先天梅毒に対する形態異常歯の診断的価値に関する研究

Abstract

It is commonly acknowledged that occurrence in children of certain morphological abnormities of teeth is closely associated with the presence of congenital syphilis in them. Although a great many reports are hitherto available on this problem, most of these were very divergent in either the classification or representation of the abnormities of tooth anatomy, and failed to provide any exact criterion with which one is able to make successful diagnosis. In the present study, a series of oral examination programs was undertaken on a total of 5324 pupils of primary schools, and, based on the eleven dental stigmata hitherto proposed to be involved with congenital syphilis, a group of 29 subjects bearing any one or two such stigmata was gathered out. These subjects were examined for other possible signs of congenital syphilis besides above 11 stigmata to serve for further aid of diagnosis and, based on the serology test as final evidence, diagnostic value of the above 11 stigmata was respectively evaluated. The results were summarized as follows. 1. It was concluded that Fournier's and Hutchinson's teeth proved most reliable for diagnosis of congenital syphilis. 2. Nineteen subjects had Hutchinson's teeth and 18 had Fournier's teeth and when both groups were combined, these members accounted for 29 out of the total children or 0.54% of the total. 3. Eight (31%) out of 29 subjects had both Hutchinson's and Fournier's signs combined. 4. Although no typical instance of Hutchinson's teeth was encountered in the examination of deciduous teeth, similar atypical signs of Hutchinson's stigmata were observed in both permanent and deciduous dentitions, particularly in the lower anterior and upper lateral incisor teeth of the same individuals in whom the manifestation was exceptionally strong. 5. Syphilitic eye disturbances were detected in 11 subjects (0.2%) out of the total children and these subjects accounted for about two third of 29 subjects who had either Hutchinson's or Fournier's teeth or both. 6. A lesser diagnostic value should be assigned to the dwarf teeth as compared to the above two stigmata. 7. About 10% of the teeth with constricted cusps was supposed to be involved in congenital syphilis. 8. Although occurrence of the teeth with a lava-like appearance was very few, results of the serology test administered strongly suggested that such teeth were sure evidence of congenital syphilis. 9. Those manifestations such as Kraupa's symptom (abnormal form of upper lateral incisors), the spiral teeth, mottled teeth, erosion, Carabelli's tubercle and diastema ; these proved of no value for true diagnosis of congenital syphilis.