title: Diagnosing congenital syphilis using Hutchinson's method: Differentiating between syphilitic, mercurial, and syphilitic-mercurial dental defects.
abstract: OBJECTIVE
  This study focuses on the dental abnormalities observed by Sir Jonathan Hutchinson, Henry Moon and Alfred Fournier in patients with congenital syphilis and in those treated with mercury, in order to define alterations in dental morphology attributable to each of these causes. These definitions are applied to reported paleopathological cases, exploring various etiologies behind the defects, in order to aid in the diagnosis of congenital syphilis.
  
  
  METHODS
  Original works were examined for descriptions of dental abnormalities in congenital syphilis and in mercurial treatments. These descriptions were compared with dentitions of paleopathological cases (n = 4) demonstrating abnormalities attributed to congenital syphilis.
  
  
  RESULTS
  Distinct morphological differences were recognized between congenital syphilitic teeth and teeth affected by mercury. Mercury produces a pronounced deficiency in enamel of incisors, canines and first permanent molars that become rugged and pitted, and of dirty grey honeycombed appearance. Mercury-induced dental changes are evident in three out of four cases studied here. In one case, only syphilitic changes were present.
  
  
  CONCLUSIONS
  Dental changes in congenital syphilis range from no visible signs to those beyond the classical models of Hutchinson, Moon and Fournier. Treatment of neonates and infants with mercury produces additional changes. Signs of disease and treatment with mercury on teeth may occur together; permanent incisors, first molars and canines, are typically affected, premolars and second/third molars are usually spared. Signs of treatment with mercury might be the only evidence of the occurrence of the disease as mercury was rarely used to treat other diseases.
authors.affiliation: Biological Anthropology and Comparative Anatomy Research Unit, School of Medicine, The University of Adelaide, South Australia 5005, Australia.
authors.forename: Stella
authors.initials: S
authors.lastname: Ioannou
authors.affiliation: Biological Anthropology and Comparative Anatomy Research Unit, School of Medicine, The University of Adelaide, South Australia 5005, Australia.
authors.forename: Sadaf
authors.initials: S
authors.lastname: Sassani
authors.affiliation: Biological Anthropology and Comparative Anatomy Research Unit, School of Medicine, The University of Adelaide, South Australia 5005, Australia.
authors.forename: Maciej
authors.initials: M
authors.lastname: Henneberg
authors.affiliation: Biological Anthropology and Comparative Anatomy Research Unit, School of Medicine, The University of Adelaide, South Australia 5005, Australia.
authors.forename: Renata J
authors.initials: RJ
authors.lastname: Henneberg
mesh_terms: D060432:Anthropology, Medical; D000885:Anthropology, Physical; D002648:Child; D003744:Dental Enamel Hypoplasia / Q000139:chemically induced / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D003937:Diagnosis, Differential; D006801:Humans; D007180:Incisor / Q000187:drug effects / Q000473:pathology; D008628:Mercury / Q000009:adverse effects / Q000627:therapeutic use; D008963:Molar / Q000187:drug effects / Q000473:pathology; D013590:Syphilis, Congenital / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology
chemical_list: D008628:Mercury
keywords: dental development; incisors; molars; severe hypoplasia