2025 – PAGE 151 – DERMATOLOGY
TEETH ISSUES
TOOTH TIMELINE
Tooth appearance follows a timeline. All anterior teeth are present (eight of them) by about 12 months. Primary teeth are typically fully erupted by age 30 months. Some children do not have teeth by 1 year of age, so reassurance is okay. For ABP questions, they will be more focused on abnormal-looking teeth.
PEG TEETH
Peg teeth refers to teeth that are smaller than usual. Sometimes they are tapered and look like fangs. This usually affects the lateral incisors and is associated with INCONTINENTIA PIGMENTI and HYPOHIDROTIC ECTODERMAL DYSPLASIA.
IMAGE: www.pbrlinks.com/PEGTEETH1
IMAGE: www.pbrlinks.com/PEGTEETH2
HUTCHINSON TEETH
Hutchinson teeth are found in CONGENITAL SYPHILIS. These children have teeth that are smaller and more widely spaced. They also have notches on the biting surfaces.
IMAGE: www.pbrlinks.com/HUTCHTEETH1
IMAGE: www.pbrlinks.com/HUTCHTEETH2
TETRACYCLINE TEETH STAINING
If tetracycline is used at a young age, teeth can end up having yellow, brown, or blue band-like stains. Avoid tetracycline until patients are at least 8 years of age.
IMAGE: www.pbrlinks.com/TETRATEETH1
FLUOROSIS
Fluorosis is the mottled discoloration of teeth due to excess fluorine use during tooth development (up to age 8).
IMAGE: www.pbrlinks.com/FLUOROSIS1
AVULSED TEETH
Do not reimplant avulsed primary (baby) teeth to avoid harming developing permanent teeth. Reimplant permanent teeth ASAP, ideally within one hour. Store the tooth in balanced salt solution, milk, saliva (inside cheek), or, as a last resort, water until implantation occurs.
VASCULAR & PIGMENTED LESIONS
PEARL/MNEMONIC: HEMANGIOMAS are different from VASCULAR MALFORMATIONS (e.g., Port Wine Stains/capillary malformations). VASCULAR MALFORMATIONS tend to have much more associated morbidity. You might say that VMs are Very Morbid in comparison.
IMAGE: (slideshow on birthmarks) www.pbrlinks.com/VM1
HEMANGIOMAS
Hemangiomas are an abnormal build-up of blood vessels. They eventually self-involute but are dangerous during PROLIFERATION PHASE. They are otherwise benign. They usually look red, but can appear blue if deep (CAVERNOUS HEMANGIOMAS). Proliferation is greatest during the first 6 months, and lesions are largest around 1 year of age. Lesions start to involute around 2 years of age and disappear by 5–10 years of age. If in a benign area, they can be left alone. If in a more sensitive area (near the eyes, ears, nose, throat, or spine), they may require medical treatment with propranolol (first line drug). Second line therapies include systemic steroids, pulsed dye laser therapy and surgery.
COMPLICATIONS: If located in the beard area, look for airway issues. If near the eye, it’s okay as long as there is no problem with VISION. Those near the ears, nose, and lips can be troublesome if they ulcerate. If in the lumbosacral area, there is concern for spinal dysraphism (incomplete fusion of a raphe, especially the neural folds/tube). High output congestive heart failure (CHF) can occur due to large, or multiple hemangiomas.
IMAGE: www.pbrlinks.com/HEMANGIOMAS1
IMAGE: www.pbrlinks.com/HEMANGIOMAS2