A panoramic radiograph shows multiple unerupted and supernumerary teeth with impacted permanent dentition. Considering a syndromic cause, which of the following is MOST consistent with these findings?

Correct answer: D. Gardner syndrome

• A. Regional odontodysplasia ('ghost teeth') affects a localized segment, producing thin enamel and dentin with a faint, ghost-like radiographic appearance — not multiple supernumeraries.
• B. Eagle syndrome is elongation of the styloid process producing throat/neck pain on head turning — it has no effect on tooth eruption.
• C. Paget disease causes a cotton-wool bone pattern with hypercementosis in older adults, not multiple impacted supernumerary teeth.
• D. CORRECT. Gardner syndrome (a variant of familial adenomatous polyposis, APC gene, autosomal dominant) classically produces MULTIPLE OSTEOMAS of the jaws and skull, SUPERNUMERARY and IMPACTED teeth, odontomas, epidermoid cysts, and — critically — intestinal polyps with essentially 100% malignant transformation. The dental findings often precede the bowel disease, so the dentist may be the first to detect it. Referral for GI evaluation is mandatory.

Note: If you see multiple osteomas + supernumerary/impacted teeth: refer for colonoscopy. The dental findings can save a life.