Management and Treatment of Natal Teeth
Natal teeth should be evaluated individually, with extraction recommended for highly mobile teeth due to risk of aspiration, while stable teeth can often be maintained with appropriate monitoring and management of complications. 1, 2
Assessment and Diagnosis
When evaluating an infant with natal teeth, consider:
- Mobility assessment: Test tooth mobility as this is the primary factor in determining management 2
- Location: Most commonly mandibular central incisors 3
- Type: Determine if they are prematurely erupted primary teeth (90% of cases) or supernumerary teeth 1
- Associated complications:
- Feeding difficulties (especially breastfeeding)
- Traumatic lingual ulceration (Riga-Fede disease)
- Risk of aspiration due to mobility
- Maternal discomfort during breastfeeding
Treatment Algorithm
1. For Highly Mobile Teeth
- Extract immediately if mobility is excessive (grade 2-3) due to high risk of aspiration 2
- Extraction considerations:
- Wait until infant is at least 10 days old when possible to avoid bleeding risk
- Consider vitamin K administration prior to extraction if performed in first week of life
- Ensure complete removal of the tooth including root to prevent development of reactive lesions 4
2. For Minimally Mobile or Stable Teeth
- Maintain with monitoring if the tooth is stable or has minimal mobility 3
- For sharp incisal edges causing ulceration:
- Smooth sharp edges with a dental handpiece and polishing bur 5
- Monitor for signs of pulpal necrosis until exfoliation
3. For Riga-Fede Disease (lingual ulceration)
- Smooth incisal edges
- If ulceration persists despite smoothing, extraction may be necessary 1
Follow-up Care
- Schedule periodic dental follow-up to:
- Monitor tooth stability
- Assess for development of oral lesions
- Ensure normal eruption pattern of subsequent primary teeth 6
- Parents should be educated about:
- Signs of increased mobility requiring immediate attention
- Proper oral hygiene for the infant
- Feeding techniques to minimize discomfort
Important Considerations and Pitfalls
- Complete extraction is critical: Incomplete removal of natal teeth can lead to reactive soft tissue lesions such as inflammatory fibrous hyperplasia or pyogenic granuloma 4
- Avoid unnecessary extractions: Most natal teeth (64%) can be maintained with appropriate monitoring 3
- Collaborative care: Early coordination between pediatricians and dentists is essential for timely diagnosis and effective management 6
- Radiographic assessment: Consider radiographs to confirm if teeth are part of normal dentition or supernumerary, which influences treatment decisions 2
The management of natal teeth requires balancing the risk of complications against the benefits of maintaining the natural dentition. While extraction is often necessary for highly mobile teeth, stable natal teeth can frequently be preserved with appropriate monitoring and management of complications.