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DMD3 sem 2 > Natal Teeth > Flashcards

Natal Teeth Flashcards

1
Q

What are natal teeth?

A

Teeth that are present in the oral cavity of the infant at the time of birth

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2
Q

What are neonatal teeth?

A

Teeth which erupt during the neonatal period (from birth to 30 days)

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3
Q

What are early infancy teeth?

A

Teeth which erupt within one to three and a half months of life

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4
Q

What are precocious teeth?

A

Teeth which erupt during the 3rd to 5th month of life

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5
Q

Which is more common natal or neonatal teeth?

A

Natal teeth are 3x more common than neonatal teeth

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6
Q

Are natal teeth primary teeth or supernumerary teeth?

A

They can be either, more commonly they are true primary teeth in 95% of cases and supernumerary in 5% of cases

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7
Q

How common are natal and neonatal teeth?

A

Investigated in multiple studies:

1: 716 to 1:30000
1: 2000 to 1:3500

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8
Q

Are natal teeth more common in males or females?

A

More common in females compared to males in most studies but F = M in a study by Basavanthappa et al. 2011

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9
Q

Which teeth most commonly erupt natally?

A

Mandibular incisor region most common site (85%)

Maxillary incisors second most common (11%)

Mandibular (3%)

Maxillary canine and molar (<1%)

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10
Q

What causes natal teeth?

A

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)

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11
Q

How do natal teeth appear clinically?

A

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

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12
Q

What are the types of natal teeth based on development of the tooth?

A

Mature (nearly or fully developed) and immature (Incomplete or substandard structure with poor prognosis)

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13
Q

What are the types of natal teeth based on appearance of the crown?

A

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

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14
Q

What are the histological features of the enamel of natal teeth?

A

Enamel is often a thin layer or absent.

Enamel hypoplasia or hypomineralisation are often seen

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15
Q

What are the histological features of the dentin of natal teeth?

A

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)

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16
Q

What are the histological features of the dentino-enamel junction of natal teeth?

A

Not scalloped

17
Q

What are the histological features of the cementum junction of natal teeth?

A

Lack of cementum and Hertwig’s sheath

Acellular cementum in some cases

18
Q

What are the histological features of the pulp chamber and pulp canal of natal teeth?

A

Larger than normal

Vascularised pulps along with few inflammatory cells

19
Q

What are the histological features of the roots of natal teeth?

A

Lack of root formation

20
Q

What are the structural characteristics of natal teeth?

A

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

21
Q

What are the potential complications of natal teeth?

A

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

22
Q

What problems can mobility cause for babies with natal teeth?

A

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.

23
Q

What adverse outcomes can natal teeth cause to the mother?

A

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.

24
Q

What is Riga-Fedes syndrome?

A

Benign ulceration of the ventral surface of the tongue of lingual frenum caused by repetitive trauma from the sharp incisal edges of teeth.

25
Q

Why does Riga-Fedes syndrome occur?

A

In infants the tongue rests between the alveolar processes causing ventral surface of the tongue to rest against the incisal edges of natal teeth.

26
Q

What is the outcome of Riga-Fedes syndrome?

A

Discomfort, refusal to feed

27
Q

Which systemic conditions can lead to formation of natal teeth?

A

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

28
Q

How are natal teeth diagnosed?

A

History, clinical examination, radiographs

29
Q

What differential diagnoses are for natal teeth?

A

Bohn’s nodules

Dental lamina cysts

Supernumerary teeth

Inclusion cysts (Odontogenic hamartomas, congenital epulis)

Lymphangioma of the alveolus

30
Q

What information do radiographs give about natal teeth?

A

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

31
Q

What should be considered when taking radiographs of natal teeth?

A

ALARA principle

Diagnostic quality of the radiograph

Risk/benefit analysis

32
Q

How are natal teeth managed?

A

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

33
Q

What factors should be considered when treatment planning for natal/neonatal teeth?

A

Degree of mobility

Is tooth supernumerary or part of normal dentition

Inconvenience during suckling

Problems with breastfeeding

34
Q

How can grinding of the incisal edge of natal teeth be carried out?

A

Finishing burs

Sandpaper disc

Soflex disc

35
Q

What are the indications for extraction of natal teeth?

A

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

36
Q

What precautions should be taken when extracting natal teeth?

A

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

37
Q

What complications can arise from extraction of natal teeth?

A

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

DMD3 sem 2 (69 decks)

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