The spectrum of dental manifestations in vitamin D-resistant rickets: implications for management

Department of Pediatric Dentistry

Lutheran Medical Center

 

Resident’s Name:  Chad Abby                                    Date: 3/20/2009

Article title:  The Spectrum of Dental Manifestations in Vitamin D-resistant Rickets:  Implications for Management

Author(s):  W. Kim Seow, S.C. Latham

Journal:  Pediatric Dentistry

 Volume (number): Vol. 8, No. 3

Month, Year:  1986

Major topic:  Rickets

 Minor topic(s):  Implications for management in vitamin D-resistant rickets (VDRR)

Type of Article:  literature review

Main Purpose:  To provide guidelines in the prevention of dental abscesses in the VDRR patient and to determine whether varying degrees of dental manifestations appear

Methods:  Thirteen patients were used in this study and they were divided into 3 main grades depending on their dental manifestations and the need for treatment and prevention of dental abscesses.

Findings:  Grade 1 is comprised of patients who show minimal or no dental manifestations of VDRR.  These patients only require routine dental care and preventative measures.  Grade 2 patients are those who show moderate dental manifestation of the disease, only a few teeth are involved, and the prophylactic procedures required moderate.  Grade 3 is comprised of patients who show severe dental manifestations of the disease and require extensive treatment and aggressive prophylactic measures to prevent the development of dental abscesses.  Besides prophylactic coverage to prevent occlusal wear, routine preventative care for dental caries is extremely important as minimal caries can lead to pulp exposures.

Key points/Summary :  The most common form of rickets in developed countries is an inherited form of rickets known as vitamin D-resistant rickets (VDRR), usually inherited in an X-linked dominant manner.  Low levels of serum phosphate lead to defective calcification with signs and symptoms of rickets appearing at about 8-10 months of age.  These signs include lateral bowing of the legs, frontal bossing, enlargement of the costochondral junctions, scoliosis and lordosis.  Medical management of VDRR consists of phosphate replacement together with vitamin D given usually in the form of calcitriol.  Dental manifestations are quite characteristic with multiple “spontaneous” dental abscesses usually caused by the large pulp chambers the teeth usually posses.  Histological studies often show abnormal dentin calcification.  The dental manifestations seen in patients with VDRR appear in a spectrum of severity, ranging from the very severe, with involvement of nearly the entire dentition, to the very mild with normal appearance of the teeth.  Effective strategies for the prevention of dental abscesses are available and should be employed to suit each individual patient’s needs. 

Assessment of article:  A child with grade 3 VDRR would be very interesting and stressful to treat.