Clinical Features of premature ExfoliationDone by : Abdulrahman Al-Otaiq
HYPOPHOSPHATASIA• The clinical dental finding diagnostic of hypophosphatasia in children is premature exfoliation of the anterior primary teeth associated with deficient cementum.• The loss of alveolar bone may be limited to the anterior region. The disease is characterized by improper mineralization of bone caused by deficient alkaline phosphatase activity in serum, liver, bone, and kidney (tissue nonspecific). Increased levels of urinary phosphoethanolamine are also seen.
CHERUBISM (FAMILIAL FIBROUS DYSPLASIA)• Age: Clinical features start after the age of 3yrs and growth starts to decrease when patient reaches 5yrs of age and stops at 12-15yrs of age• Sex: Males > Females• The earlier the lesion appears the more rapidly it progresses• Jaw lesions are usually Painless and Symmetric• The swelling is not appreciated in the beginning as it mostly occurs in children, it is noticed only when the mandibular swelling becomes large and detectable in the 3rd decade of life.• In case of maxillary swelling the pressure on the floor of orbit may result in upward looking pupil which is refereed to as “heaven ward look” (can be seen clearly in the image below), the maxillary arch achieves a V ahaped appearance
• Increased cheek fullness, expansion and widening of alveolar ridge, flattening of the palatal vault.• Sub Mandibular swelling which is due to chronic lymphadenopathy• Bilaterally symmetrical enlargement of the jaw• The main diagnostic features are related to Dental problems -• Premature exfoliation of deciduous teeth• Abnormal growth of permanent teeth due to displacement by cysts and lesions• Absence of 2nd and 3rd mandibular molars
ACRODYNIAThe clinical features of the disease include fever,anorexia, desquamation of the soles and palms (causing them to be pink), sweating, tachycardia, gastrointestinal disturbance, and hypotonia. The oral findings include inflammation and ulceration of the mucous membrane, excessive salivation, loss of alveolar bone, and premature exfoliation of teeth.
HYPOPHOSPHATEMIA (FAMILIAL OR X-LINKEDHYPOPHOSPHATEMIC RICKETS OR VITAMIN DRESISTANRICKETS)Clinical features become evident in thesecond year of life. They include short stature andbowing of the lower extremities in affected boys.Premature tooth exfoliation is sometimes also a feature.Other dental manifestations often include apicalradiolucencies, abscesses, and fistulas associated with pulp exposures in the primary and permanent teeth.
CYCLIC NEUTROPENIA (CYCLIC HEMATOPOIESIS)The patients manifest a fever, malaise, sore throat, stomatitis, and regional lymphadenopathy, as well as headache, cutaneous infection, and conjunctivitis. Children exhibit a severe gingivitis with ulceration.
Reference :• McDonald RE, Avery DR, Dean JA. Dentistry for the child and adolescent. 8th edition, St Louis, Missouri: Mosby, Inc; 2004,P109-113.