The hidden environment behind the injury: A narrative review of upstream environmental factors in oral and maxillofacial trauma

<b>Objectives:</b> Oral and maxillofacial trauma (OMFT) presents significant public health challenges, impacting individuals' functional, aesthetic, and psychological well-being. While clinical and sociodemographic factors are well-documented, environmental influences remain underexplored. This review explores how social, physical, and familial factors are associated with the prevalence and severity of OMFT. <b>Methods:</b> A comprehensive literature search was performed across MEDLINE (PubMed), Scopus, Web of Science, Cochrane Library, Google Scholar, and Embase (Ovid), with no restrictions on publication date and limited to English-language articles. Study quality was assessed using the JBI tool for prevalence studies, categorising studies as high (≥70%), moderate (50-69%), or low quality (≤49%) based on the proportion of affirmative responses. Findings were synthesized using a narrative approach. <b>Results:</b> A total of 25 observational studies from 10 countries, published between 1982 and 2024, with sample sizes ranging from 731 to 55,858 participants, were included. The findings indicate that physical environments-particularly schools and homes-are common injury sites, while lower socioeconomic conditions of the area is associated with a higher prevalence of trauma. Additionally, supportive family environments correlate with reduced injury risk. All studies were rated as having a low risk of bias according to the JBI tool. <b>Conclusions:</b> By classifying environmental influences into physical, socioeconomic, and familial domains, this review highlights key areas where targeted interventions and preventive strategies can be most effective in the context of OMFT. Prevention and intervention strategies should focus on high-risk settings and vulnerable populations. Future research should further examine how social determinants mediate injury outcomes.