Trauma to the primary dentition in under three-year- olds can have long-lasting effects on the
developing permanent dentition. Traumatic injury by the root of the primary tooth may affect
development of the tooth germ, by altering the secretory phase of the ameloblasts, which
form the enamel matrix, leading to enamel discolouration, hypoplasia and/or abnormalities in
root formation. Studies have found that 66% patients who experienced trauma to the primary
dentition before the age of 3 experienced sequelae in the permanent dentition compared with
only 25% of patients who experienced sequelae primary dental trauma which occurred after
the age of 3. 1
An eleven-year- old female was referred to the Paediatric Dental Department with concerns
regarding the aesthetics and sensitivity of 21 and 22. She felt unable to smile in photographs,
and several attempted restorations had failed to improve the aesthetics. Medical history was
Clinical examination revealed a well demarcated yellow/brown opacity of 21 and 22 had
evidence of post eruptive breakdown. Caries was also noted on the 21 and both were reliably
positive to sensibility testing. Occlusal D1 lesions were also noted on the 26, 36 and 46.
Differential diagnoses included primary trauma and systemic infection. Her mother noted the
patient sustained an injury to her anterior dentition at the age of 2.