Natal and neonatal teeth: review of the literature

Resident: Cho

Author(s): Cunha RF,

Journal: Pediatric Dentistry

Year. Volume (number). Page #’s: 2001. 23. 158-162.

Major topic: Natal teeth, neonatal teeth

Minor topic: Riga-Fede disease

Type of Article: Literature Review

Main Purpose: To present a literature review of the important aspects about natal and neonatal teeth.

Findings:

Natal Teeth: present at birth

Neonatal Teeth: erupt during the first 30 days of life

Riga-Fede Disease: condition caused by a natal or neonatal tooth by rubbing the ventral surface of the tongue during feeding, leading to ulceration

Why are natal and neonatal teeth a concern?

- possibility of being swallowed or aspirated due to great mobility

- interference when breast feeding

- possibility of traumatic injury

There is no difference in prevalence between males and females. There is no conclusive evidence of a correlation between early eruption and systemic condition or syndrome. However, in a 17 year retrospective study of 50,892 records in a hospital in Canada, 15 cases of natal teeth were noted, 5 of whom presented with one of the following: cleft palate, Pierre Robin syndrome, Ellis-van Creveld syndrome, hypocalcemia with fracture of the ribs and rickets, and adrenogenital syndrome with 18-hydroxylase deficiency. The accepted possible cause of natal and neonatal teeth is superficial position of the germ associated with a hereditary factor. The etiology of natal and neonatal teeth needs to be further researched.

Natal and neonatal teeth may be conical and smaller than primary teeth or normal size and shape and opaque yellow-brownish in color. These teeth may be classified into mature (fully developed in shape and comparable in morphology to primary teeth) and immature (structure and development is incomplete). The term mature implies a relatively good prognosis and immature implies a poor prognosis. Histological studies have demonstrated that most of the natal and neonatal teeth are covered with hypoplastic enamel with varying degrees of severity, absence of root formation, ample and vascularized pulp, irregular dentin formation, and lack of cementum formation. Most of the dentin observed was normal dentin except for certain irregular areas.

Natal and neonatal teeth are primary teeth of the normal dentition 95% of the time and supernumerary teeth only 5% of the time. They are located in the lower incisors 85% of the time and erupt as double in 61% of cases. Natal and neonatal teeth, though rarely, can also present as upper incisors, canines, and molars.

Diagnosis of whether a tooth is a supernumerary tooth or primary tooth is determined by radiographic and clinical findings. A supernumerary tooth should be extracted. A tooth diagnosed as a primary tooth should be attempted to be maintained by smoothing the incisal margin or adding composite to the rough incisal margin. However, if the tooth is interfering with feeding or a risk of aspiration or causing trauma to the baby’s tongue/maternal breast, extraction is indicated.

Considerations when extracting a natal or neonatal tooth:

- avoid extraction up to 10^th day of life to prevent hemorrhage (need to wait for commensal flora of the intestine to become established and to produce vitamin K, which is essential to produce prothrombin in the liver)

- consult pediatrician whether vitamin K (delivered IM) needed before extraction

- avoid unnecessary injury to the gingiva

- alert to the risk of aspiration during removal

Since mineralization of natal and neonatal teeth are not complete, the prevention of dental caries is a concern and controlled by good oral hygiene and frequent fluoride application.

Key points/Summary:

1. Natal and neonatal teeth are rare (1:1000 to 1:30,000)

2. Radiographic examination is necessary in order to diagnosis whether it is a supernumerary or primary tooth.

3. Supernumerary natal/neonatal tooth should be extracted. The decision to maintain or extract a primary natal/neonatal tooth is multifactorial. The clinician must consider age of patient and whether vitamin K needs to be administered before the extraction of a natal/neonatal tooth.

4. Periodic follow-up by pediatric dentists is necessary and education of parents is necessary regarding OHI and fluoride.

Assessment of Article: Good article. I learned a lot about natal and neonatal teeth that I did not know before.