Physiology & Biochemistry · patient case question
Notched screwdriver-shaped incisors and multicusped mulberry molars indicate:
Patient case: Syndromes recognised at the chair
demo: Paediatric and young adult clinic
chief: Several patients whose facial and dental features point to a recognisable syndrome.
history: One child has bilateral painless expansion of the mandibular angles with an upward gaze, and a father with the same childhood history. Another has downslanting palpebral fissures, malar hypoplasia and malformed external ears. A third has notched, screwdriver-shaped permanent incisors and multicusped first molars. A fourth has a smooth philtrum, a thin upper lip and short palpebral fissures.
meds: None.
findings: Not applicable.
Show answer and explanation
Correct answer: D. Congenital syphilis
- A. Congenital rubella causes cataracts, cardiac defects and deafness, and may cause enamel defects, but not this specific tooth morphology.
- B. Tetracycline produces intrinsic banded discolouration but leaves crown morphology unchanged.
- C. Amelogenesis imperfecta is a hereditary enamel disorder affecting all teeth in both dentitions and does not alter crown shape in this notched, multicusped way.
- D. Correct. Hutchinson incisors and mulberry or Moon molars are dental stigmata of congenital syphilis, arising when Treponema pallidum disturbs the developing tooth germs. With interstitial keratitis and eighth nerve deafness they form Hutchinson's triad. The changes are permanent, since they occurred during crown formation.
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