Exfoliation of non-resorbed primary incisors in a 4-year-old child – case report and literature review

Introduction. Early exfoliation of non-resorbed
tooth can be a symptom of severe systemic disease,
even a fatal one. Case description. A 4-year-old boy
presented with increased mobility of the lower incisors
which resulted in missing 81; the tooth exfoliated
with non-resorbed root six months earlier. Intra-oral
examination revealed that mobility of 71 was more
pronounced than that of the lateral incisors (it exfoliated
non-resorbed within the next three months), while the
remaining teeth were of normal mobility. Additionally,
teeth 51 and 61 had pinkish crowns with horizontal
gingival recessions. The boy was caries-free and had
not experienced any dental trauma (DMF=0). His oral
mucosa was sound, but he presented poor oral hygiene.
The pantomogram showed a horizontal reduction of
the maxillary front alveolar bone height. The patient
was mouth breathing due to recurrent infections of
the upper respiratory tract with adenoid hypertrophy.
The skin of the hands and feet was normal. There was
a case of inherited skeletal disorder in the patient’s
family. The patient was consulted by the paediatric
haematologist, orthopaedic surgeon and laryngologist
(adenoidectomy). The laboratory tests showed proper blood cell count and no signs of calcium-phosphate
metabolism disorders. The boy stayed under dental
observation for six years without any further abnormal
exfoliations. Discussion. Careful medical and dental
diagnostics was required to exclude possible reasons
for the tooth loss such as quantitative or qualitative
neutrophil defects, metabolic or connective tissue
disorders or neoplasia. Conclusion. This was a case of
idiopathic early teeth exfoliation, which self-limited.
Nevertheless, thorough diagnostics, adenoidectomy
and oral hygiene improvement were fundamental for
the diagnostic and treatment process.