Need of early dental intervention in vitamin D deficiency ri
The following case has been reported in the Indian Journal of Dental Sciences.

A 17-year-old male patient reported to the Department of Oral Medicine and Radiology with a complaint of severe pain in the upper right region of the jaw. The patient was diagnosed 7 years back with Vitamin D deficiency rickets (VDDR) and had undergone the treatment for the same. There was no genetic history as an examination of additional family members (mother, father, and sisters) gave no evidence of disease. There was no history of any change in the chest shape or spinal abnormalities.

On general examination, the patient presented with short stature, bowed legs, enlarged ulnar joint, appeared pale, lean with 32 kg weight, 4 feet height, and body mass index of 22.8 kg/m2. On intraoral examination, the patient presented with localized and inflamed swollen attached gingiva in relation to 13, gingival enlargement in relation to 32 and 33 with generalized periodontitis. Over retained deciduous in respect to 55, 65, and 75 was also present.

Generalized chalky white opaque hypoplastic patches were observed on all surfaces of all teeth with generalized yellowish staining and pitting. A tentative, provisional diagnosis of suspected periapical pathology in respect to 13, generalized enamel hypoplasia, generalized periodontitis with partial anodontia were formulated.

IOPA revealed the obliteration of lamina-dura in the periapical region with respect to the upper right permanent canine 13 and enlarged pulp chambers, incomplete root formation with ill-defined radiolucencies periapically suggestive of periapical abscesses. OPG revealed multiple periapical radiolucencies with relation to 32, 42, 12, and 13.

A generalized reduced radiodensities of enamel and dentin with enlarged pulp chambers, incomplete root formation in multiple teeth, congenital missing teeth buds with respect to 14, 15, 16, 25, 26, and 35 also over retained 55, 65, and 75 teeth at occlusal level were also observed. The patient was referred to the respective dental departments for treatment needs and endocrinologist for further management.

Key takeaways:-
• Rickets can severely affect the developments of the tooth, and this condition becomes more accentuated by the patient's negligence toward the dental health.

• It requires effective medical strategies as well as multidisciplinary approach including dentist toward the defect. Early intervention must be required to prevent more complication in the future.

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