Advertisement

European Archives of Paediatric Dentistry

, Volume 12, Issue 6, pp 312–317 | Cite as

Premature exfoliation of primary teeth in a 4-year-old child, a diagnostic dilemma

  • G. SharmaEmail author
  • R. Whatling
Case Report

Abstract

BACKGROUND: Premature exfoliation of primary teeth is an important diagnostic event warranting urgent investigation. The majority of conditions presenting with early loss of teeth are serious and in some cases fatal. CASE REPORT: This is a case of premature exfoliation of primary teeth in a 4-yr-old female. On presentation her teeth were mobile and there was a history of gingival bleeding when biting into food. Hair loss and fatigue were also reported. Her medical history revealed she had dry skin but was otherwise fit and healthy. Extra-oral examination was unremarkable. Dental examination revealed she had a full complement of primary teeth with unusual spacing, generalised tooth mobility, halitosis and an orange extrinsic dicolouration. Her gingivae were inflamed in the 84 region. Radiographic examination revealed severe generalised bone loss. TREATMENT: She received periodontal care including regular scaling, a short course of metronidazole, preventative advice and continued monitoring. She was also sequentially referred to the departments of Dermatology, Paediatric Haematology, Immunology, Oral Microbiology and Oral Pathology for further investigation. Underlying disorders known to cause premature tooth loss were ruled out. FOLLOW-UP: Two years on, there has been early exfoliation of her 54, 51, 61, 62, 64, 71, 84 and 81 with no new progressive mobility of her remaining primary teeth. CONCLUSION: The commonest causes of premature tooth loss have been eliminated including Papillion-Lefevre syndrome, Chediak-Higashi syndrome, hypophosphatasia, Langerhans’ cell histiocytosis, neutropenia and leukemia. Therefore, this fit and healthy 4-yr-old has an aggressive early onset periodontal condition with associated fatigue and hair loss. Diagnosis of associated systemic conditions is not straightforward in these cases and requires multi-disciplinary input.

Keywords

Premature exfoliation of primary teeth 4 year-old child diagnostic dilemma 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Al-Jundi SH, Hammad M.M, Dabous I. Hypophosphatemic rickets and aggressive periodontitis: a review of the role of dentine matrix protein 1 in the pathogenesis. Eur Arch Paediatr Dent 2011; 12:46–50.PubMedCrossRefGoogle Scholar
  2. Bender IB. Bone changes in leukemia. Am J Orthodon Oral Surgery 1944; 30:556–563.CrossRefGoogle Scholar
  3. Cameron, Widmer, Handbook of Paediatric Dentistry, 1997; 167–177.Google Scholar
  4. Cohen DW, Morris AL. Periodontal manifestations of cyclic neutropenia. J Periodontol 1961; 32:159–168.CrossRefGoogle Scholar
  5. Deasy MM, Vogel RR, Annes IK, Simon BI. Periodontal disease associated with preleukemic syndrome. J Periodontol 1976; 47:41–45.PubMedGoogle Scholar
  6. Fallon MM, Teitelbaum SS, Weinstein RR et al. Hypophosphatasia: Clinical pathologic comparison of the infantile, childhood and adult forms. Medicine (Baltimore) 1984; 63:12–24.Google Scholar
  7. Hartman KS, Colonel L. Histocytosis X: A review of 114 cases with oral involvement. Oral Surg 1980; 49:38–54.PubMedCrossRefGoogle Scholar
  8. Johnes JH, Mason DK. Oral manifestations of systemic disease. Philadelphia: W.B. Saunders, 1980; p.58,141, 361.Google Scholar
  9. Page RR, Beatty P, Waldrop TC. Molecular basis for the functional abnormality in neutrophils from patients with generalised prepubertal periodontitis. J Periodont Res 1987; 22:182–183.PubMedCrossRefGoogle Scholar
  10. Prichard JJ, Ferguson DD, Windmiller J, Hurt WC. Prepubertal periodontitis affecting the deciduous and permanent dentition in a patient with cyclic neutropenia: A case report and discussion. J Periodontol 1984; 55: 114–122.PubMedCrossRefGoogle Scholar
  11. Rowe OS. The molecular background to hypophosphatemic rickets. Arch Dis Child 2000; 83:192–194.PubMedCrossRefGoogle Scholar
  12. Waldrop TT, Anderson DD, Hallmon WW. et al. Periodontal manifestations of the heritable Mac-1, LFA-1, deficiency syndrome: Clinical, histopathologicand molecular characteristics. J Periodontol 1987; 58:400–416.PubMedCrossRefGoogle Scholar
  13. Watnabe K. Prepubertal periodontitis: a review of diagnostic criteria, pathogenesis and differential diagnosis. J Periodont Res 1990; 25:31–48.CrossRefGoogle Scholar

Copyright information

© Adis International 2011

Authors and Affiliations

  1. 1.Department of Paediatric DentistryBarts and the London NHS TrustLondonUK

Personalised recommendations