What are the characteristics of Hutchinson teeth in congenital syphilis?

Hutchinson Teeth: Characteristic Dental Stigmata of Late Congenital Syphilis

Hutchinson teeth are notched, peg-shaped permanent upper central incisors that represent a classic late manifestation of congenital syphilis, typically becoming apparent after 5 years of age. 1, 2

Physical Characteristics

Hutchinson's incisors display several distinctive features:

• Notched incisal edges with a characteristic screwdriver or peg shape affecting the permanent upper central incisors 1, 3
• Reduced dimensions with abnormally thin enamel compared to normal teeth 4, 5
• Barrel-shaped or tapered appearance where the incisal edge is narrower than the cervical portion 3, 5
• Apical hypoplasias may also affect the permanent canines in affected individuals 4

The teeth develop these abnormalities due to Treponema pallidum infection during tooth formation in utero, causing disruption of ameloblast function during the critical developmental period 3.

Associated Dental Findings

Beyond Hutchinson's incisors, congenital syphilis produces other characteristic dental stigmata:

• Mulberry molars (Fournier's molars): First permanent molars with crowding and infolding of cusps, creating a mulberry-like appearance 1, 3, 5
• Moon's molars (bud molars): Abnormal first molars with dome-shaped crowns and reduced cusp development 1, 3, 5
• Increased frequency of enamel hypoplasias: Affected individuals show triple the frequency of all hypoplasias compared to unaffected populations 4

Clinical Context: Hutchinson's Triad

Hutchinson teeth form one component of the classic Hutchinson's triad of late congenital syphilis manifestations:

1. Hutchinson's teeth (notched permanent incisors) 1, 2
2. Interstitial keratitis (corneal inflammation) 1, 2
3. Eighth nerve deafness (sensorineural hearing loss) 1, 2

This triad typically becomes apparent after 5 years of age, though the infection was present during pregnancy and at birth 2.

Other Late Stigmata to Recognize

When evaluating for Hutchinson teeth, examine for additional late manifestations of congenital syphilis:

• Saddle nose deformity (collapsed nasal bridge) 1
• Frontal bossing (prominent forehead) 1
• Anterior bowing of shins (saber shins) 1
• Rhagades (linear scars around the mouth) 1
• Clutton joints (painless knee effusions) 1

Diagnostic Pitfall

Milder cases of Hutchinson teeth can be mistaken for other causes of enamel hypoplasia, making the diagnosis challenging in contemporary practice where most clinicians have never encountered a case 3. The key distinguishing features are the specific notching pattern, peg shape, and association with mulberry molars affecting the permanent dentition 6, 3.

Clinical Significance

The presence of Hutchinson teeth indicates late congenital syphilis that was untreated or inadequately treated during pregnancy 2, 6. While these dental findings provide valuable diagnostic evidence, they represent a failure of prenatal care and syphilis control programs, as congenital syphilis is entirely preventable with appropriate maternal screening and treatment 6.