Hutchinson teeth

Hutchinson teeth result from Treponema pallidum infection in utero affecting tooth development, specifically the permanent central incisors, which erupt with a screwdriver or peg shape, central notching, and widened spacing. This occurs because the infection disrupts normal enamel and dentin formation during odontogenesis. Hutchinson teeth are a classic stigmata of late (tertiary) congenital syphilis, typically appearing in children who were infected transplacentally but not treated in infancy. They form part of Hutchinson's triad, a highly tested board association, along with interstitial keratitis (corneal inflammation causing photophobia and vision changes) and sensorineural (8th cranial nerve) deafness. Other features of late congenital syphilis include saddle nose deformity, saber shins (anterior bowing of the tibia), frontal bossing, mulberry molars (abnormal first molars with multiple small cusps), and rhagades (perioral fissures/scarring). Diagnosis of congenital syphilis relies on maternal serologic screening during pregnancy (VDRL/RPR followed by confirmatory treponemal tests) and treatment with penicillin, which can prevent these late manifestations if given early. Clinically, Hutchinson teeth and the associated triad are important for recognizing missed or untreated maternal syphilis and underscore the importance of routine prenatal screening.