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British Journal of Oral and Maxillofacial Surgery 52 (2014) 860

Short communication
Untreated dentofacial deformity: in defence of Luis Suárez
Shofiq Islam ∗ , Keith Jones
The Department of Maxillofacial Surgery, Royal Derby Hospital, Uttoxeter New Rd, Derby DE22 3NE, United Kingdom

Accepted 29 July 2014

Available online 22 August 2014

During the recent FIFA World Cup in Brazil, one of the most
controversial episodes concerned the conduct of Uruguayan
forward Luis Suárez. In the second half of Uruguay’s group
fixture with Italy on 24 June 2014, he was involved in a colli-
sion with Italian defender Giorgio Chiellini, and both ended
up on the turf.
There was immediate world-wide condemnation of a
perceived third biting offence by Suárez, and FIFA promptly
scheduled a disciplinary hearing. In his defence Suárez
denied the charges and stated: “I lost my balance... falling on
top of my opponent... I hit my face against [Chiellini], leaving
a small bruise on my cheek and a strong pain in my teeth”.1
The disciplinary panel, however, was not persuaded by this
argument, and issued an unprecedented and severe sanction
that included a total ban from all footballing activities for 4
months. The punitive nature of the ban was influenced by the
player’s apparent lack of insight and remorse.
The authors wish to highlight Suárez’s evident dentofacial
deformity, which could partly explain his version of events
and Chiellini’s tooth-related bruising to his left shoulder.
Suárez has an untreated severe skeletal class II division 1
malocclusion with associated vertical maxillary excess. The
mass media reported that Suárez’s defence was dismissed out
of hand as ridiculous, and this could be because his malocclu-
sion is not recognised. However, it has been well documented
that people with a severe class II malocclusion have a con-
siderably higher incidence of dental trauma as a result of
tripping or falling, and in this instance, the collision involved a
face-to-shoulder mechanism, which could potentially be con-
sistent with the contact being inadvertent as Suárez claimed.
A recent Cochrane systematic review highlighted the fact
that early treatment during adolescence effectively reduces
the overall incidence of dental trauma in this group.2 In the
case of Suárez, we think that combined orthodontic and max-
illofacial orthognathic surgical treatment would fully correct
his dentofacial deformity and in turn would minimise the
chance of further injuries being related to his prominent upper
front teeth in the context of a professional player of a contact
sport. Had he been born in England, as well as benefiting
our national football team, he would undoubtedly have met
the NHS criteria for combined orthodontic and maxillofacial
surgical treatment.
Many sportsmen with untreated dentofacial deformities
have a predisposition to orofacial injury and to injuring other
players as a result of inadvertent frontal facial collisions.
The Suárez episode potentially highlights a lack of aware-
ness of this type of injury amongst football governing bodies.
Protective devices such as mouthguards could be a solution to
the problem as they provide frontal protection of the anterior
maxillary teeth. They can reduce the incidence of dentoalv-
eolar injuries and inadvertent injury to opponents, and are
universally worn in rugby union and rugby league. At present
this is not the case in professional football, and their use
warrants further discussion and scientific investigation.
Conflict of interest
We have no conflicts of interest
References

1. Gibson O., Luis Suárez bite defence: I lost balance and hit my teeth against
∗
Chiellini. The Observer 2014 June 28 (Accessed 29 June 2014).
Corresponding author. Department of Maxillofacial Surgery, Royal
2. Thiruvenkatachari B, Harrison JE, Worthington HV, O’Brien KD.
Derby Hospital, Uttoxeter New Rd, Derby DE22 3NE.
Orthodontic treatment for prominent upper front teeth (Class II maloc-
Tel.: +0300 303 1573.
clusion) in children. Cochrane Database Syst Rev 2013;11. CD003452.
E-mail address: drshafiqislam@hotmail.co.uk (S. Islam).

http://dx.doi.org/10.1016/j.bjoms.2014.07.257
0266-4356/© 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.