d. Tertiary Syphilis. The third and terminal stage of syphilis may appear at any
time from several months to several years after the initial infection. The lesions of this
stage, called gummas, are not very contagious. They rarely contain causative
organisms. They appear in the mouth less frequently than secondary lesions. They
normally appear as nodules and slowly get bigger, becoming softer and less dense.
Eventually the center of the nodule becomes necrotic and a destructive lesion results.
The soft tissue and underlying bone are destroyed. When gummas appear in the oral
cavity, they often result in perforations of the soft palate.
e. Congenital Syphilis. A mother having syphilis during pregnancy may
transmit the disease to the child. Certain tooth formations are considered typical of
congenital syphilis if the child is not treated. In these cases, the incisors are notched on
their incisal edges and shaped like a screwdriver. The cusps of the first molars are
underdeveloped. The typically notched, screwdriver-shaped incisors are called
Hutchinson's incisors. Deformed (mulberry) molars are another diagnostic sign. The
presence of these teeth alone, however, should not be considered sufficient reason for
making a diagnosis of congenital syphilis.