How should a newborn with natal teeth be managed?

Management of Natal Teeth in Newborns

Natal teeth should be individually assessed and managed based on mobility, feeding difficulties, and risk of aspiration, with extraction indicated for mobile teeth to prevent aspiration risk and feeding complications, while stable teeth without complications can be monitored. 1, 2

Initial Assessment

When a newborn presents with natal teeth, perform a focused evaluation to determine the appropriate management strategy:

• Assess tooth mobility by gentle palpation—this is the most critical factor in determining whether extraction is needed 1, 2, 3
• Evaluate feeding ability by asking the mother about breastfeeding difficulties or pain during nursing 1, 2
• Examine the ventral tongue surface for traumatic ulceration (Riga-Fede disease), which occurs from repetitive trauma against the natal teeth 1, 2, 4
• Determine tooth type through clinical examination—approximately 90% are prematurely erupted normal primary teeth (most commonly mandibular central incisors), while only 10% are supernumerary 1, 5

Management Algorithm

Indications for Extraction

Extract natal teeth when any of the following are present:

• Significant mobility that poses aspiration risk—this is the primary indication for extraction since poorly developed roots make the tooth unstable 2, 3, 5
• Feeding difficulties including maternal pain during breastfeeding or infant's refusal to feed 2, 3
• Traumatic lingual ulceration (Riga-Fede disease) on the ventral tongue surface 1, 2, 4
• Pedunculated presentation where the tooth is attached by only a stalk of alveolar mucosa 4

Conservative Management Options

Monitor or smooth teeth when:

• Tooth is stable with minimal mobility and well-developed roots 1
• No feeding complications are present 1
• No tongue ulceration is evident 1

Smoothing of sharp incisal edges can be performed for stable teeth causing minor irritation without ulceration 1

Clinical Characteristics to Document

• Location: 70% occur in the mandibular incisor region, though maxillary teeth can occur 5
• Number: Most commonly 1-2 teeth, though multiple natal teeth may be present 5
• Root development: Typically poorly developed with incomplete root formation, contributing to mobility 2, 5

Common Pitfalls to Avoid

• Do not delay extraction of mobile natal teeth due to aspiration risk—the fear of aspiration into the respiratory passage is a legitimate concern that warrants prompt intervention 2, 3
• Do not assume all natal teeth are supernumerary—the vast majority (approximately 90%) are prematurely erupted normal primary teeth, and unnecessary extraction of normal primary teeth can affect the permanent dentition 1, 5
• Do not overlook systemic syndromes—while most natal teeth are isolated findings, some may be associated with developmental syndromes, warranting complete physical examination 5

Referral Considerations

• General dental practitioners can provide initial management including assessment and extraction of mobile natal teeth in straightforward cases 1
• Refer to pediatric dentistry for complex cases, suspected supernumerary teeth, or when radiographic evaluation is needed to differentiate between normal primary and supernumerary teeth 1, 5
• Radiographic examination is essential when there is uncertainty about whether the tooth is supernumerary or a normal primary tooth—supernumerary teeth should always be extracted 5

Post-Extraction Counseling

• Reassure parents that extraction of mobile natal teeth prevents serious complications and does not typically affect future dental development when the tooth is a prematurely erupted primary tooth 2, 3
• Provide feeding guidance to resume normal breastfeeding after extraction once any minor bleeding has resolved 2