A Rare Case of Congenital Syphilis and a Supernumerary Fourth Molar in an Early 20th Century African American Woman

Abstract

Congenital syphilis is a disease recognized for interfering with odontogenesis, producing specific dental characteristics including Hutchinson’s incisor, Moon’s molar, Fournier’s molar and mulberry molar, while its past treatments including mercury are known to affect amelogenesis. Supernumerary teeth, mainly associated with syndromes, are not commonly found in cases of congenital syphilis. A rare case of congenital syphilis in an individual (P000707) treated with mercury and a mandibular left fourth molar with normal morphology is presented.

Materials and Methods: During a systematic examination of 28 skeletons with treponemal disease at the Smithsonian museum in Washington, DC, a supernumerary mandibular distomolar in one individual (P000707) was revealed.

Results: P000707 was an African American female, 26 years of age. Dentition showed severe enamel hypoplasia of the maxillary and mandibular incisors, left canine, and upper first molars, consistent with the effects of treatment of congenital syphilis by mercurial compounds. Crown of the left mandibular distomolar has typical molar morphology but is smaller in size than other permanent molars. Arrangement of grooves resembles the +4 pattern, but is complex due to crenulation. Oblique x-ray revealed that the fourth molar had one root with a pulp chamber extending towards the apex, suggesting taurodontism. No other distomolar teeth were present.

Conclusions: Congenital syphilis and treatment containing mercury may not influence the development of supernumerary
teeth due to: (1) the age at which the development of the fourth molar takes place, (2) the stage of the infection at the time of development and (3) the age at which treatments containing mercury are administered to patients with congenital syphilis.