Natal Teeth Flashcards
What are natal teeth?
Teeth that are present in the oral cavity of the infant at the time of birth
What are neonatal teeth?
Teeth which erupt during the neonatal period (from birth to 30 days)
What are early infancy teeth?
Teeth which erupt within one to three and a half months of life
What are precocious teeth?
Teeth which erupt during the 3rd to 5th month of life
Which is more common natal or neonatal teeth?
Natal teeth are 3x more common than neonatal teeth
Are natal teeth primary teeth or supernumerary teeth?
They can be either, more commonly they are true primary teeth in 95% of cases and supernumerary in 5% of cases
How common are natal and neonatal teeth?
Investigated in multiple studies:
1: 716 to 1:30000
1: 2000 to 1:3500
Are natal teeth more common in males or females?
More common in females compared to males in most studies but F = M in a study by Basavanthappa et al. 2011
Which teeth most commonly erupt natally?
Mandibular incisor region most common site (85%)
Maxillary incisors second most common (11%)
Mandibular (3%)
Maxillary canine and molar (<1%)
What causes natal teeth?
Unknown; several theories exist:
Superficial position of tooth germ in alveolar bone during development
Trauma or infection
Osteoclastic activity within tooth germ area
Hereditary transmission of an autosomally dominant gene
Certain syndromes and newborns with orofacial clefts
Maternal-related factors: Dietary deficiencies (malnutrition), poor maternal health, endocrine disturbances, excessive secretion of pituitary, thyroid or gonads
Febrile state
Environmental factors (polychlorinated biphenoyls and bibenzofurans)
How do natal teeth appear clinically?
Usually small and conical
May resemble normal primary teeth in size and shape
Usually have an immature appearance with poorly-developed hypoplastic enamel
Occurs in pair usually
May be attached to the mucosa and covered by soft tissue
Absent or poor root development
Mostly mobile
What are the types of natal teeth based on development of the tooth?
Mature (nearly or fully developed) and immature (Incomplete or substandard structure with poor prognosis)
What are the types of natal teeth based on appearance of the crown?
Shell-shaped crown (poorly fixed to the alveolus by the gingival tissue usually absent root)
Solid crown (Poorly fixed to the alveolus by gingival tissue with little or no root)
Eruption of the incisal margin of the crown through the gingival tissue
Edema of gingival tissue with an unerupted palpable tooth
What are the histological features of the enamel of natal teeth?
Enamel is often a thin layer or absent.
Enamel hypoplasia or hypomineralisation are often seen
What are the histological features of the dentin of natal teeth?
Interglobular dentin in the coronal region
Irregular dentin and cell inclusions in the cervical region
Atypical dentin often seen as well (due to response to irritant stimulus from oral cavity)
What are the histological features of the dentino-enamel junction of natal teeth?
Not scalloped
What are the histological features of the cementum junction of natal teeth?
Lack of cementum and Hertwig’s sheath
Acellular cementum in some cases
What are the histological features of the pulp chamber and pulp canal of natal teeth?
Larger than normal
Vascularised pulps along with few inflammatory cells
What are the histological features of the roots of natal teeth?
Lack of root formation
What are the structural characteristics of natal teeth?
Enamel have hypoplpastic, depressed areas and lack of enamel on incisal edge.
Thickness of enamel 280 microns to 1200 microns
Enamel has normal prism structure and mineralisation
Cervical and apical dentin is tubular
In developing teeth, dentin in these regions changed to an irregularly formed hard tissue of osteodentin
What are the potential complications of natal teeth?
Dysplastic enamel
Mobility (Potential risk of aspiration)
Difficulty suckling (interferes with feeding)
Traumatic injury to the baby’s tongue and/or maternal breast
Riga-Fede disease
Poor quality enamel leading to increased caries risk as well as risk of chipping and attrition and PA abscesses
What problems can mobility cause for babies with natal teeth?
Natal teeth are loose ad moveable which poses the risk of detatchment and aspiration/swallowing. This has never been reported in the litearture and danger doesn’t seem very likely.
What adverse outcomes can natal teeth cause to the mother?
Can cause ulceration, laceration, and can interfere with feeding.
Children with normal primary teeth have often been nursed up to 2 - 3 years of age without complication.
What is Riga-Fedes syndrome?
Benign ulceration of the ventral surface of the tongue of lingual frenum caused by repetitive trauma from the sharp incisal edges of teeth.
Why does Riga-Fedes syndrome occur?
In infants the tongue rests between the alveolar processes causing ventral surface of the tongue to rest against the incisal edges of natal teeth.
What is the outcome of Riga-Fedes syndrome?
Discomfort, refusal to feed
Which systemic conditions can lead to formation of natal teeth?
Cleft lip, palate and cyclopia
Ellis-Van Crevald
Pachyonychia Congenital
Hallermann-Streiff
Steatocystoma Multiplex
Pierre-Robin
Pallister Hall
Short Rib-Polydactyly
Wiedemann-Rautenstrauch (neonatal progeria)
Pfeiffer, Ectodermal dysplasia, craniofacial dysostosis
Rubinstein-Taybi
Sotos
Adrenogenital
Epidermolysis-Bullosa Simplex including Van der Woude
Down’s syndrome
Walker-Warburg syndromes
How are natal teeth diagnosed?
History, clinical examination, radiographs
What differential diagnoses are for natal teeth?
Bohn’s nodules
Dental lamina cysts
Supernumerary teeth
Inclusion cysts (Odontogenic hamartomas, congenital epulis)
Lymphangioma of the alveolus
What information do radiographs give about natal teeth?
Radiographic verification of the relationship between natal and/or neonatal teeth and adjacent structures, nearby teeth, and presence/absence of a germ in primary tooth area.
Differentiate premature eruption of primary tooth from supernumerary tooth
Provides information about root development
Shows tooth relationship to underlying structures
What should be considered when taking radiographs of natal teeth?
ALARA principle
Diagnostic quality of the radiograph
Risk/benefit analysis
How are natal teeth managed?
If erupted teeth are normal dentition they should ideally be maintained. (if asymptomatic and breastfeeding isn’t impaired)
Application of corticosteroid in orabase can aid in relieving symptoms of the ulcer.
Smoothing the tooth by grinding is carried out if the tooth is causing mild subgingival ulceration or mild discomfort to the mother or trauma to the infant’s tongue.
Coverage of the tooth with composite dome restoration, breast feeding splint, or somahesive wafers
Extraction
What factors should be considered when treatment planning for natal/neonatal teeth?
Degree of mobility
Is tooth supernumerary or part of normal dentition
Inconvenience during suckling
Problems with breastfeeding
How can grinding of the incisal edge of natal teeth be carried out?
Finishing burs
Sandpaper disc
Soflex disc
What are the indications for extraction of natal teeth?
If tooth is confirmed to be supernumerary
Excessive mobility
Unsuitable to retain due to severe dysplasia
Tooth developed an abscess due to pulpal hyperplasia
Tooth interfering with pre-surgical orthopaedic or surgical phase of oral cleft management
Severe sublingual ulceration which is seriously interfering with feeding and the child is severely malnourished or dehydrated
What precautions should be taken when extracting natal teeth?
Considering general health condition of the infant prior
Avoiding extraction before the 10th day of life to prevent haemorrhage (literature uncertain)
Assessing need to administer vitK before extraction
Avoiding unnecessary injury to the gingiva
Socket should be curetted following extraction to prevent development of the cells of the dental papilla from continuing.
Being alert to risk of aspiration during removal
What complications can arise from extraction of natal teeth?
Potential increased risk of space loss following extraction
Gardiner reported 9 cases with space loss following extraction of natal teeth, however, space was regained when permanent teeth erupted
