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Management Of Natal and

Neonatal Teeth
By Suparn V Kelkar
4 th 1 st
Roll no 27

Natal teeth

Teeth that are

present at birth are

known as Natal teeth

Neonatal teeth

Teeth which errupt during neonate period,

from birth to 30 days are called Neonatal teeth

They are
referred to
teeth, Fetal
teeth or

al Teeth

Kates (1984) reporting a 66% proportion for

females against a 31%proportion for males.

Natal teeth > Neonatal teeth
According to Bodenhoff and Gorlin (1963), the
teeth most affected are
1. Mandibular Incisors 85%

1. Maxillary Incisors 11%

Mandibular Canines and Molar

Maxillary Canines or Molars 1%


The presence of natal and neonatal teeth is

definitely a disturbance of biological chronology

whose etiology is still unknown.
Hormonal stimulation
Febrile states
The current concept suggest that natal and neonatal

teeth are attributed to the superficial position of the

developing tooth germ which predisposes the tooth to
erupt early

Boyd and Meles used and anatomical section

and a radiograph of the fetal mandible to

demonstrate that the tooth was not localized
in an alveolus but slightly below the surface of
the alveolar bone, very much above the germ
of its permanent successor

Hereditary transmission of a dominant

autosomal gene
Osteoblastic activity inside the germ area
related to the remodeling phenomenon

Leung (1986) in a 17-year retrospective study of 50,892

records for children born at the Foothills Provincial
Calgary, Canada, detected the occurrence of natal teeth
in 15
infants, 5 of whom presented one of the following
cleft palate, Pierre Robin syndrome. Ellis-van Creveld
hypocalcemia with fracture of the ribs and rickets, and
adrenogenital syndrome with 18-hydroxylase deficiency.

Fauconnier and Gerardy (1953)24 presented an excellent

discussion of the difference between early eruption and premature
eruption in which they also proposed an etiology of
natal and neonatal teeth. They considered early eruption to
be that occurring because of changes in the endocrine system,
whereas premature eruption would be a clearly pathological
phenomenon with the formation of an incomplete rootless
tooth that would exfoliate within a short period of time. This
structure, designated expulsive Capdepont follicle, may result
from trauma to the alveolar margin during delivery, with
the resulting ulcer acting as a route of infection up to the dental
follicle through the gubernacular canal, causing premature
loss of the tooth.

Associated Syndromes
1. Ellis Van Creveld Syndrome or

Chondroectodermal dysplasia

2. Hallermann-Streiff Syndrome

Riga Fede Syndrome or neonatal sublingual

traumatic ulceration

Pachyonychia Congenita

Clinical Findings
Natal and neonatal teeth may resemble


normal primary teeth but in many instances

they are
Poorly develpoed
With hypoplastic enamel and dentin
Poor or Total Failure of development of roots

central incisor

Category 1
A shell like crown
structure loosely
attached to the
alveolus by a rim
of oral mucosa,
no roots

Category 2
A solid crown
loosely attached
to the alveolus by
oral mucosa, little
or no root

Category 3
The incisal edge
of the crown just
erupted through
the oral mucosa

Category 4
A mucosal
swelling with the
tooth unerrupted
but palpable

It has been recommended that natal teeth of

category 1 2 are candidates for extraction if

mobility is moretan 2 mm as the could
become hypermobile and may be danger of

1. Traumatic ulceration on the ventral surface of


2. Ulceration on the Sublingual area (Riga Fede


The importance of a correct diagnosis of natal and neonatal
teeth has been pointed out by several investigators1,9,26,31,32,33
who used clinical and radiographic findings in order to determine
whether these teeth belonged to the normal dentition or
were supernumerary, so that no indiscriminate extractions
would be performed.
A radiographic verification of the relationship between a
natal and/or neonatal tooth and adjacent structures, nearby
teeth, and the presence or absence of a germ in the primary
tooth area would determine whether or not the latter belongs
to the normal dentition.33 It should be pointed out that most
natal and neonatal teeth are primary teeth of the normal dentition
and not supernumerary teeth.6 These teeth are usually
located in the region of the lower incisors,5, 34 are double in 61%
of cases 4, 14 and correspond to teeth of the normal primary
dentition in 95% of cases, while 5% are supernumerary.29
Ooshima et al (1986)35 emphasized that multiple natal teeth
are extremely rare

After clinical diagnosis Radiographs must be

taken to determine root development

King and Lee recommended that inflamed

gingival tissue around teeth should be

controlled by applying chlorhexidine gluconate
gel 3 times a day

In some cases sharpe incisal edge of tooth

may cause laceration of the lingual surface of

the toungue and selective grinding of tooth is
advised in such conditions

Most prematurely erupted teeth are

hypermoblie because of the limited root

formation and development
Some teeth may be mobile to the extent that
there is a danger of aspiration in which case
removal of the tooth is indicated
If extraction is indicated, after the tooth is
removed, careful Curttage of Socket is indicated
In an attempt to remove all odontogenic cellular
remnants that may otherwise be left in the
extraction site

Such remnants may subsequently develop a

typical tooth like structure that requires

additional treatment

Earlier it was recommended to delay surgical

procedures untill after 10th postpartum due to

inability of clotting in newborns

Now a prophylactic dose of Vit K is given as

standard procedure

Eruuption of neonatal teeth may cause

difficulties for a mother who wishes to

breastfeed her infant
If breastfeeding is painfull initially, breast
pump and bottling the milk are indicated

The preferable approach is however to leave

the tooth in place and to explain to the

parents the desireability of maintaining this
tooth in the mouth because of its importance
in the growth
Adjascent teeth would erupt within a short
time and the prematurely erupted teeth will
become stabilized as the others teeth in the
arch will erupt