Management of Natal and Neonatal Teeth in Newborns
Natal teeth (present at birth) and neonatal teeth (erupting within the first month) should be extracted immediately if they are highly mobile to prevent aspiration risk, but can be monitored if firmly attached and not interfering with feeding. 1, 2
Initial Assessment
When natal or neonatal teeth are identified, perform the following evaluation:
- Assess tooth mobility by gently palpating the tooth—this is the single most critical factor determining management 1, 3
- Evaluate feeding difficulties, including inability to suck milk, maternal discomfort during breastfeeding, and continuous crying in the infant 1
- Examine for traumatic lingual ulceration (Riga-Fede disease), which can develop from repetitive tongue trauma against the sharp incisal edge 3, 4
- Document tooth location—the vast majority occur in the mandibular anterior region as central incisors 1, 2, 4
Management Algorithm
Immediate Extraction Indicated
Extract the tooth without delay in the following situations:
- High mobility that poses aspiration risk—this is the most urgent indication 1, 2, 3
- Severe feeding interference preventing adequate nutrition 1, 2
- Maternal breast trauma causing significant discomfort during breastfeeding 1
- Traumatic lingual ulceration that is progressive or severe 3, 4
The extraction can be performed in primary care for simple cases, with referral to pediatric dentistry for complex presentations 3.
Conservative Management (Monitoring)
Monitor without intervention if:
- The tooth is firmly attached with minimal to no mobility 2, 3
- No feeding difficulties are present 2, 4
- No maternal discomfort during breastfeeding 1
- No traumatic ulceration of the tongue 3
Alternative Option: Smoothing
- Smoothing the sharp incisal edges may be considered as an intermediate option if the tooth is stable but causing minor tongue irritation, though this is less commonly employed than extraction or monitoring 3
Post-Management Care
After extraction or if monitoring:
- Schedule periodic follow-up to maintain oral health and monitor for premature loss or eruption issues in the primary dentition 2
- Ensure adequate feeding is established, particularly if extraction was performed 1
- Coordinate care between pediatrician and dentist for early diagnosis and efficient treatment of any subsequent dental issues 2
Important Clinical Considerations
- Most natal/neonatal teeth are prematurely erupted primary teeth (not supernumerary), so their extraction will result in absence of that tooth until the permanent successor erupts 2, 3, 4
- Aspiration risk is the most serious complication and justifies immediate extraction even in very young newborns (as early as 2 hours after delivery) 1
- Undernutrition can develop if feeding difficulties are not promptly addressed 1
- Decision-making must be individualized based on degree of mobility and interference with breastfeeding, but mobility takes precedence as the primary safety concern 1