CLINICS 2010;65(10):1043-1047 Table 3 - Countries’ seat belt laws and the occupants of the vehicles who are bound by such laws. Country Brazil Argentina Chile Cuba Colombia Ecuador Mexico Venezuela Uruguay Peru Presence of a national seat belt law Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Occupants to whom the law applies All occupants All occupants All occupants Only front seat passengers All occupants Only front seat passengers All occupants Only the driver All occupants All occupants Pernambuco.29 Significant facial impact occurs during a motorvehicle accident. Even with the use of a safety belt and an airbag, simple or multiple fractures can occur that crush the face. Researchers affirm that the major problem is not treating patients with multiple traumas, but their re-entry into society. Many of these individuals lose their teeth and cannot afford dental implants, a treatment that is currently done only in the private sector.30 The seat belt is considered to be the most effective device in reducing the severity of trauma in motorvehicle accidents and the most available safety equipment for vehicles currently operating in Brazil.31 Using a seat belt reduces the risk of death in individuals sitting in the front seat of a vehicle by 40-65% and may reduce deaths in rear seat passengers by 25-75%.6 However, results of other studies show that only 57% of countries require the use of seat belts in vehicles for all passengers, both seated in the front and back of the vehicle, with only 38% of low-income countries having such laws12 (see Table 3). Research evaluating young drivers at the Catholic University of Sa˜o Paulo showed that only 74% of university students always use a seat belt; therefore, one quarter of the population studied does not use frequently use one. Costs for the health care system Falls and traffic accidents have been reported, respec- tively, as the first and second leading cause of hospitaliza- tions from external causes in Brazil.32 In both Brazil and Sa˜o Paulo, external causes account for increased length of hospital stay, more than natural causes, despite the lower proportion of hospital admissions and shorter average hospital stay of the latter.33 In Sa˜o Paulo in 2005, the Facial trauma and the compulsory seat belt law de Barros et al. proportion of hospital admissions due to external causes was 48% for falls and 17% for motorvehicle accidents, although the proportion of expenditures was 41% for falls and 22% for motorvehicle accidents.32 A study of hospita- lizations for external causes paid for by the Unified Health System (Sistema U´ nico de Sau´ de, SUS) at the Municipal Hospital in Sa˜o Jose´ dos Campos conducted between January 1 and June 30, 2003 found that motorvehicle accidents were not only the leading cause of hospitalization (32%), but also the most expensive to treat (41.2%).34 (see Table 4). In Brazil, approximately two-thirds of hospital beds in the orthopedics and traumatology sectors are occupied by victims of motorvehicle accidents. They have an average hospital stay of 20 days, generating an average cost of $20,000 per serious injury. The estimated annual cost exceeds $3 billion.35 Dry Law Throughout the world, between one-quarter and one-half of motorvehicle accidents with fatalities are related to alcohol use by some of those responsible for the event.36 In a study conducted between December 2005 and December 2006, on Friday and Saturday nights between 10 p.m. and 3 a.m., it was found that 334 (36.6%) res- pondents stated that they had been involved in traffic accidents as drivers. Among these individuals, 200 (60%) had a pattern of alcohol consumption two days per week, and 185 (55.4%) were between the ages of 18 and 30 years.37 The positive results of Municipal Law 11,705/08.4 rever- berated throughout the Brazilian press.4 This law, which became known as the ‘‘Dry Law,’’38 established zero limit for alcohol in drivers’ blood. As a result of this new law, some cities saw a reduction of up to 40% in the number of motorvehicle deaths in the first 30 days of enforcement. The work of the emergency care system, known as the Urgent Mobile Care Service (Servic¸o de Atendimento M o´vel de Urgeˆncia, SAMU), was reduced by an average of 25%. The city of Sao Paulo, for example, saved more than $4 million reais in hospital expenses.39 DISCUSSION Facial traumas are of great significance in modern society because they have emotional and functional influences on people’s lives and can cause permanent deformities. Further, they frequently involve serious injuries.15,16,40 Various researchers have described the etiologies of facial Table 4 - Admissions due to external causes, total amount, average length of stay, average cost, and daily cost, according to the type of cause. City Hospital of S a˜o Jos e´ dos Campos, Sa˜ o Paulo, Brazil, in the first half of 2003.34 Hospitalizations Cost Average stay Average Cost Daily Cost Cause Motorvehicle accidents Falls Other accidental causes Assaults Self-inflicted injuries Medical care complications Undetermined causes After-effects All causes n 320 260 81 49 12 60 184 10 976 % 32.0 26.6 8.3 5.0 1.2 6.1 18.9 1.0 100.0 reais 196,682 122,845 25,576 29,149 6,007 19,821 72.424 5,013 477,521 1045 % 42.2 25.7 5.4 6.1 1.3 4.2 15.2 1 100.0 days 7.7 8.7 3.2 5.3 4.9 7.4 3.9 7.8 6.7 reais 614.63 472.48 315.76 594.9 500.61 330.35 393.61 501.33 489.26 reais 80.21 54.28 99.52 112.11 101.82 44.84 102.01 64.27 73.23