Sir, an unusual case of dental trauma presented within the paediatric dental department. A 2-year-old boy was referred by his general dental practitioner regarding management for the avulsion of four incisors (61, 81, 71 and 72) following minor bumps and falls. The patient's parents were concerned regarding the early loss of his teeth. His primary incisors were traumatised on three occasions including falling on his mother's knee, knocking his teeth on the edge of a bouncy castle and a fall at home on a rug. His trauma history was inconsistent with the dental injuries suffered – raising caution to a possible non-accidental injury.

The parents had reported that their child is somewhat unstable with delayed walking and his health visitor has made a referral to a physiotherapist. In light of his trauma history and medical history, hypophosphatasia was suspected. His general medical practitioner had been contacted, blood tests were requested and referral to a to a paediatric endocrinologist made for further investigations.

Since his initial referral, the patient has been formally diagnosed with hypophosphatasia, an inherited metabolic disorder that has variable clinical presentation. The condition is extremely rare and is often linked with premature loss of teeth. This demonstrates the value of taking a good dental and medical history to aid diagnosis, which can significantly improve a child's ability to thrive.

1. Eastman Dental Hospital