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Meningococcal septicaemia and dental changes

V Siapka, P J M Crawford

Child Dental Health, Dental School, Bristol, UK

Correspondence to:
peter.crawford{at}bristol.ac.uk

A case is described where localised tissue necrosis in meningococcal septicaemia led to profound dental disturbances in later life. Neisseria meningitides infection may lead to disseminated intravascular coagulation (DIC), necrosis and infarction of organs, haemorrhage into the internal organs,^1–3 hypocalcaemia² and post-recovery bone abnormalities.³ Dental complications have been reported with disruption of odontogenesis or delayed tooth eruption.^{1 3 4}

An 8-year-old girl was referred because of the discolouration of her permanent teeth.

She had had an episode of meningococcal septicaemia at 13 months of age. The main findings at that time were DIC with necrosis of part of the facial skin of her upper lip and fasciitis affecting her limbs.

Extra-oral examination at 8 years of age revealed old scars above the upper lip. Intra-oral examination showed that two lower permanent and one primary upper incisor teeth were severely hypoplastic.

Intra-oral radiographs showed a complicated image in the area of the upper front teeth (fig 1). There was a disturbance in the formation of the permanent upper lateral incisors and the upper left permanent canine. The crown of the upper left permanent central incisor (21) had stopped developing after the formation of the incisal edge. The other upper central incisor (11) presented with a similar image but tooth development seemed to have recommenced, probably with resolution of the septicaemia.

View this figure (25K): in this window | in a new window | PowerPoint for Teaching   Figure 1 Left: upper occlusal radiograph. Middle: line drawing showing the identified tooth fragments Right: line drawing showing expected tooth development at this age.

 

The teeth do not all form at the same time and permanent incisors have usually initiated at or about the time of birth. Tooth structure does not remodel and so changes in the form of teeth do not "heal" but go on to form a permanent record. Disturbances in the permanent dentition usually become obvious at 6–7 years of age when eruption of the permanent teeth begins.

It is difficult to discern the level at which the meningitic septicaemia affected the process of tooth development. Walton et al suggested that the occurrence of enamel defects was due to a probable subclinical premaxillary osteomyelitis.³

The purpose of this article is to inform paediatrician colleagues about such possible dental complications and to suggest that they might guide the families affected to seek dental care offered by specialist paediatric dentists.

This article has been adapted from Siapka V, Crawford P J M. Meningococcal septicaemia and dental changes Archives of Disease in Childhood 2007;92:719

Competing interests: None.

1. Coyne, BMC, & Montague, T. Teeth grinding, tongue and lip biting in a 20-month-old boy with meningococcal septicaemia. Report of a case.Int J Paediatr Dent2002; 12: 277–80.[CrossRef][Medline]
2. Baines, PB, & Hart, CA. Severe meningococcal disease in childhood.Br J Anaesth2003; 90(1): 72–83.[Abstract/Free Full Text]
3. Walton, AG, Meechan, JG, & Welbury, RR. Meningococcal septicemia and disseminated intravascular coagulation affecting the premaxillary permanent tooth germs.J Dent Child1998; 65(3): 191–3.[Medline]
4. Faibis, S, Widmer, R, & Sapir, S. Meningococcal septicaemia and dental complications: a literature review and two cases.Int J Paediatr Dent2005; 15: 213–19.[CrossRef][Medline]

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