What are the associations and management of natal teeth in infants?

Natal Teeth: Associations and Management

Natal teeth are teeth present at birth that require careful assessment and management to prevent complications such as feeding difficulties, tongue ulceration, and risk of aspiration.

Definition and Classification

• Natal teeth: Teeth present at birth
• Neonatal teeth: Teeth that erupt within the first 30 days of life 1
• Most natal/neonatal teeth (approximately 90%) are prematurely erupted normal primary teeth rather than supernumerary teeth 2

Epidemiology

• Incidence: Approximately 1 in 2,000-3,400 live births 2, 3
• More common in males than females 2
• Most commonly affects mandibular incisors, followed by maxillary incisors 2

Clinical Characteristics

• Usually appear as mandibular incisors (most common)
• Often have mobility due to underdeveloped root formation
• May be poorly formed or hypoplastic
• Can appear singly, in pairs, or multiple teeth

Associated Conditions and Syndromes

Natal teeth may be associated with several conditions:

1. 22q11.2 Deletion Syndrome: May present with natal teeth among numerous other manifestations 4
2. Isolated occurrences: Most cases are not associated with any syndrome
3. Other potential associations (though evidence is limited):
   • Ellis-van Creveld syndrome
   • Hallermann-Streiff syndrome
   • Pierre Robin sequence
   • Cleft lip and palate

Complications

1. Feeding difficulties: Can interfere with breastfeeding
2. Riga-Fede disease: Traumatic ulceration of the ventral surface of the tongue due to sharp incisal edges 2
3. Maternal discomfort: Laceration of mother's breasts during nursing 3
4. Risk of aspiration: Especially with highly mobile teeth 2
5. Difficulty with proper oral hygiene

Management Approach

Treatment decisions should be based on:

1. Degree of mobility:

   • Highly mobile teeth with risk of aspiration → extraction recommended 2
   • Mild to moderate mobility → monitoring or smoothing edges

2. Type of tooth:

   • Supernumerary teeth → extraction recommended 2
   • Normal primary teeth → preserve if possible

3. Presence of complications:

   • If causing feeding difficulties → intervention needed
   • If causing tongue ulceration → smoothing of incisal edges or extraction

Specific Management Options:

1. Monitoring: For stable teeth without complications

2. Smoothing of incisal edges: For teeth causing tongue ulceration but otherwise stable 1

3. Extraction: Indicated when:

   • Tooth is extremely mobile with risk of aspiration
   • Tooth is supernumerary
   • Severe feeding difficulties persist despite conservative measures
   • Significant tongue ulceration not responding to smoothing 2

4. Post-extraction care:

   • Monitor for space maintenance if needed
   • Reassure parents about normal eruption pattern of remaining teeth

Important Considerations

• Radiographic examination is essential to differentiate between supernumerary and normal primary teeth 2
• Parental education about the condition is crucial to alleviate anxiety
• Cultural beliefs may influence parental concerns about natal teeth
• Extraction should be delayed until infant is at least 10 days old to avoid risk of hemorrhage due to hypoprothrombinemia in newborns

Follow-up

• Regular monitoring for complications if teeth are retained
• Assessment of normal eruption pattern of remaining primary dentition
• Evaluation of any potential impact on permanent dentition

Referral Indications

Referral to a pediatric dentist is recommended for:

• Multiple natal teeth
• Associated syndromes
• Need for extraction
• Significant complications not manageable in primary care

Remember that while natal teeth may cause initial concern for parents, proper assessment and management can address complications and provide reassurance about this relatively uncommon but well-documented phenomenon.