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Ribeiro A, Decaup PH, Andriantavy M, Couture C, Garot E. Skeletal indicators of pathology in the context of early tooth loss in children: A systematic literature review. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2024; 46:37-49. [PMID: 39029336 DOI: 10.1016/j.ijpp.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 07/02/2024] [Accepted: 07/12/2024] [Indexed: 07/21/2024]
Abstract
OBJECTIVE To provide an evidence-based resource for paleopathologists to consider multiple skeletal indicators of pathology associated with early tooth loss in children to aid in diagnosis. MATERIALS Three databases (Cochrane Library, MedLine, and Scopus) were used for a review. METHODS According to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria, a systematic review guideline, 85 articles were selected. RESULTS A total of 189 children had a syndrome or disease associated with early tooth loss. Our review, based on 25 diseases, lists the bone and dental lesions observable in archeological remains. CONCLUSIONS Based on a review of the literature, a synthesis of 25 diseases and syndromes that may be associated with premature loss of permanent or deciduous teeth in children was developed for paleopathologists. It highlights the importance of a thorough dental examination by paleopathologists to further assess past health conditions. SIGNIFICANCE This paper provides an extensive resource addressing early tooth loss in childhood to assist researchers with differential diagnosis. LIMITATIONS The articles included in this review are case reports based on living populations. SUGGESTIONS FOR FURTHER RESEARCH Further studies into diseases and their association with early tooth loss would complement this work, as would utilizing the differential diagnoses on archeological individuals to clarify its value and limitations.
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Affiliation(s)
- Ana Ribeiro
- Univ. de Bordeaux, UFR des Sciences odontologiques, Bordeaux, France; Pôle de médecine et chirurgie bucco-dentaire, C.H.U de Bordeaux, France
| | - Pierre-Hadrien Decaup
- Univ. de Bordeaux, UFR des Sciences odontologiques, Bordeaux, France; Université de Bordeaux, CNRS, Ministère de la Culture, PACEA, UMR 5199, Pessac, France; Centre de Compétence des Maladies Rares Orales et Dentaires, CCMR O-Rares, C.H.U. de Bordeaux, France
| | | | - Christine Couture
- Université de Bordeaux, CNRS, Ministère de la Culture, PACEA, UMR 5199, Pessac, France
| | - Elsa Garot
- Univ. de Bordeaux, UFR des Sciences odontologiques, Bordeaux, France; Université de Bordeaux, CNRS, Ministère de la Culture, PACEA, UMR 5199, Pessac, France; Centre de Compétence des Maladies Rares Orales et Dentaires, CCMR O-Rares, C.H.U. de Bordeaux, France.
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Decaup PH, Ribeiro A, Couture C, Kacki S, Kausmally T, Garot E. A probable case of hypophosphatasia in St Bride's Lower Churchyard (1770-1849, London, UK). INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2024; 46:24-36. [PMID: 39018834 DOI: 10.1016/j.ijpp.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/18/2024] [Accepted: 06/23/2024] [Indexed: 07/19/2024]
Abstract
OBJECTIVES The objective of this study was to analyse an individual whose remains are characterised by early deciduous tooth loss and multi-focal lesions on the post-cranial skeleton. MATERIALS Skeletal remains of an immature individual buried between 1770 and 1849 in London. METHODS The remains were examined by visual macroscopic inspection, supplemented by radiographic examination of the mandible and maxillae. A differential diagnosis with possible conditions, frequent in this archaeological context, was conducted. A comprehensive examination of dental lesions was performed to investigate the aetiologies of deciduous tooth loss. RESULTS The individual exhibited a mosaic of skeletal and dental pathological changes, including premature loss of deciduous dentition, premature eruption of permanent teeth generalised bone loss in both the mandible and maxilla; osteomyelitis of the left radius; osteolytic lesion on the body of the second lumbar vertebra, and marked expansions of the rib shafts due to sub-periosteal new bone formation. CONCLUSION A differential diagnosis considered indicates that the pathological changes of the individual were most likely associated with a comorbidity involving hypophosphatasia and tuberculosis. SIGNIFICANCE We present in this study several oral signs that could alert paleopathologists and bioarcheologists to systematically consider the potential of a condition that is rarely encountered in archaeological contexts. LIMITATIONS Due to poor preservation, this study was confined to the analysis of a partial maxilla and mandible, a left radius shaft and the axial skeleton (rib heads and vertebrae) of the individual. SUGGESTIONS FOR FURTHER RESEARCH Further radiographic, histological and genetic analyses would confirm the diagnosis.
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Affiliation(s)
- Pierre-Hadrien Decaup
- Univ. de Bordeaux, UFR des Sciences odontologiques, Bordeaux, France; Univ. de Bordeaux, PACEA UMR 5199, CNRS, MCC, Pessac, France; Centre de Compétence des Maladies Rares Orales et Dentaires, CCMR O-Rares, C.H.U. de Bordeaux, France
| | - Ana Ribeiro
- Univ. de Bordeaux, UFR des Sciences odontologiques, Bordeaux, France; Pôle de médecine et chirurgie bucco-dentaires, C.H.U de Bordeaux, France
| | | | - Sacha Kacki
- Univ. de Bordeaux, PACEA UMR 5199, CNRS, MCC, Pessac, France
| | | | - Elsa Garot
- Univ. de Bordeaux, UFR des Sciences odontologiques, Bordeaux, France; Univ. de Bordeaux, PACEA UMR 5199, CNRS, MCC, Pessac, France; Centre de Compétence des Maladies Rares Orales et Dentaires, CCMR O-Rares, C.H.U. de Bordeaux, France.
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Kim TS, Moutsopoulos NM. Neutrophils and neutrophil extracellular traps in oral health and disease. Exp Mol Med 2024; 56:1055-1065. [PMID: 38689085 PMCID: PMC11148164 DOI: 10.1038/s12276-024-01219-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 05/02/2024] Open
Abstract
Neutrophils perform essential functions in antimicrobial defense and tissue maintenance at mucosal barriers. However, a dysregulated neutrophil response and, in particular, the excessive release of neutrophil extracellular traps (NETs) are implicated in the pathology of various diseases. In this review, we provide an overview of the basic concepts related to neutrophil functions, including NET formation, and discuss the mechanisms associated with NET activation and function in the context of the prevalent oral disease periodontitis.
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Affiliation(s)
- Tae Sung Kim
- Oral Immunity and Infection Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, 20892, USA.
| | - Niki M Moutsopoulos
- Oral Immunity and Infection Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, 20892, USA
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Heggie C, Al-Diwani H, Arundel P, Balmer R. Diagnosis and initial management of children presenting with premature loss of primary teeth associated with a systemic condition: A scoping review and development of clinical aid. Int J Paediatr Dent 2024. [PMID: 38609350 DOI: 10.1111/ipd.13188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/21/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Premature loss of primary teeth (PLPT) can be a rare presentation of systemic medical conditions. Premature loss of primary teeth may present a diagnostic dilemma to paediatric dentists. AIMS To identify systemic conditions associated with PLPT and develop a clinical aid. DESIGN OVID Medline, Embase and Web of Science were searched up to March 2023. Citation searching of review publications occurred. Exclusion occurred for conference abstracts, absence of PLPT and absence of English-language full text. RESULTS Seven hundred and ninety-one publications were identified via databases and 476 by citation searching of review articles. Removal of 390 duplicates occurred. Following the exclusion of 466 records on abstract review, 411 publications were sought for retrieval, of which 142 met inclusion criteria. Thirty-one systemic conditions were identified. For 19 conditions, only one publication was identified. The majority of publications, 91% (n = 129), were case reports or series. Most publications, 44% (n = 62), were related to hypophosphatasia, and 25% (n = 35) were related to Papillon-Lefèvre. Diagnostic features were synthesised, and a clinical aid was produced by an iterative consensus approach. CONCLUSIONS A diverse range of systemic diseases are associated with PLPT. Evidence quality, however, is low, with most diseases having a low number of supporting cases. This clinical aid supports paediatric dentists in differential diagnosis and onward referral.
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Oral manifestations of Chediak-Higashi syndrome: A systematic review. Dis Mon 2023; 69:101356. [PMID: 35414415 DOI: 10.1016/j.disamonth.2022.101356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Chediak-Higashi syndrome (CHS) is an autosomal recessive disorder characterized by leukocytes with giant secretory granules and a myriad of clinical features. However, it is unknown whether oral lesions are part of the syndrome or are refractory to systemic treatment. Herein, we integrated the available data published in the literature on the oral manifestations of individuals with CHS. Searches on PubMed, Web of Science, Embase, Scopus, and LILACS were conducted to identify studies published up to March/2022. The Joanna Briggs Institute tool was used for the critical appraisal of studies. Fourteen articles (21 cases) were detected. The mean age of individuals was 15.9±8.8 years. There was a slight predominance of males (52.4%). The major manifestation was periodontal disease (81%), although ulceration of the oral mucosa (14.3%), gingival/labial abscess (4.8%), and periodontal abscess (4.8%) were also reported. Oral rehabilitation including dental implants (9.5%) was performed after tooth losses due to the poor prognosis of periodontal therapy. CHS is usually diagnosed in an early stage due to its systemic manifestations such as classic oculocutaneous albinism, recurrent infections, and a propensity for bleeding. Oral health providers should be aware of the manifestations of individuals with CHS. Special care, including oral prophylaxis, is indispensable.
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Spodzieja K, Olczak-Kowalczyk D. Premature Loss of Deciduous Teeth as a Symptom of Systemic Disease: A Narrative Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063386. [PMID: 35329073 PMCID: PMC8953685 DOI: 10.3390/ijerph19063386] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 12/22/2022]
Abstract
Background: Premature loss of primary teeth can occur as a consequence of dental trauma, neonatal tooth extraction, early childhood caries, or periodontal problems, or it can be a manifestation of systemic disease. This review aims to present systemic disorders that can lead to premature loss of deciduous teeth in children and to provide a comprehensive resource for clinical practice for both physicians and dentists. Methods: This study is a narrative review of original studies and case reports published in English and Polish between 1957 and 2021 that was conducted by searching electronic scientific resources: PubMed, Google Scholar, Web of Science, and Science Direct. The schema of the qualification process is represented by a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). In total, 196 articles were identified; after provisional assessment of the titles and abstracts by two reviewers, 46 were found to be relevant to the topic, including 1 review, 16 original papers, and 27 case reports regarding systemic disease resulting in premature tooth loss. Results: In this study, 16 systemic diseases were linked to premature primary tooth loss in children: Papillon–Lefèvre syndrome, mucocutaneous dyskeratosis, Coffin–Lowry syndrome, congenital adrenal hyperplasia, Langerhans cell histiocytosis, cherubism, hypophosphatasia, acatalasia, Chediak–Higashi syndrome, cyclic neutropenia, erythromelalgia, Down syndrome, Hajdu–Cheney syndrome, short bowel syndrome, leukocyte adhesion deficiency type 1 (LAD-1), and Wiedemann–Steiner syndrome (WSS).
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Albandar JM, Susin C, Hughes FJ. Manifestations of systemic diseases and conditions that affect the periodontal attachment apparatus: Case definitions and diagnostic considerations. J Clin Periodontol 2019; 45 Suppl 20:S171-S189. [PMID: 29926486 DOI: 10.1111/jcpe.12947] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/14/2017] [Accepted: 10/21/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVES This review proposes case definitions and diagnostic considerations of systemic disorders and conditions that affect the periodontal attachment apparatus. IMPORTANCE Periodontal diseases and certain systemic disorders share similar genetic and/or environmental etiological factors, and affected patients may show manifestations of both diseases. Characterizing these diseases and the nature of the association between them could have important diagnostic value and therapeutic implications for patients. FINDINGS Numerous systemic disorders and certain medications can affect the periodontal attachment apparatus and cause loss of periodontal attachment and alveolar bone. Although many of these disorders are rare or uncommon, they often cause significant loss of periodontal tissue by influencing periodontal inflammation or through mechanisms distinct from periodontitis. Most of these disorders are due to innate mechanisms and some are acquired via environmental factors or lifestyle. Several disorders affect periodontal inflammation through alterations in the host immune response to periodontal infection; others cause defects in the gingiva or periodontal connective tissue, instigate metabolic changes in the host that affect various tissues of the periodontal apparatus, or operate by other mechanisms. For some systemic disorders that are more common, their contribution to the loss of periodontal tissue is modest, while for others, contribution is not supported by clear evidence. Few systemic medications are associated with increased loss of periodontal tissue, and these are typically medications used in the treatment of malignancies. CONCLUSIONS This review identifies systemic diseases and conditions that can affect the periodontal attachment apparatus and cause loss of periodontal supporting tissues and, where possible, presents case definitions for these. Many of these diseases are associated with a profound loss of periodontal attachment and alveolar bone, and for some of these disorders the periodontal manifestations may be among the first signs of the disease. These case definitions may be useful in the early diagnosis of these diseases and may contribute to an improvement in the management of periodontal manifestations and improve the quality of life for these patients.
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Affiliation(s)
- Jasim M Albandar
- Department of Periodontology and Oral Implantology, Temple University School of Dentistry, Philadelphia, PA, USA
| | - Cristiano Susin
- Department of Periodontics, Augusta University Dental College of Georgia, Augusta, GA, USA
| | - Francis J Hughes
- Unit of Periodontology, Dental Institute, Kings College London, London, UK
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Albandar JM, Susin C, Hughes FJ. Manifestations of systemic diseases and conditions that affect the periodontal attachment apparatus: Case definitions and diagnostic considerations. J Periodontol 2018; 89 Suppl 1:S183-S203. [DOI: 10.1002/jper.16-0480] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/14/2017] [Accepted: 10/21/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Jasim M. Albandar
- Department of Periodontology and Oral Implantology; Temple University School of Dentistry; Philadelphia PA USA
| | - Cristiano Susin
- Department of Periodontics; Augusta University Dental College of Georgia; Augusta GA USA
| | - Francis J. Hughes
- Unit of Periodontology; Dental Institute; Kings College London; London UK
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Thumbigere Math V, Rebouças P, Giovani PA, Puppin-Rontani RM, Casarin R, Martins L, Wang L, Krzewski K, Introne WJ, Somerman MJ, Nociti FH, Kantovitz KR. Periodontitis in Chédiak-Higashi Syndrome: An Altered Immunoinflammatory Response. JDR Clin Trans Res 2017; 3:35-46. [PMID: 29276776 DOI: 10.1177/2380084417724117] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Chédiak-Higashi syndrome (CHS), a rare autosomal recessive disorder caused by mutations in the lysosomal trafficking regulator gene (LYST), is associated with aggressive periodontitis. It is suggested that LYST mutations affect the toll-like receptor (TLR)-mediated immunoinflammatory response, leading to frequent infections. This study sought to determine the periodontal status of patients with classic (severe) and atypical (milder) forms of CHS and the immunoregulatory functions of gingival fibroblasts in CHS patients. In contrast to aged-matched healthy controls, atypical (n = 4) and classic (n = 3) CHS patients presented with mild chronic periodontitis with no evidence of gingival ulceration, severe tooth mobility, or premature exfoliation of teeth. As a standard of care, all classic CHS patients had undergone bone marrow transplantation (BMT). Primary gingival fibroblasts obtained from atypical and BMT classic CHS patients displayed higher protein expression of TLR-2 (1.81-fold and 1.56-fold, respectively) and decreased expression of TLR-4 (-2.5-fold and -3.85-fold, respectively) at baseline when compared with healthy control gingival fibroblasts. When challenged with whole bacterial extract of Fusobacterium nucleatum, both atypical and classic CHS gingival fibroblasts failed to up-regulate TLR-2 and TLR-4 expression when compared with their respective untreated groups and control cells. Cytokine multiplex analysis following F. nucleatum challenge showed that atypical CHS gingival fibroblasts featured significantly increased cytokine expression (interleukin [IL]-2, IL-4, IL-5, IL-6, IL-10, IL-12, interferon-γ, tumor necrosis factor-α), whereas classic CHS cells featured similar/decreased cytokine expression when compared with treated control cells. Collectively, these results suggest that LYST mutations in CHS patients affect TLR-2 and TLR-4 expression/function, leading to dysregulated immunoinflammatory response, which in turn may influence the periodontal phenotype noted in CHS patients. Furthermore, our results suggest that atypical CHS patients and classic CHS patients who undergo BMT early in life are less susceptible to aggressive periodontitis and that hematopoietic cells play a critical role in mitigating the risk of aggressive periodontitis in CHS. Knowledge Transfer Statement: Results from this study can be used to create awareness among clinicians and researchers that not all CHS patients exhibit historically reported aggressive periodontitis, especially if they have atypical CHS disease or have received bone marrow transplantation. LYST mutations in CHS patients may affect TLR-2 and TLR-4 expression/function leading to dysregulated immunoinflammatory response, which in turn may influence the periodontal phenotype noted in CHS patients.
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Affiliation(s)
- V Thumbigere Math
- Laboratory of Oral and Connective Tissue Biology, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health (NIH), Bethesda, MD, USA
| | - P Rebouças
- Department of Pediatric Dentistry, State University of Campinas, Piracicaba Dental School, Piracicaba, SP, Brazil
| | - P A Giovani
- Department of Pediatric Dentistry, State University of Campinas, Piracicaba Dental School, Piracicaba, SP, Brazil
| | - R M Puppin-Rontani
- Department of Pediatric Dentistry, State University of Campinas, Piracicaba Dental School, Piracicaba, SP, Brazil
| | - R Casarin
- Department of Prosthodontics and Periodontics, State University of Campinas, Piracicaba Dental School, Piracicaba, SP, Brazil
| | - L Martins
- Department of Prosthodontics and Periodontics, State University of Campinas, Piracicaba Dental School, Piracicaba, SP, Brazil
| | - L Wang
- Laboratory of Oral and Connective Tissue Biology, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health (NIH), Bethesda, MD, USA
| | - K Krzewski
- Receptor Cell Biology Section, Laboratory of Immunogenetics, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Rockville, MD, USA
| | - W J Introne
- Office of the Clinical Director, National Human Genome Research Institute, National Institutes of Health (NIH), Bethesda, MD, USA
| | - M J Somerman
- Laboratory of Oral and Connective Tissue Biology, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health (NIH), Bethesda, MD, USA
| | - F H Nociti
- Department of Prosthodontics and Periodontics, State University of Campinas, Piracicaba Dental School, Piracicaba, SP, Brazil
| | - K R Kantovitz
- Department of Pediatric Dentistry, State University of Campinas, Piracicaba Dental School, Piracicaba, SP, Brazil.,Department of Dental Materials, São Leopoldo Mandic Research Center, Dental School, Campinas, SP, Brazil
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Abstract
BACKGROUND Hypophosphatasia (HPP) is a rare inherited metabolic disease in which mutations in the ALPL gene (encoding tissue-nonspecific alkaline phosphatase) result in varying degrees of enzyme deficiency. HPP manifests in a spectrum of symptoms, including early primary tooth loss (root intact) and alveolar bone mineralisation defects. OBJECTIVE To provide an overview of HPP for dental professionals to help recognise and differentially diagnose patients for appropriate referral to a specialist team. METHODS A non-systematic review of publications on HPP was performed. RESULTS Different forms of HPP are described, along with characteristic symptoms and laboratory findings. Diagnosis is challenging due to the rareness and variable presentation of symptoms. Low alkaline phosphatase levels are a signature of HPP, but reference ranges vary according to gender and age. Key features are defined and management strategies discussed, focusing on enzyme replacement therapy. Finally, a patient registry aimed at better defining the prevalence of HPP and raising awareness is described. CONCLUSIONS HPP is a rare disease with a wide spectrum of manifestations, with orodental symptoms featuring prominently in the natural history. Dental professionals may be positioned at the beginning of the diagnostic pathway; thus, recognition of HPP features for timely referral and optimal disease management is important.
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Affiliation(s)
- Agnès Bloch-Zupan
- Faculté de Chirurgie Dentaire, Université de Strasbourg, Strasbourg, France.
- Hôpitaux Universitaires de Strasbourg, Pôle de Médecine et Chirurgie Bucco-Dentaires, Centre de référence des manifestations odontologiques des maladies rares (CRMR), Reference Centre for Orodental Manifestations of Rare Diseases, Strasbourg, France.
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM U964, CNRS-UdS UMR7104, Université de Strasbourg, Illkirch, France.
- Eastman Dental Institute, University College London, London, UK.
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Angelopoulou MV, Kontogiorgos E, Emmanouil D. Congenital adrenal hyperplasia: a case report with premature teeth exfoliation and bone resorption. Pediatrics 2015; 135:e1524-9. [PMID: 26009625 DOI: 10.1542/peds.2014-3577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Congenital adrenal hyperplasia (CAH) is an inherited autosomal recessive disorder characterized by insufficient production of cortisol. The aim of this case report was to present a child with CAH, premature exfoliation of primary teeth and accelerated eruption of his permanent teeth related to bone resorption. A 4.5-year-old Caucasian boy with CAH and long-term administration of glucocorticoids was referred for dental restoration. Clinical examination revealed primary molars with worn stainless steel crowns, severe attrition of the upper canines, and absence of the upper incisors. Before the completion of treatment, abnormal mobility of the first upper primary molars and the lower incisors was detected, and a few days later the teeth exfoliated prematurely. Histologic examination revealed normal tooth structure. Alkaline phosphatase and blood cells values were normal. Eruption of the permanent dentition was also accelerated. Tooth mobility was noticed in the permanent teeth as soon as they erupted, along with bone destruction. Examination revealed an elevated level of receptor activator of nuclear factor-κB ligand and lower-than-normal osteoprotegerin and vitamin D levels. The patient was treated with vitamin D supplements, and his teeth have been stable ever since. CAH is a serious chronic disorder appearing in children with accelerated dental development and possibly premature loss of primary teeth.
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Affiliation(s)
- Matina V Angelopoulou
- Division of Pediatric Dentistry, Marquette University School of Dentistry, Milwaukee, Wisconsin;
| | - Elias Kontogiorgos
- Department of Restorative Sciences, Texas A&M Baylor College of Dentistry, Dallas, Texas; and
| | - Dimitris Emmanouil
- Department of Paediatric Dentistry, Dental School, University of Athens, Greece
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