A 9-year-old child with severe learning difficulties is seen at the dentist and found to have a thin, grayish-blue line visible along the margins of the gum at the base of his front teeth. What diagnosis should be suspected?
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The Burton line is seen in patients with lead poisoning.
It is a thin, grayish-blue line visible along the margin of the gums at the base of the teeth.
A similar line, the bismuth line, occurs with ingestion of bismuth compounds. However, the toxicity of bismuth compounds is lower than lead.
Lead poisoning causes abdominal pain, constipation, headaches, irritability, memory problems, inability to have children, and tingling in the hands and feet. In severe cases, it may cause anemia, coma, seizures, or death. It causes 10% of intellectual disability of otherwise unknown cause and behavioral problems. Children are at greater risk because they often eat lead paint. Blood lead level determines the diagnosis. Elevated lead is detected by changes in red blood cells or in dense lines in the bones of children as seen on x-ray.
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