Hutchinson's Incisors — MFDS Part 1 MCQ

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ModerateAnatomy (Head & Neck)Hutchinson's IncisorsMFDS Part 1

A 13-year-old has small permanent maxillary central incisors that taper towards the incisal edge and have a central semilunar notch. The first permanent molars have multiple poorly developed cusps, producing a mulberry-like occlusal surface. Which condition most likely caused this pattern of dental abnormalities?

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Correct answer: A — Congenital syphilis

Explanation lettering: D = shown as C · E = shown as D · C = shown as E

A is correct. Tapered, screwdriver-shaped permanent incisors with a central semilunar notch are Hutchinson's incisors, while malformed first permanent molars with numerous poorly developed cusps are mulberry molars. Both are characteristic dental stigmata of congenital syphilis. Hutchinson's incisors also form part of Hutchinson's triad with interstitial keratitis and eighth-nerve deafness. Tetracycline exposure primarily causes intrinsic banded discolouration rather than this crown morphology. Fluorosis causes diffuse enamel opacities or mottling, and rickets may cause non-specific enamel hypoplasia and delayed eruption. Measles is not associated with this characteristic combination of incisor and molar abnormalities.

Reference: Nissanka-Jayasuriya EH, Odell EW, Phillips C. Dental Stigmata of Congenital Syphilis: A Historic Review With Present Day Relevance. Head and Neck Pathology. 2016;10:327–331. https://pubmed.ncbi.nlm.nih.gov/26897633/