CLINICS 2010;65(10):1043-1047 REVIEW Facial trauma in the largest city in latin america, sa˜ o paulo, 15 years after the enactment of the compulsory seat belt law Tarley Eloy Pessoa de Barros, Gabriel Denser Campolongo, Talita Zanluqui, Dayane Duarte Hospital Geral Vila Nova Cachoeirinha, Universidade Bandeirante de S a˜o Paulo (UNIBAN), Programa de Resideˆ ncia em Cirurgia e Traumatologia Buco-Maxilo-Facial, S a˜o Paulo, SP, Brazil. Traffic accidents are a reality throughout Brazil. The face is one of the anatomic parts most affected by these accidents, especially when a seat belt is not used. These accidents are costly for the public health system and have a significant impact on society and the lives of families involved. The compulsory use of seat belts in Brazil, especially in S a˜o Paulo, has decreased the rate of facial trauma. This suggests that the public health policies and measures adopted by the Brazilian authorities have benefited the population 15 years after the enactment of the law of compulsory seat belts in the city of S a˜o Paulo. KEYWORDS: Traffic accidents; Seat belts; Facial injuries; Trauma severity indices; Wounds and injuries; Tooth injuries. Barros TEP, Campolongo GD, Zanluqui T, Duarte D. Facial trauma in the largest city in latin america, s a˜o paulo, 15 years after the enactment of the compulsory seat belt law. Clinics. 2010;65(10):1043-1047. Received for publication on June 23, 2010; First creview completed on June 23, 2010; Accepted for publication July 9, 2010 E-mail: tpbarros@uol.com.br Tel.: 55 11 3885-9008/3884-4543 DOI:10.1590/S1807-59322010001000021 INTRODUCTION The face is a frequent target for trauma in motorvehicle accidents, especially when seat belts are not used. The high rate of motorvehicle accidents leads to economic and social problems and causes harm to the country, including increased costs for hospital care, pension expenses, and changes in family structure.1 Further, individuals lose their strength and ability to work at their most productive, given that most traumas due to car accidents occur among individuals who are under the age of 45 years. Results of epidemiological studies show that the etiology of facial fractures is variable across the world. However, motorve- hicle accidents are among the most frequent causes of facial fractures.12,13 In Brazil, rates of hospitalization due to motorvehicle accidents are high. Consequently, authorities made changes in the Brazilian Traffic Code,2 such as the Sa˜o Paulo Municipal Law of 1994.3 Ultimately adopted by most Brazilian cities, this law regulated the use of seat belts in November 1994. More recently, the ‘‘Dry Law’’ (number 11,705)4 also gained prominence in epidemiologi- cal indices and effectively reduced the number of accident victims attended in hospitals due to car accidents.5 The purpose of this paper is to highlight the importance of these Copyright 2010 CLINICS – This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non- commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 1043 laws the Brazilian our health system and demonstrate their effectiveness. Traffic accidents Brazil has the fifth highest number of traffic deaths in the world. In 2007, 35,100 thousand resulted from motorvehicle accidents in Brazil. In absolute terms, this number is lower than only four other countries: India (1,057,000 deaths), China (966,000 deaths), the United States (426,000 deaths), and Russia (359,000 deaths) (see Figure 1). However, Brazil occupies an intermediate position in a ranking among countries, with 18 deaths for every 100,000 inhabitants. Therefore, the rate of traffic deaths is higher than that of the United States (13/100) and lower than Russia (25/100).6,7 In 2002, motorvehicle accidents claimed the lives of 1.18 million people and injured 20 to 50 million more worldwide. Millions of people were hospitalized and perhaps 5 million have been disabled for life. It is estimated that by 2020, if this frequency is maintained, the annual proportion of people killed and disabled as a result of motorvehicle accidents will rise to more than 60%. Consequently, motor vehicle accidents will be third on the World Health Organization’s (WHO) list of the main causes of disease and traumas.8 Motorvehicle accidents have become a significant cause of morbidity and mortality among the Brazilian population as a result of the increase in the number of vehicles circulating and the high frequency of inappropriate behavior, coupled with ineffective monitoring and poor public road condi- tions.9 In addition, the number of vehicles on the road continues to grow. Sa˜o Paulo’s fleet of vehicles, which makes up more than 90% of the national fleet,10 was