Our appreciation is extended to Dr. Juan Yepes, Indiana University School of Dentistry Department of Pediatric Dentistry and Riley Hospital for Children, for contributing this case.

History: A 6-year-old boy presented to the pediatric dentist, referred by a family dentist, because of unusual discoloration of the anterior teeth.

The boy’s past medical history was remarkable for a genetic condition, the name of which the parents couldn’t recall. The parents also mentioned the presence of kidney stones (diagnosed one year prior), spinal cord “issues,” and occasional knee pain.

The extraoral exam revealed frontal bossing. The intraoral exam revealed a clinical abscess apical to tooth #I. (Click to enlarge the image.) No caries were observed, and there was no history of trauma.

The pediatric dentist ordered a periapical radiograph. Click to enlarge.