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 specificdental 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 associatedwith syndromes, are not commonly found in cases of congenital syphilis. A rare case of congenitalsyphilis in an individual (P000707) treated with mercury and a mandibular left fourth molar with normal morphologyis presented.Materials and Methods: During a systematic examination of 28 skeletons with treponemal disease at the Smithsonianmuseum in Washington, DC, a supernumerary mandibular distomolar in one individual (P000707) wasrevealed.Results: P000707 was an African American female, 26 years of age. Dentition showed severe enamel hypoplasiaof the maxillary and mandibular incisors, left canine, and upper first molars, consistent with the effects of treatmentof congenital syphilis by mercurial compounds. Crown of the left mandibular distomolar has typical molarmorphology 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 pulpchamber 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 supernumeraryteeth due to: (1) the age at which the development of the fourth molar takes place, (2) the stage ofthe infection at the time of development and (3) the age at which treatments containing mercury are administeredto patients with congenital syphilis.