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CASE REPORT

Natal teeth in a premature baby: A case report and review of literature


Ramesh S Reddy1, Umadevi H S2, Lokesh Babu K.T3, Mallika P Reddy4

ABSTRACT
The presence of teeth at birth is a rare condition. A premature baby with two mandibular incisor natal teeth was examined. The teeth were mobile and extracted because of the fear of aspiration and breast feeding was difficult. The purpose of this report is to present natal teeth in a premature baby which is rare. Key words: Premature baby, Mandibular incisors, Natal teeth

of growth and development of the baby. No other abnormality was diagnosed after a pediatric consultation

Discussion
Natal teeth Incidence - Usually eruption of deciduous teeth occurs first in the oral cavity when the child is six months old. The presence of teeth in new born is uncommon, varying from 1:6000 to 1:800 cases, occurring in general with incidences of two or three teeth2 Definition - The presence of teeth at birth or within a month post delivery is a rare condition. Massler and Savara have divided these teeth into two groups according to the time of eruption of the teeth that are present at birth are known as natal teeth. Teeth developing in the first month (first 30 days of life) after birth are called neonatal teeth3 The occurrence of natal teeth is relatively rare with a frequency of one case for each 2000 births4 .Natal teeth are found more frequently than neonatal teeth in a proportion of three to one5. The teeth most often associated with this anomaly are the mandibular central incisors followed by maxillary central incisors4. Many theories have been proposed to explain the etiology of premature eruptions of teeth: increased eruption rate during or after fever, endocrine disorders, dietic deficiencies, effect of congenital syphilis, superficial position of tooth germ, family history and association with some syndromes, such as chondroectodermal dysplasia6,7

Introduction
Premature baby is defined as a baby born before 37 weeks of gestation have passed. Historically, the definition of prematurity was 2500grams (about 5 pounds) or less at birth. The current world health organization definition of prematurity is a baby born before 37 weeks of gestation, counting from the first day of the last menstrual period.1

Case report

An infant aged 5 days was referred to the dental department with the complaint of two teeth in the lower jaw since birth. On reviewing, the infant was a premature baby born in the 31st week and weighed 2.77lbs. The mother had noticed teeth like structures in the mouth and Natal teeth are present in 2:1 of infants unilateral cleft lip complained that breast feeding was difficult. and palate and 10% of infants with bilateral cleft lip and Oral examination revealed two crowns of the teeth in the palate8. Natal teeth have been reported in association mandibular anterior region. They were white in color, with syndromes such as Ellis-van creveld (chondro mobile (grade 3). The gingiva was of normal appearance. ectodermal dysplasia), Jadassohn-lewandowsky These teeth were diagnosed as natal teeth. (Pachyonychia congenita), Hallerman-streiff The mother was counseled and the natal teeth were (Oculomandibululofacial syndrome with hypotrichosis), extracted. The extracted teeth had only crown without Craniofacial dysostosis, Steacystoma multiplex, Sotos, roots in both the teeth. The mother was explained the Wiedermann-Rautenstraunch, Meckel-Gruber and Pierre importance of follow up to observe the milestones of Robin9. growth and development of the baby. No other IJCD JUNE, 2012 3(2) abnormality was diagnosed after a pediatric consultation Differential diagnosis 37 2012 Int. Journal of Contemporary Dentistry Bohns nodules and congenital epulis might be confused

CASE REPORT
number of dilated blood vessels in the pulpal tissue11,12. Root formation is often incomplete9. Review of literature Natal teeth were reported during Roman times by Titus Livius (59BC) and Caius Plinius Secundus (23BC) and were described in the cuneiform inscriptions found at Nineveh. Superstitions and folklore about natal teeth have varied from claims that affected children were exceptionally favored by fate to the belief that they were doomed. In England, infants born with natal teeth were considered destined to be famous soldiers, while those born in France and Italy were considered future conquerors of the world. In China, Poland, India, and Africa, affected children were considered monsters and bearers of misfortune9. Natal teeth are rare in extremely preterm infants15. There is a racial variation in the incidence; the problem is more common among infants of some American Indian tribes16. Synonyms Several descriptions have been used for natal teeth. Some terms such as fetal teeth, predeciduous teeth, and early teeth have also been described. Currently the terminologies natal and neonatal used by Massler and savara have been adopted. Even these terms only define the time of eruption and give no consideration of anatomy and histology or whether the tooth is a component of primary dentition or whether it is supernumerary5,17.

Fig 1: Intra oral photograph showing natal teeth

Differential diagnosis Bohns nodules and congenital epulis might be confused with natal teeth. Bohns nodules are usually multiple and found along the buccal lingual aspects of the mandibular and maxillary ridges10. These remnants of mucus gland tissue are firm, whitish and have a ricelike appearance, are asymptomatic, do not interfere with feeding and are spontaneously shed within several weeks. Epulis are tumor like growths of the gum that might be either sessile or pedunculated, and are reactive rather than neoplastic lesions9 Clinical appearance The most commonly affected teeth are the lower primary central incisors (85%), followed by the maxillary incisors(11%), mandibular canines and molars(3%) and maxillary canines and molars(1%)11 Natal teeth might resemble normal primary teeth in size and shape; however, the teeth are often smaller, conical and yellowish, and have hypoplastic enamel and dentin with poor or absent root development11,12. Most natal teeth are mobile12,13. Four clinical categories of natal teeth have been described. 1) Shell like crown structure loosely attached to the alveolus by gingival tissue with no root 2) Solid crown loosely attached to the alveolus by gingival tissue with little or no root. 3) Eruption of the incisal margin of the crown through gingival tissue. 4) Edema of the gingival tissue with an unerupted but palpable tooth 9 Clinical significance Histologically, the majority of natal teeth have hypomineralised enamel , irregular dentin and osteodentin in the cervical portions, and interglobular dentin in the coronal regions11,14. The incisal edge might lack enamel. Both Hertwigs sheath and cementum might be absent. There is often an increase in the

Conclusion
1) The occurrence of natal tooth is a rare phenomenon. 2) The decision to keep or to extract a natal tooth should be evaluated in each case keeping in mind scientific knowledge, clinical common sense and parental opinion after the parents are properly informed about all aspects involved in this situation. 3) Radiographic examination is an essential auxiliary tool for the differential diagnosis between supernumerary primary teeth and teeth of the normal dentition. 4) Periodic follow-up by pediatric dentists is of fundamental importance18.

References
1) www.medterms.com . 2) Goncalves FA,Birmani EG,Sugayai NN,Melo AM. Natal teeth: Review of literature and report of an unusual case. Braz.Dent J 1998; 9:53-6 3) Roopa S Rao, Sudha V Mathad. Natal teeth: case report and review of literature. Journal of oral and

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CASE REPORT
maxillofacial pathology Jan- June 2009; vol 13 issue 1.41-46 4) Halse.Natal and neonatal teeth,Histologic investigations in two brothers. Oral surgery Oral medicine Oral pathology.1957; 10(5): 349-59 5) Alvarez MP, Crespi PV,Shanske AL. Natal molars in Pfeiffer syndrome type3: a case report J clin.pediatric Dent 1993;18(1).21-4 6) Massler M,Savara BS.Natal and neonatal teeth; a review of 24 cases reported in the literature.J Pediatr.1950;36(3):349-59 7) Water LRF,Ferelle A,IssaoM.Odontologia para o bebe. Sao Paulo: Artes Medicas;1996 8)De Almeida CM, Gomide MR, Prevalence of natal/ neonatal teeth in cleft lip and palate infants. Cleft palate J .1996;33:297-299. 9) Alexander K.C Leung and William lane M Robson, Natal teeth: A review Journal of the national medical association Feb2006; vol 98,no 2: 226-228. 10) Leung AK, RobsonWL. Bohns nodules, Resident and staff physician. 1992;38(3):28 11) Zhu J King D Natal and neonatal teeth. ASDC J Dent child. 1995;62: 123-128. 12) Galassi MS, Santos-Pinto L, Ramalho LTO. Natal maxillary primary molars: case report J clin pediatr Dent 2004; 29; 41-44 13) Ziai MN, Bock DJ, Da Silveira A,et al. Natal teeth: a potential impediment to nasoalveolar molding in infants with cleft lip and palate. The journal of craniofacial surgery 2005; 16: 262-266. 14) Hyatt HW. Natal teeth: its occurrence in five siblings. Clin pediatr.1965; 4: 46-48. 15) Suresh kumar R MC Aulay AH, Natal and neonatal teeth. Arch Dis child Neonatal Ed 2002; 87: p227. 16) Leung AK. Natal teeth in American Indians. Am J Dis child. 1986;140: 1214. 17) Anderson RA. Natal and neonatal teeth: Histologic investigation of two black females. ASDC J Dent child 1982; 49: 300-3 18) Robson Frederico cunha, Dr. Farli AparecidancarrilhoBoer, Dr Diore Dias Torriani, Dr Wanda Terezin ha Garbeline Frossard. Natal and neonatal teeth: review of the literature. Pediatric Dent. 2001; 23: 158-162.
About the Authors

1.Dr. Ramesh S Reddy,


Professor & HOD, Department of Oral & Maxillofacial Surgery, K.G.F College of Dental Sciences

2.Dr. Umadevi H S,
Reader, Dept of Oral Pathology, V S Dental College & Hospital

3.Dr. Lokesh Babu K T,


Reader, Department of Oral & Maxillofacial Surgery, K.G.F College of Dental Sciences.

4.Dr. Mallika P Reddy


Reader, Department of Oral & Maxillofacial Surgery, K.G.F College of Dental Sciences.

Address for correspondence:

Dr. Ramesh S Reddy


Professor & HOD Department of Oral & Maxillofacial Surgery K.G.F College of Dental Sciences Kolar E mail: ksrbabu@hotmail.com

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IJCD JUNE, 2012 3(2)


2012 Int. Journal of Contemporary Dentistry