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DENTAL HEALTH…NATAL AND NEONATAL TEETH
By Dr. Neromini Fagu
Eruption of the first tooth is usually expected around six months of age and is considered as a 
normal milestone. Any sooner eruptions have often been associated with superstition and folklore in various cultures. Erupted teeth in the mouth of a newborn is a rare phenomenon and has been linked with good or bad omens that surround beliefs and assumptions which still exist today.
Natal teeth are those present in the oral cavity at birth, and neonatal teeth are those teeth that erupt within the first 30 days of birth. These natal or neonatal teeth are also termed as premature or predecidious dentition. The teeth commonly occur in pairs, mostly in the lower anterior region. The presence of natal teeth is three times more likely than neonatal teeth and ninety percent of these teeth are true primary (baby) teeth that have come in early. The remaining ten percent are supernumerary or extra teeth.
The cause of natal and neonatal teeth is unknown but one explanation is the positioning of superficial tooth buds. There also appears to be a hereditary aspect to developing natal teeth, with up to 60% of cases reporting a positive family history. Natal teeth are associated with cleft lip/palate, with 10% of children with bilateral cleft lip/palate having natal teeth and two per cent of unilateral cleft lip/palate having natal teeth.
Natal and neonatal teeth can sometimes 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.
The presence of natal teeth may lead to a number of complications and include:
- Potential risk of the infant inhaling the tooth into his/her airway and lungs if the tooth becomes dislodged during nursing due to its greater mobility
- Trauma to the tip or undersurface of the tongue resulting in ulceration – Riga-Fede disease
- The child’s refusal to feed due to pain
- Ulceration of the nipple of the mother and interference with breast feeding
Natal teeth are usually diagnosed based on a complete history and physical examination of the infant. X-rays may be performed soon after birth to determine if the teeth are normal baby teeth or extras, the extent of root development, enamel and dentine, and the relationship to other teeth.
The management option of conservative treatment versus extraction needs to be discussed with the parents. Treatment of natal and neonatal teeth is advisable at an early stage. 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
It has been reported that 30-60 % of natal teeth fall out in the first year of life. However, natal teeth that are only slightly loose at birth often quickly stabilize, and if still present at four months of age the teeth have a good prognosis.
Extraction may be a course of treatment if the teeth are supernumerary, very loose, or because of interference with the nasoalveolar molding appliance associated with cleft lip/palate. Extraction can often be performed with just topical anesthetic cream because of the poor root development. Usually the procedure is done after age 10 days to allow for appropriate levels of accumulation of Vitamin K in the blood for clotting.
For more information contact OMNI DENTAL at 295 Quamina Street, Georgetown Tel: 227-0025, Parika Tel: 260-3133 or send emails to [email protected].
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