Types of Rickets, Dental and Histologic Findings: Review of the Literature

Abstract

Introducti on: A disease that occurs during childhood, rickets is the failure of growing bone to mineralize. Many skeletal and radiographic changes can ocur because of the lack of calcifi ed osteoid and the buildup of unossifi ed carti lage. Proper bone formati on requires a complex interplay of several organs and chemicals, and vitamin D deserves special menti on because any disturbance in its producti on, absorpti on, or metabolism is paramount in the development of rickets. The pathophysiology of the disease is thought to be impaired phosphate transport, especially decreased phosphate resorpti on in the renal proximal tubule, as well as in the intesti ne. In most cases, the diagnosis is established with a thorough history and physical examinati on and confi rmed by laboratory evaluati on. Early diagnosis is essenti al because morbidity can be minimized if children are treated before eight months of age. Objecti ve: The aim of this literature review is to present various types of rickets with clinical features and the dental fi ndings, preventi ve measurements and treatments. Conclusion: The denti st as well as the pediatrician should be made aware of the features of this disorder so that early interventi on can prevent subsequent serious and more invasive dental procedures. KEYWORDS DESCRITORES Rickets;Hypophosphataemia; Oral manifestati ons; Therapeuti cs. RESUMO ABSTRACTIntrodução: O raquiti smo, uma doença que ocorre durante a infância, é a falta de crescimento ósseo necessário para a mineralização. Diversas alterações radiográfi cas esqueléti cas podem ocorrer devido a ausência de osteóide calcifi cado e a formação de carti lagem. A formação óssea adequada requer uma complexa interação de vários órgãos e produtos químicos, e a vitamina D merece uma menção especial, pois qualquer alteração na sua produção, absorção ou no seu metabolismo é fundamental para o desenvolvimento do raquiti smo. Acredita-se que a fi siopatologia da doença está no transporte inadequado do fosfato, especialmente na diminuição da reabsorção de fosfato no túbulo renal proximal bem como no intesti no. Na maioria dos casos, o diagnósti co é estabelecido com uma história completa e exame fí sico, e confi rmado por exames laboratoriais. O diagnósti co precoce é essencial, pois a morbidade pode ser minimizada se as crianças forem tratadas antes dos oito meses de idade. Objeti vo: Apresentar os vários ti pos de raquiti smo com suas característi cas clínicas, aspectos dentários, medidas preventi vas e tratamento. Conclusão: O cirurgião-denti sta, bem como o pediatra, devem ser informados das característi cas desta desordem para que a intervenção precoce possa evitar seqüelas subsequentes e procedimentos odontológicos mais invasivos.

Dental findings in Fanconi Bickel Syndrome: Case Report

“…Mainly, dental enamel is the most mineralized tissue in human body, white opaque areas (hy-pocalcification) or enamel hypoplasia, has been reported in a child with Fanconi Bickel Syndrome. [10,13,14] Clinical and histologic abnormalities may be seen in the dental hard tissue, essentially when systemic symptoms appear during a period of odontogenesis. [15] Hypophosphatemic rickets are characterized by different skeletal and dental manifestations.…”

Orofacial and Skeletal Manifestations of Hypophosphatemic Rickets in Fanconi Bickel Syndrome

“…Among various types of rickets, hypophosphatemic rickets presents mainly with dental manifestations. [10] The skeletal and dental manifestations of hypophosphatemic rickets have been enumerated in Table 2 and Table 3 [7,11,12]. Spontaneous dental abscesses in clinically normal teeth HISTOLOFICAL FINDINGS Thin hypoplastic and hypocalcified enamel Dysplastic and poorly mineralized dentin with areas of interglobular dentin in circumpulpal dentin, dentinal clefts Dentin dysplasia…”

Dental Management of Hypophosphatemic Vitamin D Resistant Rickets

“…In these cases, to avoid attrition and microfractures of enamel and dentine, prefabricated metal or polycarbonate resin crowns can be applied (23). However, in the present case, this application was not carried out because there was no defect in the enamel and the perforation risk to the pulp chambers (16). Finally, following the therapeutic, restorative and preventive applications, the patient was recalled for periodical check-ups of the prosthetic appliance, general dental condition, orthodontic examination and caries preventing procedures.…”

“…In VDRR cases, in spite of the impairment of dentine mineralization, it is known that the odontoblastic cell function is normal (15,16). Additionally, dentine tissue is more…”

“…However, permanent dentition development can be improved by medical therapy after birth. Therefore, mineralized tissue defects are more common in primary dentition than permanent dentition (3,4,16).…”