Early tooth loss in children: a warning sign of childhood hypophosphatasia (Dent Update 2017; 44: 317–321)

I would like to thank Ms Hughes et al for shedding light on dental manifestations associated with congenital metabolic disorder hypophosphatasia (HP)in children.¹ The conclusions of the authors of this recent paper published in Dental Update are concurrent with my reflections in the review report which emphasized the need for thorough diagnosis of dental patients with unexplained premature teeth loss.²

The early loss of deciduous teeth or loss of permanent teeth support, despite good plaque control, should draw the attention of primary care dental practitioners, with the focus being on potentially inherited aetiology, including undiagnosed hypophosphatasia. As a detailed mechanism of premature tooth loss is still unknown, further studies might deliver a clearer answer. There is no doubt that metabolic disturbances during tooth structure development in early stages of odontogenesis, caused by a low level of alkaline phosphatase, affect the mineralization process of hard tissues, especially root cementum, impacting teeth support.