Pediatric Dentistry · patient case question
To whom should this patient be referred for coordination of long-term care?
Patient case: Sparse Hair, Dry Skin, Missing Teeth
Patient: 9-year-old male
Chief Complaint: Mother: “He has almost no teeth, and he can’t handle hot weather at all.”
Background: Recurrent unexplained fevers each summer, previously attributed to viral illness. Two maternal uncles reportedly “had the same teeth problem.” Normal cognitive development.
Medications: None
Vital Signs: BP 98/62 mmHg · HR 88 bpm · RR 18 · T 98.8°F
Findings: Sparse, fine, light-colored scalp hair; sparse eyebrows. Frontal bossing, depressed nasal bridge, protuberant lips, and fine wrinkling of periorbital skin. Skin dry and smooth; mother reports he almost never sweats. Intraorally, several conical anterior teeth and multiple missing teeth with knife-edge alveolar ridges.
Show answer and explanation
Correct answer: B. A pediatric dentist to coordinate multidisciplinary management
- A. Incorrect. Conical teeth are a morphologic variation, not a pulpal problem. There is no indication for endodontic treatment.
- B. Correct. Management spans prosthodontics, orthodontics, oral surgery, and general medicine over many years of growth. The pediatric dentist is the appropriate coordinator, typically beginning with removable overdentures in early childhood and revising them as the child grows.
- C. Incorrect. Implants are contraindicated in a growing patient because the fixture behaves as an ankylosed unit and becomes progressively infraoccluded as the alveolus develops. The anterior mandible is the only site sometimes considered early, and that is a specialist decision made much later.
- D. Incorrect. Orthodontics has a role, but with so few teeth present there is nothing to align at this stage, and it is not the entry point to care.
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