Trauma to Baby Teeth

In the primary dentition, it has been estimated that 54% of children age 6 years or younger will have an injury to their primary teeth. 5% of children may have trauma to their anterior permanent teeth, most commonly the maxillary anterior teeth and boys, aged 10-11, are the most susceptible group. Trauma to anterior teeth, occurs most commonly in the 1.5 to 2.5 year old age group when the child is learning to walk. The typical trauma that occurs is displacement rather than fracture, and the child needs to be examined as soon as possible to asses the extent of damage. Trauma to the primary (baby) teeth typically result in discoloration, which indicates the response of the pulp to the trauma. Typically you see either a yellowish color, which indicates a calcific reaction that can result in complete calcification, or an endogenous root canal. A blue-black color indicates pulpal degeneration, and the tooth is typically extracted to prevent damage to the developing tooth bud. Root fractures are rare in the primary dentition, but if they do occur the tooth should be removed. A completely avulsed primary tooth should not be intentionally reimplanted, but a space maintainer may be indicated. Slightly displaced baby teeth can be repositioned and splinted and monitored for color change. Primary teeth and developing permanent teeth have a very good blood supply and sometimes do not undergo either pulpal degeneration or calcification.

There are several possible sequelae to the developing permanent tooth bud, because the permanent teeth are in close proximity to the primary tooth, and can transmit injury to their permanent replacements. The most common development is a white or yellow-brown discoloration of the enamel, or Turner’s tooth, which are thought to be areas of hypocalcification caused by periapical inflammation that lowers the pH and interferes with enamel maturation. Permanent crown can be malformed in 3% of cases, if the injury occurs when the crown is matured halfway. You can also see root dilacerations and disturbances in eruption patterns.

The premature loss of teeth does not have a long term effect on speech development, the younger the child is at the time of extraction, the greater the tendency for speech discrepancies and boys seem to be more prone to speech discrepancies.

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