Case Report: Dental Treatment of a Child with Hypophosphataemic Rickets

Abstract

Background: Hypophosphataemic rickets is an hereditary metabolic disease characterised by osseous and dental structural defects. The oral manifestations include highly frequent pulp infections as a result of enamel and dentinal defects. The pulp infections are multiple, spontaneous and can occur from an early age, becoming, in some cases, the first signs of the disease. An early preventive treatment is essential for a good oral health of these patients. Case report: The purpose of this case report was to illustrate the dental repercussions of hypophosphataemic rickets in a five-year-old child. Intraoral examination showed a complete primary dentition and two fistulae at the labial periapical region of teeth 51 and 61. Bitewing radiographs revealed multiple interproximal caries of the primary molars. Pulp chambers were enlarged, with pulp horns extending to the dentino-enamel junction. Treatment: Quadrant dentistry with rubber dam isolation was carried out. Pulpotomies were performed with ferric sulphate and reinforced zinc-oxide eugenol cement on the entry of the radicular canals. For all teeth, after pulpotomy, complete haemostasis was achieved, suggesting healthy pulps. Molars were restored with pre-formed metal crowns cemented with glass ionomer cement. For canines, after pulpotomy, a glass ionomer base and a composite resin was used. Follow-up: At six-month follow-up unsuccessful multiple pulpotomies (55, 75, 85, 74, and 63) were noted. Clinically there were abscesses on 55 and 63 and pulpectomies will now be needed, but the prognosis remains unclear