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Case report
Oral manifestations of Alagille syndrome
  1. Anne-Laure Bonnet1,2,
  2. Victor Greset3 and
  3. Tiphaine Davit-Beal2,4
  1. 1EA2496, Université de Paris, F-92120 Montrouge, France
  2. 2Department of Dentistry, AP-HP. Sorbonne Université, Paris, France
  3. 3Faculté d'odontologie, Université de Lorraine, Nancy, France
  4. 4Pediatric Dentistry, Université de Paris, F-92120 Montrouge, France
  1. Correspondence to Professor Tiphaine Davit-Beal; tiphaine.davit-beal{at}


Alagille syndrome (AGS) is a multisystem disorder classically involving liver and heart failure, characteristic vertebral and facial features and ocular abnormalities. AGS is caused by heterozygous mutations in JAG1 or NOTCH2, with variable phenotype penetrance. We report two cases of AGS in children with tooth defects characterised by green discolouration and hypomineralisation. The role of hyperbilirubinaemia (HB) in this atypical colour, a classical feature of AGS, has been well described. However, it does not totally explain the dental phenotype. As JAG1 and NOTCH2 mutations can affect bone development and considering common physiological pathways between bone and tooth mineralisation, both mutations could participate in this unusual dental phenotype. The role of HB and genetics in the development of the dental phenotype of AGS is discussed in two prototypical cases. Future research should focus on the underlying genetic component of tooth abnormalities.

  • dentistry and oral medicine
  • metabolic disorders

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  • Contributors A-LB drafted the manuscript. A-LB and VG were in charge of clinical follow-up of patients. A-LB, VG and TD-B critically revised the manuscript and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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