Five Cases of Dental Anomalies Attributable to Congenital Syphilis from Early 20th Century American Anatomical Collections

Abstract

Specific dental abnormalities are considered pathognomonic of congenital syphilis (CS); however, European physicians recognized their variation during the late 19th to mid 20th centuries. Observations of syphi-lis-related dental abnormalities in American individuals from similar time periods are made to determine types of variation among the American population.From a survey of the Smithsonian Institution’s National Museum of Natural History anatomical human skeletal collection, five individuals demonstrated dental characteristics consistent with CS (P00011R, P219398, P000707, P000679, and P000161). Hutchinson’s three categories of dental anomalies were used to describe variations among syphilitic individuals.Previously identified pathological dental characteristics related to CS were present in the analyzed individuals. P00011R, 24-year-old Black female, has a maxillary right Moon’s molar. P219398, approximately 20-year-old Black female, has Hutchinson’s incisors and Fournier’s molars. P000707, 26-year-old Black male, displays severe hypoplasia on all incisors, canines and maxillary first molars. P000679, 33-year-old Black female has “screw-driver” shaped maxillary central incisors, altered occlusal morphology of first maxillary molars and hypoplasia. P000161, 45-year-old Black female, demonstrates severe hypoplasia on incisors and canines (molars lost).“Classic” dental characteristics of CS are not ubiquitous to all identified cases. This study exemplifies that den-tal anomalies associated with CS do not all have to be present for diagnosis. Although other causes for some of these anomalies are possible, observations in these five cases are most consistent with CS.

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“…case P00011R, fig. 1, published by Ioannou et al 2017), which is the differential diagnosis proposed in the site report and one supported here, as it is the author's experience that individuals with congenital or acquired treponematosis or syphilis often have very severe (and plane-form) enamel hypoplastic defects present (see Connell et al 2012). Research by Towle et al (2017) suggests that for sk 1672, these are a severe form of enamel hypoplastic defect and not caused by syphilis; they propose that these are the earliest examples of a severe plane-form defect.…”

“…1, published by Ioannou et al . 2017), which is the differential diagnosis proposed in the site report and one supported here, as it is the author's experience that individuals with congenital or acquired treponematosis or syphilis often have very severe (and plane-form) enamel hypoplastic defects present (see Connell et al . 2012).…”

“…Their remains consisted of a skull, vertebrae and a left tarsal bone. 168 Hillson et al 1998;Ioannou et al 2017;Nissanka-Jayasuriya et al 2016. These sources note that less-severe defects are similar in appearance to hypoplastic defects (i.e.…”

Advancing the understanding of treponemal disease in the past and present

“…Alterations that may have resulted from mercury treatment have been increasingly recognized, particularly in the dentition (e.g., Iouannou & Henneberg, ; Ioannou, Henneberg, Henneberg, & Anson, ; Ioannou et al, , ; Iouannou, Hunt, & Henneberg, ; Radu & Soficaru, ). Because mercury affects amelogenesis if ingested at significant repeated doses (around 650 mg), dental anomalies provide evidence for the use of mercurial treatments in infants and children (Ioannou, et al, 2015).…”