case_images: PMC4313064_01
case_images: The healthy patient at 9 years of age.
case_images: CRID2015-571098.001.jpg
case_images: PMC4313064_01_CRID2015-571098.001.jpg
case_images: fig1
case_images: The center specializes in dental care for special needs patients. The patient presented with neonatal icterus; however, the patient was a full-term baby, underwent a normal delivery, and reached normal milestones until 9 years of age (Figures 1(a) and 1(b)).
case_images: The patient's clinical appearance at 11 years of age included neuropsychomotor delay, dystonic posture of the hands and feet, and vertical supranuclear gaze palsy (VSGP).
case_images: CRID2015-571098.002.jpg
case_images: PMC4313064_01_CRID2015-571098.002.jpg
case_images: fig2
case_images: Subsequently, the patient presented with learning difficulties and progressive intellectual decline (Figure 2).
case_images: Oral findings revealing marked overjet and skeletal malocclusion angle class II, division I.
case_images: CRID2015-571098.003.jpg
case_images: PMC4313064_01_CRID2015-571098.003.jpg
case_images: fig3
case_images: Furthermore, the patient had halitosis, excessive salivation, enamel cracking of the maxillary central incisors, an incisal fracture in the right central incisor, marked overjet, skeletal malocclusion angle class II, division I (Figure 3), narrow palate, mobility in the upper primary molars, and caries in the first left and right permanent mandibular molars and first left premolar. 
case_images: Periapical radiographic examination showing the presence of the first permanent molar with extensive caries and periodontal ligament thickening (a). An intraoral radiographic film enclosed in a plastic bag (4 x 23 cm) (b).
case_images: CRID2015-571098.004.jpg
case_images: PMC4313064_01_CRID2015-571098.004.jpg
case_images: fig4
case_images: Periapical radiographs showed extensive caries on the occlusal surface of the right permanent mandibular first molar accompanied by a slight thickening of the periodontal ligament (Figure 4(a)). The radiograph film was placed within a 4 x 23 cm plastic bag (Figure 4(b)) to control its position and to avoid the risk of swallowing or possible suffocation.