Hutchinson Teeth : Symptoms, Treatment, and Prevention of Congenital Syphilis Indication

Hutchinson teeth are an indication of congenital syphilis that develop when the mother is pregnant and transmits her syphilis to fetus.⁽¹⁾ Hutchinson teeth belong to a part of “Hutchinson triad,” consisting of the teeth, eyes and ears.⁽²⁾ This congenital condition is named after an English surgeon, Sir Jonathan Hutchinson who was a syphilis specialist and worked in the late 1800s at London Hospital.⁽³⁾

Hutchinson teeth become obvious when the baby starts to develop permanent teeth.⁽²⁾ The shape of the molars and incisors is triangular or has a peg like appearance. The teeth are widely spaced and can also have deficient enamel. In this article we will discuss about appearance of symptoms, treatment options, and how to prevent this condition.

Hutchinson teeth are caused by exposure to syphilis during or before birth.⁽⁴⁾ Syphilis is a sexually transmitted infection (STI) and starts as a sore on the skin of the mouth, genitals or rectum.⁽⁵⁾ This then spreads via mucous membrane or when coming in contact with these sores.

Syphilis sores can be painless in the initial stages of the infection. Some patients do not even realize that they have this condition. Some of the symptoms of syphilis are: hair loss, rash over the body and flu-like symptoms, such as sore throat, muscle pain and fever. ⁽⁵⁾ These symptoms develop and dissipate with time.

Babies are at increased risk for getting Hutchinson teeth if the mother is suffering from syphilis for less than 24 months. The risk is more if this infection hasn’t been treated before the 18^th week in pregnancy. The baby has exposure to this condition in the womb itself via placenta or during the birthing process.

Newborn babies do not show any signs of this condition, but symptoms start to appear as they grow and consist of :^{(2, 4)}

• Interstitial keratitis which involve the eyes where there is corneal inflammation.
• Deafness can be caused by labyrinthine disease, which is inner ear problems.
• Hutchinson teeth develop where the teeth have an abnormal appearance.
• Hutchinson teeth usually make their appearance when the child is around five years old and he/she starts to have permanent teeth.⁽⁶⁾ The molars and permanent central incisors are primarily affected by this condition.

Specific Features of Hutchinson Teeth are:

• Discoloration or thinning of enamel.
• Crescent-shaped or peg-shaped notch.
• Widely spaced teeth.
• Teeth which are smaller in size than usual.

A visit with pediatrician and dentist is a must for diagnosis and treatment. A blood test and in some cases lumbar puncture is done to confirm the diagnosis of syphilis. Treatment of this condition consists of a shot of penicillin.⁽⁷⁾ If this condition has been present for more than a year, then additional doses of penicillin may be needed.

Other treatment options for treating the shape of the teeth are:

Dental restorations are done for repairing the tooth damage.

Crowns which are the caps placed on teeth to make them look normal in shape and size and also help with overall function.

Fillings are done to fill up the cavities occurring as a result of weakened enamel and other dental issues. These dental fillings are made of composite material, dental amalgam or gold.

Bridges are false teeth which are placed between the spaces seen in Hutchinson Teeth. These also help in fixing bite issues and restoring natural smile and face shape.

Dental implants are titanium metal post, which are placed surgically in the jawbone to act as a foundation for bridges or crowns. These implants cannot be placed until the complete development of jaw occurs, which is often in late teenage or young adult years.

Treating the syphilis in the mother before getting pregnant is the best way to prevent Hutchinson teeth.⁽⁷⁾ Symptoms may or may not be present, so it is important to get tested to know if you are suffering from this condition. One should always get tested for syphilis and other STIs more so if:

• One has not practiced safe sex.
• One is suffering from another STI, which increases the risk of developing others.
• One has multiple sexual partners since getting tested the last time.
• If one is planning on becoming pregnant or are pregnant.

If you are pregnant and found out that you are suffering from syphilis, then getting treated before the 16th week of pregnancy helps in preventing Hutchinson Teeth. After the passing the 18th week of pregnancy syphilis may be cured, however, the baby can still have irreversible eye issues, deafness and joint and bone issues, such as Hutchinson teeth.

After the teeth have appeared, it is important to care for them irrespective of their shape. The American Dental Association recommends the following:⁽⁸⁾

• Brushing the teeth twice daily using fluoride toothpaste.
• Daily flossing between the teeth.
• Use of mouth wash which has fluoride in it.
• Restricting the consumption of snacks and beverages with added sugars.
• Consult a dentist for regular appointments.

The Hutchinson teeth cannot be reversed; however, it is still important to treat the syphilis, which is the underlying cause for preventing other health related issues. After the appearance of permanent teeth, consult your child’s dentist and pediatrician to talk about the different treatment options for correcting the appearance of the teeth.

Always get tested for STIs if you are considering on becoming pregnant or if you are pregnant so you can get this condition treated as soon as possible.

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