Premature loss of deciduous teeth.

Premature exfoliation of deciduous teeth is very rare in children. It is well known that it may occur in severe pink disease (acrodynia) and in local disease of bone, such as osteitis and eosinophilic granuloma (Thoma, 1937; Stones, 1954). The teeth in the above conditions are extruded with the roots intact due to a loss of their supporting bony tissue. In hereditary ectodermal dysplasia teeth are badly formed or lacking. An extensive search of the literature, including all volumes of the Quarterly Cumulative Index Medicus, has failed to reveal more than two references to premature loss of deciduous teeth due to a cause other than the above. Sobel, Clark, Fox and Robinow (1953) described a child with genu valgum and premature loss of teeth. She was first seen at the age of 19 months. Six weeks previously several teeth had become loose and all had been shed before her first attendance at hospital. Her serum calcium and phosphorus levels were normal, but her serum alkaline phosphatase was low (0 9 to 1P64 BesseyLowry units). Biopsy of the liver and ribs showed a deficiency of phosphatase. Examination of the bone (by Dr. Edwards Park) showed a picture indistinguishable from that of rickets. There was no history of poisoning by beryllium, which interferes with phosphatase activity, or by fluoride. Radiographs of her limbs were thought to show an osteodystrophy. The tibiae were bowed, and there was cortical new bone formation, with irregular calcification in the metaphyses. The father's alkaline phosphatase was abnormally low, suggesting that the condition was of genetic origin. Treatment with 500,000 units of vitamin D for 10 days had no effect on the enzyme activity. The writers suggested that growing bone requires the presence of alkaline phosphatase for normal calcification, and that the skeletal disorder may be related to an abnormality in the quantity of phosphatase in the tissues. This patient has been described by Sobel elsewhere, and Clausen (1952), in discussing the case,