Hutchinson's Teeth Research Articles

Jonathan Hutchinson – A multispecialist of medicine

Sir Jonathan Hutchinson was a renowned dermatologist, surgeon, syphilologist, neurologist, and medical educator. Although his fields of interest were medicine, surgery, and ophthalmology, he contributed tremendously in the field of dermatology. He had made many original observations and published articles; many of the signs and diseases are named after him. A few to name are Hutchinson teeth, triad, nail sign, facies. Along with being a prolific author, he was a collector and teacher of many subjects. He had a feather on cap of publishing more than 600 articles and case reports in dermatology. He wrote the 10 volumes of Archives of Surgery, a remarkable singlehanded labor. He had earned honorary degrees from Universities of Glasgow, Cambridge, Edinburgh, Oxford, Dublin, and Leeds. He was knighted in 1908.

IMPACT IN NOTIFIED SYPHILIS DIAGNOSIS DURING THE COVID-19 PANDEMIC IN BRAZIL

Objective This study aimed to compare the average number of syphilis cases reported in the five Brazilian geographic regions, from March to December from 2017 to 2019, and in the same period in 2020, the latter representing the period of the pandemic. Study Design In this descriptive study, data were extracted from a SUS public disease notification database. Results There was a significant increase in syphilis incidence rates per million inhabitants in all Brazilian macro-regions during the COVID-19 pandemic, reaching +157% in the Southeast. The average increase was +78% overall, representing an additional 161 incident cases per million inhabitants. In all stages of syphilis, oral changes are observed. In congenital syphilis, pathognomonic signs and the Hutchinson triad (interstitial keratitis, Hutchinson teeth, hearing loss) can appear. The data suggest that distancing measures in the pandemic period were not able to interfere with sexual behavior in Brazil. Conclusion The epidemiology of syphilis in Brazil, in the 2019 coronavirus pandemic (COVID-19), presents interferences. Studies are needed to plan health measures. FAPEMIG, CNPq, CAPES. This study aimed to compare the average number of syphilis cases reported in the five Brazilian geographic regions, from March to December from 2017 to 2019, and in the same period in 2020, the latter representing the period of the pandemic. In this descriptive study, data were extracted from a SUS public disease notification database. There was a significant increase in syphilis incidence rates per million inhabitants in all Brazilian macro-regions during the COVID-19 pandemic, reaching +157% in the Southeast. The average increase was +78% overall, representing an additional 161 incident cases per million inhabitants. In all stages of syphilis, oral changes are observed. In congenital syphilis, pathognomonic signs and the Hutchinson triad (interstitial keratitis, Hutchinson teeth, hearing loss) can appear. The data suggest that distancing measures in the pandemic period were not able to interfere with sexual behavior in Brazil. The epidemiology of syphilis in Brazil, in the 2019 coronavirus pandemic (COVID-19), presents interferences. Studies are needed to plan health measures.

ROLE OF THE DENTIST IN CONGENITAL SYPHILIS EARLY DIAGNOSIS

Objectives The aim of this study was to review the role of the dentist in congenital syphilis early diagnosis. Study Design A search for articles published in PubMed and Scielo was performed in the period from 2010 to 2021, using the terms “congenital syphilis” AND “oral manifestations.” Results The condition was divided into late and early syphilis. Periostitis is the facial signal of early syphilis. As for late syphilis, which develops in untreated infants, facial signals are described as the Hutchinson triad, including Hutchinson's teeth, interstitial keratitis, and deafness. These 3 signals are not always present, and the investigation of other clinical signs such as frontal bossing and maxillary atresia, are required. Additionally, pregnant women should be examined for oral manifestations of primary and secondary syphilis to be treated and avoid vertical transmission. The importance of early diagnosis is due to the high figures of congenital syphilis cases in Brazil. During 2019, 24.130 new cases were diagnosed, and 173 deaths occurred. Conclusions Dentists can contribute to congenital syphilis early diagnosis by performing a complete clinical exam, and searching for signals located in the maxillofacial complex. It is necessary to use strategies to optimize diagnosis and treatment so that it does not progress to more severe stages. The aim of this study was to review the role of the dentist in congenital syphilis early diagnosis. A search for articles published in PubMed and Scielo was performed in the period from 2010 to 2021, using the terms “congenital syphilis” AND “oral manifestations.” The condition was divided into late and early syphilis. Periostitis is the facial signal of early syphilis. As for late syphilis, which develops in untreated infants, facial signals are described as the Hutchinson triad, including Hutchinson's teeth, interstitial keratitis, and deafness. These 3 signals are not always present, and the investigation of other clinical signs such as frontal bossing and maxillary atresia, are required. Additionally, pregnant women should be examined for oral manifestations of primary and secondary syphilis to be treated and avoid vertical transmission. The importance of early diagnosis is due to the high figures of congenital syphilis cases in Brazil. During 2019, 24.130 new cases were diagnosed, and 173 deaths occurred. Dentists can contribute to congenital syphilis early diagnosis by performing a complete clinical exam, and searching for signals located in the maxillofacial complex. It is necessary to use strategies to optimize diagnosis and treatment so that it does not progress to more severe stages.

Syphilis congénitale

Congenital syphilis is defined by a child born to an untreated or poorly treated mother or to a child with clinical or biological signs of congenital, the risk of transmission of syphilis depends on the stage: 100% at primary stage, 70% at secondary stage and 40% at early latent stage. Risk increases with the progression of pregnancy. Early congenital syphilis (before 2 years) may be asymptomatic or result in disseminated fulminant infection (mucocutaneous lesions, osteochondritis, anemia, hepatosplenomegaly, neurosyphilis). Manifestations of late congenital syphilis (after 2 years) may include interstitial keratitis, lymphadenopathy, hepatosplenomegaly, bone lesions, anemia, dental malformations (Hutchinson's teeth), neurosyphilis.Screening during the first trimester and again between the 28th and 32nd week of pregnancy, aims at preventing transmission of syphilis.Suspect cases of congenital syphilis should be evaluated by the National Reference Center for Syphilis, the diagnosis is based on a direct diagnosis by PCR on placenta, nasal discharge, CSF, skin lesions and serodiagnosis including the determination of specific IgM in paired maternal and neonatal sera.Maternal treatment is based on the early administration of penicillin.

Syphilis.

Syphilis is an infectious disease caused by a spirochete, Treponema pallidum; it is most commonly spread by sexual transmission. Syphilis is known as the "Great Imitator," as systemic manifestations are variable. It can involve any part of the eye, with syphilitic uveitis being the most common type. Congenital syphilis is characterized by Hutchinson's teeth, saddle nose deformity, deafness, and interstitial keratitis; pigmentary changes in the retina are varied and patchy.

Jonathan Hutchinson--The Eponyms Physician.

Jonathan Hutchinson was born in Selby, England, in 1828. He is well known for the eponymous terms named after him and his catchy descriptive terms thatwere accurate andwell-remembered, for instance, the “apple jelly” for lupus vulgaris, the “screwdriver” for central incisor peg teeth, and the “ground glass” for cornea of congenital syphilis. He believed that illustrations were a necessary adjunct of clinical observations.He employed an artist to visit thewards andpaint pictures of skin lesions, and later he built amuseum for his collection of drawings, illustrations,andwaxmodels forpathologicalanddermatologicalconditions. Hutchinson was a surgeon, dermatologist, ophthalmologist, and pathologist. Of note, his interest in pathology was influenced by James Paget. His research on syphilis started after observing severe disease of the skull bones in a young man whose mother had had syphilis. After extensive research, his first book Syphilitic Diseases of Ears and Eye was published in 1863. He named syphilis “the great imitator” and described the triad of hereditary syphilis, which was later named “Hutchinson’s Triad.” The list of the eponymous terms named after Hutchinson is long. It includes Hutchinson sign, Hutchinson teeth, Hutchinson freckle, Hutchinson disease, Hutchinson mask, Hutchinson patch, Hutchinson angina, Hutchinson facies, Hutchinson pupil, Hutchinson summer prurigo, Hutchinson syndrome, HutchinsonWeber-Peutz syndrome, and Hutchinson-Gilford progeria. Hutchinson medical bibliography has almost 1200 items. He wrote every single word in the 11 volumes of Archives of Surgery, published between 1889 and 1900. He also published 4 volumes of Lectures in Clinical Surgery; the first volume had 20 chapters on dermatology. Hutchinsonhadpeculiar ideas.Hebelieved that leprosywas caused byeatingbadlycured fish.HetraveledtoNorway,Egypt, theMiddleEast, and India togathermaterials in supportofhishypothesis.AlthoughHansen had discovered the leprosy bacillus in 1874, Hutchinson published his last book On Leprosy and Fish Eating in 1906 justifying his beliefs. He also believed that alopecia areatawas amodified ringworm, or a sequela of ringworm, even though all his microscopic examinations were negative for fungal infection. Although hewas opposedwomen to entering themedical profession, he lovedhiswifewithdeepaffection and wrote letters to her almost daily in periods of separation. He saw the person who had the disease first; thus, he would label new disease conditions with the patient’s name. Examples are Mabey malady, Penmann disease, Mortimer malady, and Branford legs. Hutchinson died in Haslemere, Surrey, England in 1913. On his tombstone was inscribed “A Man of Hope and Forward Looking Mind.” Hutchinson’scontributions tomedicineandthefieldofdermatologycontinue tomake an important impact on the recognition and diagnosis of disease.

Congenital syphilis in the skeleton of a child from Poland (Radom, 18th–19th century AD)

An incomplete skeleton of a 3-year-old child with suspected congenital syphilis was found in the Radom area of Poland. Squama frontalis and zygomatic bones are characterized by significant bone loss. Radiographic pictures show a geographic destructive lesion of a serpiginous shape surrounded by a zone of reactive osteosclerosis in the squama frontalis. The radiographic findings included a slight widening and contour irregularities of the distal humeral metaphyses. The appearance of teeth did not suggest Hutchinson teeth, but the examination of the permanent molars showed signs of mulberry molars. Two teeth were tested for the presence of mercury. Chemical analysis did not indicate mercury accumulation (enamel: 0.07 μg/g, dentine: 0.14 μg/g, bone: 0.11 μg/g). Mercury values obtained for the examined samples were similar to those that are typical of healthy teeth in today’s individuals.

Syphilis.

Syphilis.

Premature loss of primary teeth associated with congenital syphilis: a case report

Congenital syphilis is an infectious disease transmitted by an infected mother to her fetus. Several reports in the literature have focused on oral manifestations of congenital syphilis, mainly about Hutchinson's teeth and dysplastic molars, which are more common. However, this paper describes an unusual feature of congenital syphilis in a four-year-old child. A case of premature loss of primary teeth associated with congenital syphilis is reported.

Historical Atlas of Dermatology and Dermatologists

Dermatology remains a mystery to many doctors, and will do so increasingly as its toehold in the medical curriculum is eroded (in some medical schools it no longer features at all in the undergraduate curriculum). The history of the specialty, which began to develop as a distinct entity in the nineteenth century, is a fascinating subject. Skin disorders that we now regard as trivial—impetigo, head lice, scabies—were common and untreatable. Syphilis, with its protean cutaneous manifestations, was rampant and incurable. Simple bacterial infections of the skin could lead to septicaemia and death. The early descriptive dermatologists were remarkable clinical observers. Jonathan Hutchinson, for example, was the first person to describe sarcoidosis, lentigo maligna melanoma, melanoma of the nail bed, Peutz-Jegher syndrome (and its association with intussusception of the bowel), arsenical keratosis, Hutchinson's teeth (in congenital syphilis); the list is far from complete. Few doctors confined their interests to the skin alone; Erasmus Wilson, regarded by many as the leading dermatologist of his era, found time to bring Cleopatra's needle to London and amass a fortune on the stock exchange. The illustrations and clinical descriptions produced put many of our present-day efforts to shame. The changes that have occurred in therapy are also remarkable: much of the early therapeutic use of X ray was in the treatment of benign dermatological disorders (it continued to be widely used for childhood ringworm until 1958). Dr Crissey and his coauthors, all distinguished dermatologists and collectors of ‘dermatological memorabilia’, have produced a book containing a remarkable collection of illustrations, of dermatologists, of their original papers, of their clinical cases, and related material. They have interlaced this with descriptions of their subjects, and the significance of their work. There is much to fascinate and enchant any dermatologist with any sense of history. The advertisement for do-it-yourself X-ray equipment and the illustration of the first picture of the scabies mite are just two examples among many. The text likewise has plenty to capture the imagination: Kaposi (of the eponymous vascular tumour) changed his name from Cohen, because he thought that it would help his career if he sounded less Jewish. This is not a history of dermatology, and should not be bought by anyone expecting it to be so. There is no theme of progression from one topic to the next, and much is omitted (for example, there is no mention of penicillin). The work might best be described as a scrapbook assembled by three enthusiasts for their subject, whose love of dermatology shines through the pages. As such it is enormous fun, and would make a perfect Christmas or birthday present for your favourite dermatologist.

A Case of Keratitis, Ichthyosis, and Deafness Syndrome With Hutchinson's Triad-like Symptoms

Association of keratitis, ichthyosis, and deafness is known as KID syndrome. Only four cases have been reported in Japan by dermatologists. A male infant manifested absence of hair and generalized keratosis of the skin since birth. He had been diagnosed as having chronic mucocutaneous candidiasis (CMCC). The patient manifested punctuate superficial keratopathy in the right eye and corneal opacity with peripheral neovascularization in the eye when initially seen at the age of 1 year and 4 months. The corneal lesion later developed into stromal keratitis with neovascularization in the stroma. Abnormalities simulating Hutchinson teeth were detected at the age of 4 years. Neurosensory deafness in the high-frequency region was detected at the age of 6 years. Serous tests for syphilis were consistently negative. This child is the first reported case in Japan manifesting KID syndrome with Hutchinson teeth. The associated CMCC was interpreted as due to liability to infection in patients with KID syndrome.

Sarcoid Reactions in a Patient with Congenital Syphilis

AbstractA case of sarcoid reactions in a patient with congenital syphilis was reported. The eruptions appeared on the upper extremities and disappeared within 10 days after biopsy. Histological findings were compatible with those of subcutaneous sarcoidosis. The patient also had so‐called Hutchinson's teeth, rhagades of the lips, corneal scars and eighth nerve deafness.

Hutchinson teeth.

Journal of Paediatrics and Child HealthVolume 17, Issue 3 p. 226-226 Hutchinson teeth Robert Southby, Robert SouthbySearch for more papers by this author Robert Southby, Robert SouthbySearch for more papers by this author First published: September 1981 https://doi.org/10.1111/j.1440-1754.1981.tb01946.xCitations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume17, Issue3September 1981Pages 226-226 RelatedInformation

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

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.

Hutchinson's teeth and early treatment of congenital syphilis.

Hutchinson's teeth and early treatment of congenital syphilis.

Hutchinson's teeth

Hutchinson's teeth

SIGNIFICANCE OF TEETH WITH UNDERDEVELOPED HARD TISSUE AMONG STUDENTS IN SCHOOLS FOR THE BLIND IN GIFU PREFECTURE

Significance of changes in the teeth especially Hutchinson and Fournier teeth among student of schools for the blind and deaf was reported from our Department about 10 years ago. In order to assess the recent situation, 124 students were examined in a school for the blind concerning the intraoral state from an odontological point of view.Abnormalities in the development and morphology of the teeth, degree of carious state, pyorrhea, state of the cleaning of the oral cavity, presence of deposition around the teeth, and relationship with diseases of the eye were investigated. No difference was found between students in the school for the blind and other healthy subjects concerning the degree of carious state, alveolar pyorrhea, state of the cleaning of the oral cavity, and deposition around the teeth. In 4 students Hutchinson and Fournier teeth were noted simultaneously, while Hutchinson teeth alone were noted in 1 and Fournier teeth alone were seen in 8. Among those, congenital complete or almost complete blindness was seen in 8 and acquired complete or almost complete blindness was seen in 5, indicating a pronounced decrease as compared with the result of 10 years ago.

A Study on Health of People at One, Mikura-Jima of Izu Islands

The author has studied on health including dental diseases of the people in Mikurajima, one of the Izu Islands. This island is much different from the others of Japan on social and economical points of view. It has a physician in a clinic run by health insurance as the only medical institution. Health center services are scarcely given by the com-petent health center located at Miyake-jima, on account of geographical handicap there. Population is 315 and its density is 17.6 persons per 1m2. Population structure rather shows tural type.The results were as follows.1) As regards vital statistics, birth rate was 34.4 per 1000 population (1959) and death rate was 20.1 per 1000 population (the average of those 5 years from 1953). Both of them were much higher than the average of all Japan.2) Concerning physical constitutions of the people, their weights were more than the average of all Japan, and over average in the youth of male and in the age of 30 of female. Also it was showed that the girths of their chests were wider than the average of all Japan in the youth of male and the old age of both of male and female. There was no clear difference of the girths of upper arms between of these people and of all Japan, which was considered as one of nutritive indexes, 3) From nutrition survey, the followings were observed.i) Kinds of taken foods in a year were much influenced by each season especially by its weather.ii) People have taken less total quantities and higher total Calory than the average of all Japan.iii) People had taken more quantities of fat and carbohydorate, less protein especially animal protein, less Ca, more P and less all Vitamins than each. quantities of the average of all Japan.4) Rate of medical consultation was one third of all Japan. The rate was highest in the ages, between from 30 to 39, In May and Novembe, the rates were high. The most rate was by common cold, and the next was digestive organs including dental disease which occupied one-third of this consultation in a year.5) Incidence was rather low.6) As specific diseases of this district, there were many dermatological diseases and a few food poisonings by fishes which had showed intoxicated symptom. Besides, it was guessed that there were Filariasis from Hydrocele patients, and Shichito fever which was considered as one of tsutsugamushi diseases.7) There were many patients of dental caries and it was considered that this fact concerned greatly with many factors including geographical condition, an unbalanced diet by season, too much carbohydorate, taking unbalance of Ca and P, and other food life.8) Incidence of patients of dental caries was 85.1% and it was too high especially in female. Incidence of number of dental caries were 43.2% of total temporary teeth and 20.6% of total permanent teeth. The grades of dental caries were 34.6% of C1, 33.7% of C2, 31.7% of C3 amongtemporary teeth and 30.5% of C1, 33.8% of C2 and 35.7% of C3 among permanent teeth.9) There were comparatively a few patients whose tartars adhered to teeth and smally number of gingivitis and of alveolar pyorrhea.10) There were many egg-round sharped row of teeth in male and female, and its rate was 93.1% of all examinees. Normal occlusion was 68.3% of all of them.11) Mottled teeth, Hutchinson's teeth, dental hereditary, scorbute and other dental specific diseases were not found there.12) In respect of general health examination, it was found that there were comparatively many people who showed symptom of beriberi. The tendencies were not seized through the measurement of blood pressure and urine examinations.13) Concerning classification of death cause, the group of contaminatious diseases had generally decreased recently.

Dental Manifestations of Systemic Disease

HomeRadiologyVol. 58, No. 6 PreviousNext EditorialDental Manifestations of Systemic DiseasePublished Online:Jun 1 1952https://doi.org/10.1148/58.6.883MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractIn the current issue of Radiology there appears the last of a series of three articles on the Dental Manifestations of Systemic Disease. In a painstaking study, the author has collected and classified the lesions of the jaws and teeth which indicate to the trained observer the presence of developmental disturbances or generalized disease processes, demonstrating the great importance of dental roentgenography not only to the dentist but also to the clinician and the roentgenologist.The pathological changes which are depicted on the roentgenogram may involve the bony supporting structure, the teeth, and the tooth sockets. Changes in the bony structure of the jaws are often similar or identical to disease changes in the general skeleton, and minimal distortion of the trabecular pattern as revealed on intraoral roentgenograms should lead to a complete study of the other skeletal areas.In the first paper of the series the author calls attention to the fact that the development of the teeth generally conforms to chronologic skeletal development and can be used as an index in determining the approximate skeletal age. He then proceeds to show the dental manifestations of the various endocrine disturbances, citing cases and illustrating them with dental roentgenograms.The second installment concerns developmental disturbances which are manifested orally by faulty dental structure, interference with normal eruption of the teeth, and malocclusion. Most of the conditions which affect dentition are those which primarily involve the skeleton. Rarely the dental defects may be of ectodermal origin, such as ectodermal dysplasia, in the severest form of which there may be total dental aplasia. In advanced cases the dental changes may not be necessary for a diagnosis, but in mild cases they may provide the first clue to recognition of the condition.In the third and current portion of this series, attention is called to the Hutchinson teeth of congenital syphilis, probably one of the earliest characteristic dental defects to be noted. The bone changes in the jaws which are present in some of the reticulo-endothelial diseases are of unusual interest. Paget's disease also produces characteristic changes in the jaws which may be one of the earlier evidences of this condition. Metabolic diseases are manifested both through developmental changes and changes in mineralization. Radiation necrosis of the jaw is, of course, a matter of particular concern to all radiologists.In the April issue of Radiology, there appeared also an article by Robinson and Sarnat devoted to the bone changes in the jaws of 22 patients with sickle-cell anemia. Significant osteoporosis was found in 18 cases in this series.These demonstrations of the relationship between the dental changes shown on the roentgenogram and generalized abnormalities and diseases are of unusual interest.Article HistoryPublished in print: June 1952 FiguresReferencesRelatedDetailsRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 58, No. 6 Metrics Altmetric Score PDF download

Systemic Aspects of Precocious Advanced Alveolar Bone Destruction: Preliminary Report

case finding adjunct in a program of venereal disease control. Dentists are key individuals in this program because of their particular awareness of dental anomalies. Dental inspections for the study dis­ cussed were done at the rate of ioo per hour. The rapidity and ease of this tech­ nic, by which large numbers were screened, are among its chief merits. Ex­ amination of 2,156 Negro school chil­ dren resulted in 69 diagnoses of Hutch­ inson teeth. Of these 69, 53 had blood tests, of which 13 had positive reactions for syphilis, a percentage of 24.5. The occurrence of Hutchinson teeth was proportionately higher in the older children (13 to 18 years) than in the younger children (6 to 11 years) of the series. This trend is interpreted as a quantitative reduction of congenital syphilis in recent years indicating in­ creased effectiveness of venereal disease control. However, congenital syphilis will constitute a public health problem for some time, and it is imperative that den­ tists, particularly those in the field of public health, remain alert to the con­ tribution they can make toward its con­ trol.