Dental Stigmata of Congenital Syphilis: A Historic Review With Present Day Relevance

Abstract

Syphilis was the first sexually transmitted disease to be diagnosed in childhood. Most developed countries controlled syphilis effectively after the 1950s and congenital syphilis became rare. Since the late 1990s there has been a resurgence of syphilis in developed and developing countries and the WHO estimates that at least half a million infants die of congenital syphilis every year. The earliest reference to the dental manifestations of congenital syphilis was by Sir Jonathan Hutchinson, Assistant Surgeon at The London Hospital in 1861. Three main dental defects are described in congenital syphilis; Hutchinson's incisors, Moon's molars or bud molars, and Fournier's molars or mulberry molars. Although many physicians, dentists, and pathologists in developed countries will be aware of the dental features of syphilis, most will never have seen a case or made the diagnosis. The purpose of this article is to review some of the history of congenital syphilis, remind healthcare professionals of the features, and bring to their attention that the changes are still prevalent and that milder cases can be mistaken for other causes of hypoplasia.

Historic Treponema pallidum genomes from Colonial Mexico retrieved from archaeological remains

“…Although these individuals ( S1 Fig ) do not display pathognomonic dental changes such as Hutchinson’s incisors or “mulberry” (or Founier’s) molars which are known to have a broad occurrence (33% and 27% respectively) in individuals bearing a congenital infection of syphilis, they do display abnormal periosteal bone development of the long bones and cranial bones [ 28 ]. To our knowledge, dental features associated with congenital syphilis are restricted to permanent teeth and would only be confidently visible around 6–9 months of age as only the sites of initiated ameloblast activity are visible before then [ 27 , 36 ]. Although each individual was represented by a differing number of skeletal elements, all individuals presented layered periostitis.…”

Genetic Evidence Supporting the Role of the Calcium Channel, CACNA1S, in Tooth Cusp and Root Patterning

“…The detailed oral phenotype can be seen in patient 1_III.11 ( Supplementary Figures S1A–D ), patient 2_III.7 ( Supplementary Figures S1E–G ), and patient 4_II.3 ( Supplementary Figures S1I–L ). These accessory structures created deep pits and grooves, which resembled “mulberry molars” ( Nissanka-Jayasuriya et al, 2016 ). The location of these supernumerary molar cusps was clearly occlusal and appeared distinct from Carabelli cusps, the latter typically present on the external palatal side of the molar ( Hunter et al, 2010 ) (Carabelli cusp is number 5 in Figure 1A ).…”

Blind to Chains? The Potential of Bioarchaeology for Identifying the Enslaved of Roman Britain

“…Mortality: catastrophic profile; older adults Morbidity: increased risk Blakey 2001;Cameron and Martin 2012;Corruccini et al 1982;Handler and Corruccini 1983;Harrod and Martin 2014;Harris and Rathbun 1989;Kelley and Angel 1987;Okumura 2011;Owsley et al 1987;Pearson et al 2011;Rathbun 1987;Shuler 2005 Elliot and Collard 2009;Hefner et al 2012;Pilloud and Hefner 2016;Prowse et al 2010a;Sauer and Wankmiller 2009;Schroeder et al 2009; Diet: skeletal and dental evidence for metabolic diseases cause by nutritional insufficiencies Blakey 2001;Brickley and Ives 2008;Cameron and Martin 2012;Corruccini et al 1982;D'Ortenzio et al 2016;Harrod and Martin 2014;Harris and Rathbun 1989;Jacobi et al 1992;Kelley and Angel 1987;Okumura 2011;Rathbun 1987 Skeletal and dental malformations associated with sexually transmitted diseases (e.g. syphilis) Hillson et al 1998;Jacobi et al 1992;Lambert 2006;Nissanka-Jayasuriya et al 2016;1995;Patterson and Davies 2016 Death in childbirth at a young age Burnard 2004;Bush-Slimani 1996;Steckel 1986 Congenital and developmental defects associated with materna...…”

“…Their remains consisted of a skull, vertebrae and a left tarsal bone. 168 Hillson et al 1998;Ioannou et al 2017;Nissanka-Jayasuriya et al 2016. These sources note that less-severe defects are similar in appearance to hypoplastic defects (i.e.…”