An 18-year-old boy is brought by his parents for evaluation of several relatively minor skin problems, including warts, moles, and skin tags. The patient’s history is notable for multiple as-yet-unexplained bony fractures that have occurred with minimal trauma since he was born. He has a brother who was diagnosed with osteogenesis imperfecta, yet, despite an extensive workup, the patient’s constellation of findings has thus far failed to corroborate that or any other definitive diagnosis.
As an afterthought, the parents also ask about changes they have noted on the patient's gums.
There is no history of seizures, and the patient takes no medication regularly.
EXAMINATION
The potential connection to a heritable syndrome draws attention to the patient’s teeth and gums. The latter appear to be overgrown and, as such, far more prominent than normal. They also appear a bit inflamed, especially the portion of the gingiva bordering the teeth. Advanced gingival recession is noted in some of these locations. Closer examination reveals extensive plaque formation on the adjacent teeth.
During the exam, the patient is observed to be a mouth-breather. His parents corroborate this fact.
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