Multiple impacted permanent teeth, an indicator for early detection of hypoparathyroidism: A rare case report

Abstract

Eruption is a process of continuous movement of the developing tooth bud from its developmental location to functional location. Teeth that cease to erupt before emergence to their functional position in the oral cavity are termed as impactions. In permanent dentition, third molars are the most frequently impacted teeth followed by the canines. When impaction involves few teeth, the condition is localized but when it involves multiple teeth, the condition becomes generalized and is often associated with some derangement of the normal physiological processes. Factors causing impactions may be localized, pertaining to the area or, systemic or, generalized including bone disorders such as cleidocranial dysplasia and/or some sort of endocrinological disturbance such as hypoparathyroidism. Hypoparathyroidism is a rare endocrinological disorder accompanied by anomalies of various systems including bones and teeth. The dental defects due to hypoparathyroidism may present as hypocalcemia, aplasia and/or hypoplasia, defects of mineralization, short and blunted roots, delayed eruptions, and clinically missing or impacted teeth. This report describes an interesting and unusual case where multiple impacted permanent teeth and retained primary teeth accompanied by other clinical manifestations in a 16-year-old female patient probed the clinicians for further investigations which, eventually, aided in early diagnosis of hypoparathyroidism.

Keywords: Early detection; hypoparathyroidism; multiple impacted permanent teeth; retained primary teeth.

Figure 1

Clinical photograph of feet (upper) and right hand (lower left-front view and lower right- rear view of same) showing abnormal third, fourth and fifth phalanges in the feet, being almost half of the adjacent fingers, with right hand showing a soft tissue mass in the lateral ulnar surface along with prominent middle phalanx of long finger

Figure 2

Intra-oral photographs (left- maxillary arch; right- mandibular arch) showing multiple, clinically missing permanent and retained primary teeth

Figure 3

Hand-wrist radiograph of right hand (left) revealing alteration in bone architecture with mild changes in trabecular pattern and in the thickness of the cortices with orthopantomograph (OPG) (right) revealing multiple unerupted and impacted permanent teeth and retained primary teeth in both jaws