or intense physical activity, including strength training. While physical activity improves health, it raises trauma risk due to contact, falls, and equipment use. Prior studies confirm this association, with tooth fracture rates up to 15.1% among highly active youths. Therefore, promoting physical activity should be paired with protective measures like mouthguards, safety protocols, and education to reduce dental injuries.

Third, seatbelt use (OR=1.18), lack of helmet use among motorcyclists or bicyclists (OR=1.77), school-related injury experiences (OR=1.34), hospital treatment following injury (OR=1.47), and absence of school safety education (OR=1.16) were significantly linked to adolescent tooth fractures. These results highlight the importance of adherence to traffic and sports safety regulations to prevent oral injuries. This aligns with prior studies: Bae [4] showed that greater safety awareness increases protective equipment use and reduces injury risk; Gassner et al. [8] found lower injury rates among those completing safety education; and Jung [13] reported higher injury risks in adolescents with hospital-treated school injuries and no safety education, consistent with our findings. This study shows that using earphones or headphones nearly doubles the risk of injury (OR=1.89). It highlights lifestyle factors previously underexplored and reveals new risks linked to changes in adolescents’ daily behaviors. These findings emphasize the need to improve safety education and promote consistent use of protective gear to prevent tooth fractures. Specifically, seatbelts and helmets reduce impact force and injury risk, while safety education raises awareness and encourages protective actions.

This study highlights the need for a comprehensive strategy to prevent tooth fractures in adolescents. First, systematic education on using protective gear during school physical activities is crucial to promote consistent use. Second, integrating safety education into the formal curriculum ensures all students acquire essential trauma prevention knowledge. Third, enforcing youth health policies to reduce high-risk behaviors like violence and alcohol use is vital. This multifaceted approach not only prevents sportsrelated tooth fractures but also supports overall adolescent health and lifestyle management.

This study has some limitations. First, its cross-sectional design prevents establishing cause-and-effect relationships. Second, it does not provide detailed information on specific types of tooth injuries (such as fractures, dislocations, or root damage) or the circumstances in which these injuries occurred (like during sports or everyday activities). Third, it lacks comprehensive data on the use of oral protective devices, such as mouthguards, which limits the ability to compare findings with international studies. On the other hand, a key strength of this research is its use of a large, nationally representative sample, allowing for an extensive analysis of physical activity, injury experiences, safety awareness, and risk behaviors. This comprehensive approach provides a more robust evidence base for prevention policies compared to previous studies that examined isolated factors. Future studies should adopt longitudinal designs and incorporate detailed variables, including the use of oral protective equipment, to improve understanding of causality and enhance global applicability.