Premature loss of primary teeth associated with congenital syphilis: a case report The Journal of Clinical Pediatric Dentistry Volume 29, Number 3/2005 273 INTRODUCTION S yphilis is an infectious disease, which can be con- genital or acquired, caused by the spirochete Tre- ponema pallidum. Acquired syphilis is much more common and is the result of sexual contact with, or blood transfusion from, an infected person. 1 When the infection of a syphilitic mother is passed through the placenta to the fetus, the fetus has a chance of being infected. If the fetus is affected, the condition is termed congenital syphilis. 2 Early congenital syphilis occurs when the child is two years old or younger. If the child is older than two years of age, the condition is termed late congenital syphilis. 3 Maternal syphilis is a significant problem in Latin America. 4,5 Official data show that the number of infants born with congenital syphilis was 10,600 during 2002, according to 15 countries that reported data to the Pan American Health Organization. 5 In the last epi- demiological annual survey carried out in Brazil, 3,316 new cases of congenital syphilis were registered. 6 Besides, syphilis reflects one of the most glaring exam- ples of racial disparity in health status, with the rate for blacks nearly 30 times the rate for whites. 7 In relation to the oral manifestations of congenital syphilis, the most common signs are high-arched palate, short mandible, and rhagades at the commissures, sad- dle nose, frontal bossing, Hutchinson’s teeth, dysplastic molars 8 and palatal defect 9 . Dysplastic permanent incisors, interstitial keratitis and eighth nerve deafness compose the classic Hutchinson’s triad, which are defined as pathognomonic diagnostic features of con- genital siphilis. 10 Premature loss of teeth associated with systemic dis- ease usually results from some change in the immune system or connective tissue. The most common of these conditions appear to be hypophosphatasia and early- onset periodontitis. Other diseases that may be mani- fested with severe oral infection, such as Wiskott- Aldrich syndrome, diabetes mellitus, or herpes zoster, could result in early tooth loss. 11 However, premature loss reports of primary teeth in patients with congenital syphilis were not found in the literature reviewed. Although the premature loss of primary teeth in conjunction with early eruption of permanent teeth may be of no clinical significance, the clinician should not overlook the loss of primary or permanent teeth in the absence of trauma. Therefore, the aim of this paper is to report a case of premature loss of primary teeth in a four-year-old child with congenital syphilis. CASE REPORT A four-year-old female Afro-American child was brought by her mother to the pediatric dental clinic of a public university in Rio de Janeiro, Brazil. The chief complaint was the presence of dental caries in the pos- terior teeth of her daughter. Premature loss of primary teeth associated with congenital syphilis: a case report Andréa Gonçalves Antonio* / Alice Kelly** / Lucianne Cople Maia*** Congenital syphilis is an infectious disease transmitted by an infected mother to her fetus. Several reports in the literature have focused on oral manifestations of congenital syphilis, mainly about Hutchinson's teeth and dysplastic molars, which are more common. However, this paper describes an unusual feature of congenital syphilis in a four-year-old child. A case of premature loss of primary teeth associated with congenital syphilis is reported. J Clin Pediatr Dent 29(3): 273-276, 2005 * Dr. Antonio was a postgraduate student of pediatric dentistry, Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Brazil. ** Dr. Kelly is a pediatric dentist with a post graduation in Pediatric Dentistry, Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Brazil. *** Dr. Maia is Associate professor of pediatric dentistry, Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Brazil. Send all correspondence to Dr. Lucianne Cople Maia, Rua Marquês do Paraná, 189 apt. 1804 - Centro - Niterói- Rio de Janeiro - Brazil 24.030-210 Voice/Fax number: (55) (21) 2629-3738 E-mail: rorefa@microlink.com.br