# APBA Kısa Özet

Children exposed to maternal syphilis showed enamel hypoplasia, Hutchinson‑like incisors, and molar defects. T. pallidum DNA was detected in oral samples from a subset of participants via nested PCR, suggesting possible persistence of treponemal DNA after maternal treatment. Distinctive oral alterations were observed, and molecular detection supports the need for long‑term dental follow‑up and integration of oral examinations into postnatal care programs.

# Çalışma neyi araştırdı?

This two‑phase observational study investigated oral manifestations and the presence of Treponema pallidum DNA in children exposed to maternal syphilis by integrating epidemiological, clinical, and molecular data. The researchers aimed to (1) characterize the spectrum of oral clinical findings in this population, (2) assess whether bacterial DNA could be identified in the oral cavity after maternal antibiotic therapy, and (3) explore any association between maternal treatment adequacy and the severity of dental anomalies.

# Yöntem

The study comprised two sequential phases. Phase 1 involved a retrospective review of health, perinatal, and dental records for children born to mothers diagnosed with syphilis during pregnancy. Data extracted included demographic variables, timing and adequacy of maternal treatment, birth outcomes, and any documented oral findings. Phase 2 selected a subset of these children for prospective, comprehensive oral examinations. Trained pediatric dentists evaluated enamel quality, tooth morphology, and the presence of classic congenital syphilis signs such as Hutchinson incisors. Oral swabs were collected from each participant, DNA was extracted, and a nested polymerase chain reaction (PCR) targeting T. pallidum‑specific genes was performed. Positive and negative controls were included to ensure assay reliability. Clinical findings were compared across groups defined by maternal treatment status, although the study was not powered to detect small differences.

# Temel bulgular

Children exposed to maternal syphilis presented with distinctive oral alterations, most notably enamel hypoplasia, Hutchinson‑like incisors, and molar defects such as irregular crown shape and surface pits. While statistical comparisons between adequately treated and inadequately treated maternal groups did not reach significance for many outcomes, the overall pattern of dental anomalies was consistent across the cohort. Nested PCR amplification identified T. pallidum DNA in oral samples from a subset of participants, confirming that treponemal genetic material can be recovered from the oral cavity even when maternal therapy was administered during pregnancy.

# Bulgular ne anlama geliyor?

The oral alterations observed align with classic dental manifestations of congenital syphilis, reinforcing the notion that the pathogen can affect odontogenesis in utero. Detection of T. pallidum DNA in the oral cavity raises two important considerations: first, it suggests that bacterial DNA may persist beyond the period of active infection, and second, it highlights the potential for the oral cavity to serve as a reservoir for molecular surveillance. Because PCR does not differentiate between viable organisms and residual DNA, the clinical relevance of a positive result remains uncertain, but it does provide a tangible marker that can be incorporated into follow‑up protocols.

# Klinik önem

The findings underscore the necessity of systematic, long‑term dental monitoring for children with in‑utero syphilis exposure. Enamel hypoplasia and molar defects can predispose to caries, sensitivity, and aesthetic concerns, while Hutchinson incisors may affect occlusion and speech. Incorporating routine oral examinations into postnatal care pathways enables early identification of these issues, allowing preventive measures such as fluoride therapy, sealants, and orthodontic referral when appropriate. Moreover, clinicians should maintain a high index of suspicion for oral sequelae even when maternal treatment appears adequate, as molecular evidence indicates possible lingering bacterial remnants.

# Sınırlılıklar

This observational study has several limitations that affect the interpretation of results. The design precludes definitive causal inference between maternal treatment and specific oral outcomes. The sample size was modest, limiting the statistical power to detect subtle differences between treatment groups. PCR detection of T. pallidum DNA does not distinguish active infection from residual genetic material, which constrains conclusions about ongoing pathogenic risk. Additionally, the study did not track long‑term dental health beyond the observation period, so the durability of the identified defects and any subsequent complications remain unknown. Finally, the reliance on clinical records for Phase 1 may have introduced information bias if oral findings were incompletely documented.