Microscopic Findings in Primary Teeth Associated with Vitamin D Deficiency

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ABSTRACT

Background

Rickets is a medical condition caused by vitamin D deficiency, typically caused by inadequate dietary intake, limited sun exposure, or, less commonly, genetic disorders. While skeletal abnormalities are the hallmark of rickets in children, oral manifestations, such as recurrent dental abscesses occurring in the absence of carious lesions, can also be observed. This report describes the case of a child presenting with oral features suggestive of hereditary rickets, despite the lack of skeletal abnormalities and without a confirmed genetic aetiology. Histological and microstructural analyses of dental tissues played a key role in guiding the diagnosis, ultimately leading to referral to a paediatrician and confirmation of vitamin D deficiency.

Case report

A 4-year-old male presented to the Emergency Dental Department of a paediatric clinic with a history of spontaneous dental abscesses. Three affected primary teeth, extracted for clinical reasons, were comprehensively analysed using micro-computed tomography, scanning electron microscopy, energy-dispersive X-ray spectroscopy, and optical microscopy. Investigations revealed an enlarged pulp chamber, pulpal calcifications, extensive interglobular dentine, and porous, hypomineralised enamel. Additionally, an irregular and poorly defined dentino-enamel junction was observed, along with abrupt spatial variations in mineral composition. The findings are consistent with defective biomineralisation. Subsequent biochemical testing confirmed vitamin D deficiency in the absence of a detectable genetic cause. The patient was supplemented with vitamin D and calcium, resulting in clinical improvement.

Conclusion

Vitamin D deficiency profoundly impairs the development and mineralisation of dental hard tissues, including both enamel and dentine. These alterations compromise the structural integrity of teeth and may increase the risk of spontaneous dental abscesses. Early identification of such oral manifestations is critical for prompt diagnosis and appropriate management.

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