Congenital syphilis remains a preventable yet clinically significant condition, with oral and dental findings that may serve as key diagnostic clues for dentists and pediatric specialists.
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✅ Etiology and Routes of Transmission
Congenital syphilis is caused by vertical transmission of Treponema pallidum from an infected mother to the fetus. Transmission occurs primarily via:
▪️ Transplacental spread, especially after the first trimester
▪️ Untreated or inadequately treated maternal syphilis
▪️ Late prenatal diagnosis or absence of prenatal care
The risk of fetal infection increases with higher maternal spirochete load and earlier stages of maternal disease.
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Dental manifestations result from chronic inflammatory damage to developing tooth germs, particularly during the bell and apposition stages of odontogenesis. The infection interferes with ameloblast and odontoblast function, leading to enamel hypoplasia and abnormal crown morphology.
✅ Key Dental Manifestations
➤ Hutchinson Incisors
▪️ Permanent maxillary central incisors
▪️ Screwdriver-shaped crowns
▪️ Notched or crescent-shaped incisal edges
▪️ Reduced mesiodistal width
These incisors are considered pathognomonic of congenital syphilis.
➤ Mulberry (Moon) Molars
▪️ Typically first permanent molars
▪️ Irregular occlusal anatomy with multiple rounded enamel nodules
▪️ Poor cusp definition and abnormal enamel texture
These features reflect impaired enamel mineralization during early childhood.
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In addition to dental anomalies, affected children may present with:
▪️ Enamel hypoplasia in other permanent teeth
▪️ Delayed tooth eruption
▪️ High caries susceptibility
Classically, dental findings are part of Hutchinson’s triad, which includes:
▪️ Interstitial keratitis
▪️ Sensorineural hearing loss
▪️ Dental anomalies
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Dentists play a critical role in detection, as dental signs often persist even after systemic disease resolution. Diagnosis is based on:
▪️ Characteristic dental morphology
▪️ Medical history suggestive of congenital infection
▪️ Serologic confirmation (VDRL, RPR, treponemal tests)
▪️ Interdisciplinary evaluation with pediatrics and infectious disease specialists
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Medical Treatment
▪️ Penicillin G remains the gold standard for treating congenital syphilis
▪️ Early treatment prevents systemic complications but does not reverse dental defects
Dental Management
▪️ Restorative rehabilitation (composites, crowns, veneers)
▪️ Preventive care to reduce caries risk
▪️ Long-term monitoring of occlusion and eruption
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Despite global prevention strategies, congenital syphilis is re-emerging in many regions, making dental recognition increasingly relevant. Hutchinson incisors and mulberry molars are permanent markers of early systemic disease, underscoring the dentist’s role in early identification, referral, and multidisciplinary care.
🎯 Clinical Recommendations
▪️ Carefully evaluate atypical enamel defects and tooth morphology
▪️ Include congenital infections in the differential diagnosis of enamel hypoplasia
▪️ Refer suspected cases for serologic testing
▪️ Provide long-term restorative and preventive dental care
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Dental manifestations of congenital syphilis are not merely cosmetic findings but critical diagnostic indicators. Recognizing Hutchinson incisors and mulberry molars allows dental professionals to contribute to early diagnosis, comprehensive patient care, and improved long-term outcomes. Dentistry plays a vital role in identifying systemic diseases through oral signs.
📚 References
✔ Centers for Disease Control and Prevention. (2023). Congenital syphilis – STI treatment guidelines. https://www.cdc.gov/std/treatment-guidelines/congenital-syphilis.htm
✔ Neville, B. W., Damm, D. D., Allen, C. M., & Chi, A. C. (2023). Oral and maxillofacial pathology (5th ed.). Elsevier.
✔ Shafer, W. G., Hine, M. K., & Levy, B. M. (2019). Shafer’s textbook of oral pathology (8th ed.). Elsevier India.
✔ World Health Organization. (2022). WHO guidelines for the treatment of Treponema pallidum (syphilis). https://www.who.int/publications/i/item/9789240051400
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