Can a shaking natal (primary) tooth in a newborn with Pierre Robin syndrome be extracted?

Extraction of Mobile Natal Teeth in Pierre Robin Newborns

A mobile natal tooth in a newborn with Pierre Robin syndrome should be extracted due to the significant aspiration risk, which is further heightened by the airway compromise inherent to Pierre Robin sequence. 1

Primary Indication for Extraction

The key determinant for extracting natal teeth is excessive mobility, which creates aspiration risk regardless of other patient factors. 1, 2 In your case, the "shaking" (mobile) natal tooth meets the primary criterion for extraction. The presence of Pierre Robin syndrome—characterized by micrognathia, glossoptosis, and airway obstruction—substantially amplifies this aspiration hazard, making extraction even more urgent. 3

Standard Indications for Natal Tooth Extraction

Extract natal teeth when any of the following conditions are present:

• Excessive mobility with risk of aspiration into the respiratory passage 1, 2, 3
• Supernumerary tooth status (confirmed by dental radiograph) 1
• Interference with breastfeeding causing maternal discomfort 2, 3
• Traumatic lingual ulceration (Riga-Fede disease) in the infant 4, 3

Pierre Robin-Specific Considerations

The Pierre Robin sequence creates unique urgency for extraction of mobile natal teeth:

• Airway compromise is already present due to micrognathia and posterior tongue displacement, making any aspirated foreign body potentially catastrophic 5
• The infant may require prone positioning or specialized feeding techniques that could further dislodge a mobile tooth 5
• If the infant requires intubation for airway management, severely mobile tooth fragments must be removed as they pose continued aspiration hazard 5

Pre-Extraction Assessment

Before extraction, obtain:

• Dental radiograph to differentiate between premature eruption of a normal primary tooth (90% of cases) versus a supernumerary tooth (10% of cases) 1
• Assessment of tooth mobility—if the tooth is excessively mobile and "shaking," extraction is indicated regardless of radiographic findings 1, 3

When Extraction is NOT Indicated

Conservative management (monitoring only) is appropriate when:

• The natal tooth is firmly attached with minimal mobility 1
• No interference with breastfeeding occurs 1
• No traumatic ulceration is present 4
• The tooth is confirmed to be part of normal primary dentition (not supernumerary) 1

However, these conservative criteria do NOT apply to your patient with a mobile ("shaking") tooth.

Post-Extraction Management

After extraction:

• Monitor the extraction site for bleeding and healing 3
• Counsel parents about the premature loss of primary teeth and potential space management needs 6
• Arrange pediatric dental follow-up to monitor eruption of remaining primary dentition 6, 4
• Coordinate care between pediatrician and dentist given the complexity of Pierre Robin syndrome 6

Critical Pitfall to Avoid

Never adopt a "wait and see" approach with a mobile natal tooth in a Pierre Robin newborn. The combination of inherent airway vulnerability and aspiration risk from a loose tooth creates an unacceptable safety profile. 5, 2 The risk of aspiration-related morbidity and mortality far outweighs any theoretical benefit of tooth preservation. 1, 3