What is the management and care for an infant with a natal tooth?

Management of Natal Teeth in Infants

Natal teeth should be evaluated by a dentist to determine if extraction is necessary based on mobility, risk of aspiration, feeding difficulties, or trauma to the infant's tongue or mother's breast during breastfeeding. 1

Definition and Prevalence

• Natal teeth are teeth present at birth, while neonatal teeth erupt within the first 30 days of life 1, 2
• These teeth are relatively rare but well-documented phenomena, with most being prematurely erupted teeth of the normal primary dentition 1

Clinical Assessment

• Evaluate the tooth for:
  • Mobility (excessive mobility increases risk of aspiration) 3
  • Sharp edges that could cause traumatic ulceration to the infant's tongue (also called Riga-Fede disease) 1
  • Interference with breastfeeding or causing nipple pain/trauma to the mother 2
  • Whether it is part of the normal primary dentition or supernumerary 1

Management Options

1. Observation and Monitoring

• If the natal tooth is:
  • Minimally mobile
  • Not causing feeding difficulties
  • Not causing trauma to infant's tongue or mother's breast
  • Part of the normal primary dentition
• Then observation and periodic follow-up is recommended 3

2. Smoothing/Polishing Sharp Edges

• If the tooth has sharp edges causing traumatic ulceration but is otherwise stable:
  • Smoothing of the incisal edge with a dental handpiece and polishing bur is indicated 4
  • This can be performed by a dentist and does not require immediate attention unless causing soft tissue injury 4

3. Extraction

• Extraction is indicated when the tooth:
  • Is excessively mobile with risk of aspiration 3, 1
  • Causes significant feeding difficulties 1
  • Creates persistent traumatic injury despite smoothing 1
  • Interferes with specialized treatment (e.g., nasoalveolar molding in infants with cleft lip/palate) 5

Important Considerations for Extraction

• Extraction should be performed with caution to avoid:

  • Damage to neighboring tooth buds 5
  • Leaving remnants of dental papillae behind, which can lead to reactive lesions 6
  • Risk of excessive bleeding due to hypoprothrombinemia in newborns (vitamin K administration may be necessary) 1

• If the premaxilla is loose or unstable, extraction under general anesthesia may be warranted 5

Post-Extraction Care and Follow-up

• Monitor the extraction site for:

  • Proper healing 3
  • Development of reactive soft tissue lesions (e.g., inflammatory fibrous hyperplasia, pyogenic granuloma) 6
  • Potential impact on future eruption of primary teeth 1

• Periodic follow-up is recommended to maintain oral health and prevent any issues related to premature loss or eruption of primary teeth 3

Collaborative Care

• Close collaboration between pediatricians and dentists is essential for early diagnosis and efficient treatment 3
• Parents should be educated about:
  • Proper oral hygiene practices 4
  • Signs of complications to watch for 4
  • Importance of follow-up appointments 3

Potential Complications

• Traumatic lingual ulceration (Riga-Fede disease) 1
• Feeding difficulties 1
• Risk of aspiration if tooth becomes loose 3
• Maternal discomfort during breastfeeding 2
• Reactive soft tissue lesions if tooth fragments remain after extraction 6