Natal and neonatal teeth
What are natal teeth?
Any teeth present at birth are defined as natal teeth.
What are neonatal teeth?
Neonatal teeth are teeth that appear in the first 30 days after birth. Teeth normally begin to erupt from 6 months of age.
Who gets natal and neonatal teeth and why?
The incidence of natal and neonatal teeth has been reported in a number of studies, ranging from 1 in 50 (2%) in a series of over 2000 babies examined within 20 hours of birth in Mexico to 1 in 30,000, in a summary of studies published between 1876 and 1991. Most studies however give an incidence between 1 in 2000 to 1 in 3500 live births. The incidence probably varies between different racial groups, with some American Indian tribes reported to commonly present with natal teeth.
Natal teeth are said to be three times more common than neonatal teeth.
The male to female ratio varies in different studies with some reporting a male predominance and others no difference or a female predominance. In one study of babies with cleft lip/palate there was a marked male predominance in those with natal teeth and bilateral cleft lip/palate and a slight female predominance in those with natal teeth and unilateral cleft lip/palate.
Natal and neonatal teeth are rarely seen in very premature babies.
There appears to be an inherited tendency to developing natal teeth with up to 60% of cases reporting a positive family history with an autosomal dominant pattern (meaning about half the children of an affected individual are affected).
Natal teeth are associated with cleft lip/palate: 10% of children with bilateral cleft lip/palate have natal teeth and 2% of unilateral cleft lip/palate have natal teeth. Cleft lip/palate can be a feature of a number of syndromes in which natal teeth have also been reported:
- Meckel-Gruber syndrome (MIM249000)
- Pierre Robin sequence (MIM261800)
Syndromes in which natal teeth are a recognised feature:
- Ellis-van Creveld syndrome (chondroectodermal dysplasia, MIM225500)
- Jackson-Lawler (pachyonychia congenita 2, MIM167210)
- Steatocystoma multiplex with natal teeth (MIM184510)
- Hallerman-Streiff (oculomandibulofacial syndrome with hypotrichosis, MIM234100 )
There have been many single case reports of natal or neonatal teeth occurring in association with other syndromes. These probably do not represent a true feature of the syndrome.
Maternal factors reported to be associated with an increased risk of natal teeth:
- Babies born to mothers exposed to high levels of polychlorinated biphenyls and dibenzofurans during the Yusheng environmental accident in Taiwan were found to have a 10% risk of natal teeth
- Infection and febrile states
- Malnutrition including hypovitaminosis
Clinical features of natal teeth
Up to 75% of natal and neonatal teeth present as a pair of teeth in the centre of the lower gum (lower central primary incisors), probably because these are the first teeth to erupt normally. Occasionally just one of these teeth appears early. Multiple natal/neonatal teeth are rare, although in infants with cleft lip/palate the rate was 21% in one study.
- Lower central primary incisors 85%
- Maxillary incisors 11%
- Mandibular canines and molars 3%
- Maxillary canines and molars 1%
At least 90% of natal/neonatal teeth are the milk teeth (primary dentition) with no more than 10% of natal/neonatal teeth being extra (supernumerary) to the normal teeth.
Natal/neonatal teeth can be normal in size, shape and colour. However they are usually small, conical and yellow-brown. They are often loose and prone to wear and discolouration.
Four clinical categories of natal teeth have been described:
- shell-like crown structure loosely attached by gum tissue with no root
- solid crown loosely attached by gum tissue with little or no root
- eruption of the cutting edge of the crown through gum tissue
- swelling of the gum tissue with an unerupted but palpable tooth.
Complications of natal and neonatal teeth
Complications to the mother relate to breast feeding: painful bitten or bleeding nipples.
Complications to the infant may include:
- feeding difficulties: dehydration, malnutrition leading to low weight, small size (failure to thrive)
- Riga-Fede disease: trauma to the tip or undersurface of the tongue resulting in ulceration (6-10%)
- loss of the tooth – which can be swallowed or inhaled
- pain/distress due to erupting neonatal tooth
- concerns about possible development of dental caries, as the enamel is often absent or poorly developed
Management of natal and neonatal teeth
It is advisable to involve a paediatric dentist early in the management of natal/neonatal teeth.
X-rays should be performed soon after birth to determine if the teeth are normal milk teeth or extras, the extent of root development, enamel and dentin, and the relationship to other teeth.
Conservative treatment versus extraction needs to be discussed with the parents.
Extraction can often be performed with just topical anaesthesic cream because of the poor root development. Vitamin K levels or prophylactic vitamin K injection should be performed before the tooth is extracted in a neonate under the age of 10 days. Extraction may be considered if the tooth is:
- very loose
- associated with cleft lip/palate because of interference with the nasoalveolar molding appliance
Extraction (or spontaneous loss) can be complicated by the development of ‘residual neonatal teeth’, said to occur in approximately 9% and necessitating a second surgical procedure. Therefore, if extraction is going to be performed under locally injected or general anaesthesia, curettage of the underlying dental tissue is recommended.
Conservative management is generally preferred and options include:
- grinding/smoothing sharp edges of the tooth
- composite resin to form a dome shape over the edge of the tooth so the tongue glides over the tooth
- protective Stomahesive wafers/rings
- changes in feeding technique
- dental hygiene including topical fluoride application
Studies have reported that one- to two-thirds of natal teeth fall out in the first year of life. However natal teeth that are only slightly loose at birth often quickly stabilise. If still present at 4 months of age, the tooth has a good prognosis.