Hutchinson Teeth – They are Part of Something Bigger

A crucial part of raising a child is watching them grow. They get taller, their bones become heavier, and their mind develops. Parents are always on the lookout for any unusual signs during the child’s growth. Genetic diseases, deficiencies, and congenital diseases begin to manifest in early years.

Hutchinson teeth are one such anomaly that you will notice in your child’s mouth during their childhood. It is most often a presentation of another condition and requires systemic treatment for your child. This condition involves mostly just the incisors, and rarely the molars.


Congenital Syphilis and your baby’s teeth – The connection

Congenital syphilis is an infection that a newborn develops in utero. It is transmitted vertically through the mother, who has syphilis. Syphilis is a sexually transmitted bacterial infection.

If a child is born to an infected mother, or the child acquires the infection through the placenta, he or she will eventually show symptoms of congenital syphilis.

Hutchinson teeth are one of the significant signs of this condition. It forms a part of what we know as the Hutchinson Triad. The Hutchinson triad recognizes three main signs of congenital syphilis.

  • Hutchinson teeth- These are peg-shaped, notched teeth with spacing.
  • VIII Nerve Deafness- This is an ailment of the inner ear, linked to the VIII cranial nerve. (1)
  • Interstitial keratitis- It shows inflammation of the cornea of the eye. (2)

Hutchinson teeth

Congenital syphilis commonly affects the child’s incisors and molars. In each arch, a child has two central incisors and two lateral incisors. (3)

In congenital syphilis, the upper central incisors commonly show a notched appearance and a peg shape. The enamel is thin on the tooth and discolored.

The shape also shows alterations, with the tooth being narrow and short. You will notice, that unlike other teeth in your child’s mouth, the affected teeth narrow from the gums towards the biting edge.

The lateral incisors can also show similar signs, with notching and a peg shape. Hutchinson Molars are commonly called Mulberry Molars, where the first molar shows many small cusps instead of the normal four well-formed ones.

The enamel is thin over the affected teeth and shows significant yellow or brownish discoloration.

You will notice these anomalies mostly in your child’s permanent teeth. The deciduous teeth are uncommon in showing symptoms. This is because congenital syphilis affects the development of the permanent teeth.


As a common practice, visit your dentist if you notice anything unusual about your child’s teeth. A clinical examination gives the dentist a fair idea about the condition. Radiographs and the medical history of the parents also lead to a diagnosis for syphilis.

To confirm syphilis, the doctor advises some tests to check for a particular antibody in the child’s blood. Additionally, other methods include bone x-rays or testing the fluid of the nervous system- the cerebrospinal fluid (CSF).

The key to beating this disease lies in timely diagnosis and treatment. (4)


The treatment of Hutchinson teeth involves dental treatment for the symptomatic teeth. But it is equally important to seek treatment for the more significant condition of congenital syphilis.

Dental Treatment Options

The affected teeth lack strong enamel and show alterations in the tooth morphology. Therefore, dental treatment aims to regain normal tooth shape and size.

The method employed for this depends on the extent of correction needed. The dentist will either recommend a filling, a crown, or veneers over the tooth.


If the affected tooth does not show significant morphological alterations and the desired changes are possible through cement, then the dentist will advise you to get fillings done for the child. Tooth-colored resin works best for the front tooth.

The dentist will smoothen the tooth to receive the adhesive resin, and bond it to the tooth with a curing light. With this treatment, the discolored enamel is hidden, and your child will have a better looking front tooth.

Crowns & Bridges

If the tooth is unable to support itself owing to loss of tooth structure, a crown will help to regain the bulk of the tooth. If the enamel is too weak, the dentist will suggest that you have a crown placed over the affected teeth.

Crowns are suitable for affected molars so that they can withstand the chewing forces. To make a crown, the dentist will prepare the existing tooth to receive the crown and then make impressions of your child’s mouth.

The crown may be of metal, ceramic or the combination of the two. This depends on the location of the tooth, the other teeth in the mouth, and your capacity to spend money.

Alternatively, a bridge takes the support of two adjacent teeth or can cover multiple teeth next to each other. The process of getting a bridge is similar to getting a crown for your child.


Veneers are an acceptable treatment option only if the enamel condition is fair. If there is minor discoloration or chipping, your dentist will recommend veneers for your child’s front teeth.


Extraction is the last resort when all other treatment options seem to fail. If a particular tooth is severely mal-formed or has lost most of its enamel, the child will be susceptible to caries and sensitivity.

If crowns cannot fix the tooth, you may have to get it removed and replaced artificially.

Treating congenital syphilis

The standard treatment for congenital syphilis is through antibiotics. Penicillin is the drug of choice for most children. It is given either orally or through an IV line. If your child is allergic to penicillin, the pediatrician will give another antibiotic.


The treatment is an extensive procedure that includes preventive measures, reviewing the mother’s health, and reducing systemic manifestations in the child. (5)

To wrap up

Hutchinson Teeth create aesthetic and functional problems for a child. It is imperative that you seek dental and medical treatment for congenital syphilis, as the other symptoms also need immediate care and this can be done simultaneously in consultation with a dentist and pediatrician.

Even today, syphilis remains a global health problem for the medical fraternity.


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