Classes of findings:
(1) postrhagadic scarring and syphilitic rhagades about the mouth
(2) dental changes in the permanent teeth
(3) dentofacial abnormalities
Peri-oral scarring:
(1) linear scars/wrinkles radiating from the angles of the mouth
(2) linear scars/wrinkles extending down from the lower lip
where:
• Syphilic lesions may be noted at a younger age than that expected for age-related wrinkling.
• Nonsyphilitic wrinkles tend to increase with age and tend to follow the natural skin creases.
Changes in the permanent dentition related to dental hypoplasia:
(1) increased spacing of teeth along the maxilla
(2) incisors: notched, "screwdriver", peg-shaped
(3) canines: rounding of the tip
(4) first molars: "mulberry" molar (bud-shaped from moving the cusps towards the center of the crown)
where:
• The dental changes may be identified in dental X-rays prior to eruption of the permanent teeth.
Dentofacial abnormalities:
(1) malocclusion with open bite
(2) frontal bossing (involving the frontal bone)
(3) saddle nose
(4) poorly developed premaxilla
Other findings:
(1) The combination of dental changes in the incisors, eight nerve deafness and interstitial keratitis is termed Hutchinson's triad. The occurrence of all 3 findings is rare.
Limitations:
• Most of these changes are individually not specific for congenital syphilis. But the presence of multiple findings increases diagnostic certainty.
