2. INTRODUCTION…
The occurrence of natal and neonatal teeth is an
uncommon anomaly, which for centuries has been
associated with diverse superstitions among different
ethnic groups. Natal teeth are more frequent than
neonatal teeth, with the ratio being approximately 3 : 1. It
must be considered that natal and neonatal teeth are
conditions of fundamental importance not only for a
dental surgeon but also for a pediatricians since their
presence may lead to numerous complications. Early
detection and treatment of these teeth are recommended
because they may induce deformity or mutilation of
tongue, dehydration, inadequate nutrients intake by the
infant, and growth retardation, the pattern and time of
eruption of teeth and its morphology.
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3. Natal and Neonatal Teeth:
•Teeth present at birth
are termed natal teeth.
•Teeth that erupt within
the first month of life
are termed neonatal
teeth.
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4. Terminology and Synonyms…
Some of the terminologies used previously to describe natal and
neonatal teeth are –
Congenital teeth
Dentitia praecox
Fetal teeth
Dens connatalis
Infancy teeth
Predeciduous teeth
Precocious dentition
But due to lack of specificity and accuracy in description of the
condition leads to subsequent discontinuity of these terms.
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5. Incidence and Prevalence…
•Natal teeth are three times more common than neonatal
teeth.
•The incidence of natal and neonatal teeth ranges from
1 : 2,000 to 1 : 3,500.
•More than 90% of natal and neonatal teeth are prematurely
erupted deciduous series of teeth.
•Only 1% to 10% of natal and neonatal teeth are
supernumerary.
•Females, in general, being more affected. Kates (1984)
reporting a 66% proportion for females against 31%
proportion of males.
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6. Prevalence in different populations
and studies…
Authors Prevalence Number of children in the sample
Magitot,1 876 1 : 6000 17,578
Puech, 1876 1 : 30000 60,000
Ballantyne, 1896 1 : 6000 17578
Massler and 1 : 2000 6,000
Savara, 1950
Allwright, 1958 1 : 3408 6,817
Bodenhoff, 1959 1 : 3000 —
Wong, 1962 1 : 3000 —
Bodenhoff 1:3000 _
and Gorlin, 1963
Mayhall, 1967 1 : 1125 90
Chow, 1980 1 : 2000 to 3500 —
Anderson, 1982 1 : 800 —
Kates et al., 1984 1 : 3667 7,155
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7. Incidences…
According to Bodenhoff and Gorlin (1963),the
teeth most affected are-
Mandibular incisors,
85%
Maxillary incisors,
11%
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8. Incidences…
Natal or neonatal cuspids are extremely rare
Mandibular canines
and molars, 3%
Maxillary canines
and molars, 1%
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9. Etiology…
Exact etiology for the appearance of natal and neonatal teeth is not
known. In the past ,neonatal teeth were merely considered cysts of
the dental lamina of the newborn. The current concept suggest that
these teeth are attributed to the superficial position of the
developing tooth germ which predisposes the tooth to erupt early.
Studies says, in up to 60% cases they occur due to inheritance as
dominant autosomal trait.
Natal teeth may also associated with cleft lip or palate:
10% of children with bilateral cleft lip or palate have natal teeth
and 2% of unilateral cleft lip or palate have natal teeth.
Cleft lip or palate can be a feature of a number of syndromes in
which natal teeth have also been reported:
Mecke - Gruber syndrome
Pierre Robin syndrome
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10. Maternal Factors…
Maternal factors reported to be associated with an increased risk of
natal teeth.Such as-
•Infection and febrile states
•Malnutrition including hypovitaminosis
•Trauma
•Hormonal stimulation
•Syphilis
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11. Associated syndromes …
Few syndromes are reported to be associated with natal teeth and
neonatal teeth. These syndromes includes-
•Ellis-van Creveld syndrome or Chondroectodermal Dysplasia
•Hallermann-Streiff syndrome or Oculomandibulofacial
Syndrome with Hypotrichosis
•Soto syndrome
•Jackson-Lawler or Pachyonychia Congenital
•Cyclopia
• Pallister-Hall
•Short Rib-Polydactyly (type II)
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13. Environmental Predisposing Factors…
Environmental factors could play an important role in eruption of
neonatal 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.
• The toxic polyhalogenated aromatic hydrocarbons: PCBs, PCDDs, and
PCDFs may be regarded as a causative factor of natal teeth. They are
among the most widespread environmental pollutants. They cross the
placenta, and concentrations of PCDD/Fs in the adipose tissue of a
newborn are correlated with those in mother’s milk.
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14. Clinical Presentation
Natal or neonatal teeth can be normal in size, shape and color. The
appearance of these teeth is dependent on the degree of maturity
but most of the time they are-
-Poorly developed
-Conical
-Small
-Hypoplastic
-Enamel hypoplasia or hypomineralized
-Brown-yellowish
or whitish-opaque color
-Prone to wear and discoloration
-Incomplete or defective root development:
leads to mobility or loss of tooth
-Gingival edema and bleeding areas
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15. Radiographic Findings…
X-ray examination showed –
1.Absence of enamel or a thin enamel capsule
2.Dentin
3.Radicular structures
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16. Histology…
Decalcified sections showed an immature tooth where enamel
was hypomineralized or hypoplastic which could be attributed to
the disturbance in amelogenesis process.
Dentino-enamal junction is not scalloped which similar to that
found in deciduous teeth. Cervically dentin becomes atubular
with spaces and enclosed cells. Irregular dentinal tubules
through the dentin of various thicknesses could be present.
Atypical dentin was also observed.
The incipient Hertwig’s sheath was associated with little root
development. Normal pulp tissue is observed, except for the
presence of inflammatory areas in some regions..
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17. Clinical Categories…
There are four clinical categories of natal teeth have been described:
•Category-1:Shell-like crown structure loosely attached by gum
tissue with no root
•Category-2:Solid crown loosely attached by gum tissue with little or
no root
•Category-3:Eruption of the cutting edge of the crown through gum
tissue
•Category-4:Swelling of the gum tissue with an unerupted but
palpable tooth.
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22. Complications…
Complications to the infant may include:
•Feeding difficulties: dehydration, malnutrition leading to low
weight, small size.
•Trauma to the tip or ventral surface of the tongue(Riga-Fede
disease) resulting in ulceration (6-10%).
•Loss of the tooth – which can be swallowed or inhaled.
•Pain or distress due to erupting neonatal tooth.
•Development of dental caries and pulp polyp as the enamel is often
absent or poorly develop.
•Premature eruption of succesor. 22
23. Riga-Fede Disease…
Riga-Fede disease is a
mouth ulcer seen in
infants and is usually
caused by rubbing the
tongue over teeth. The
ulcer may be
uncomfortable but it is
otherwise harmless.
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25. Management of natal and neonatal
teeth:
Home Care:
Keep them clean by gently wiping the gums and teeth with a
clean, damp cloth. Examine the infant's gums and tongue
frequently to make sure the teeth are not causing injury.
When to Contact a Medical Professional?
Call your doctor if an infant with natal teeth develops a sore
tongue or mouth or other symptoms.
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26. Management of natal and neonatal
teeth:
It is advisable to involve a pediatric 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.
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27. Management of natal and neonatal
teeth:
Conservative treatment versus extraction needs to be discussed
with the parents.
Conservative management is generally preferred and options
include:
•Grinding or 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
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28. Management of natal and neonatal
teeth:
Extraction can often be performed with just topical anesthetic cream.
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:
-Supernumerary
-Very loose
-Associated with cleft lip or palate because of interference with the
nasoalveolar molding appliance
If extraction is going to be performed under locally injected or general
anesthesia, curettage of the underlying dental tissue is recommended
as development of ‘residual neonatal teeth’, said to occur in
approximately 9% and necessitating a second surgical procedure.
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29. References…
A Manual of Pediatric Dentistry
By R.J. Andlaw, W.P. Rock
Principle and Practice of Pedodontics
By Arathi Rao
http://www.bmj.sk/2011/11211-12.pdf
http://www.forp.usp.br/bdj/Bdj9%281%29/t0891/t0891.html
http://dermnetnz.org/site-age-specific/natal-teeth.html
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