Considerations in Restorative Management and New Oral Findings in a Patient With Congenital Insensitivity to Pain...

Congenital Insensitivity to Pain with Anhidrosis (CIPA) is a rare, autosomal recessive genetic condition characterized by an inability to sweat, intellectual disability, a lack of pain sensation and self-mutilating behaviours. This report describes the dental management and longitudinal oral findings of a child with CIPA, highlighting a restorative approach and novel findings in the permanent dentition.

Methods: A 3-year-10-month-old boy presented with severe early childhood caries, premature exfoliation of primary teeth, traumatic tongue biting and recurrent oral ulceration. Comprehensive dental treatment was performed under general anaesthesia, including restorations and extraction of unrestorable primary teeth.

Results: Subsequent follow-up revealed altered eruption sequence, premature eruption and hypomineralisation and hypoplasia of permanent teeth. At 7-year-1-month, he developed a large palatal ulcer and swelling associated with a recently exfoliated upper left second molar (#65). Wound debridement, excision of malformed upper left second premolar (#25) and restorative treatment of affected permanent teeth were performed under general anaesthesia. Tooth morphology was modified to reduce soft tissue trauma. Healing was observed 1 month post-operatively.

Conclusion: Conservative restorative management may preserve oral function in selected patients with CIPA, while long-term surveillance is essential because of developmental dental anomalies, altered eruption sequence and recurrent traumatic injury.