The presence of teeth at birth, or shortly thereafter, is a rare phenomenon. While most infants begin teething around six months of age, a small number of newborns will have teeth that have erupted prematurely. This early eruption of teeth is not typically a sign of a serious health issue, but it does require attention from healthcare professionals.
Natal vs. Neonatal Teeth: Defining Early Eruption
The presence of teeth in a newborn is classified based on the precise timing of their appearance. Teeth present at the time of birth are termed “natal teeth.” Those that emerge through the gums within the first 30 days of life are referred to as “neonatal teeth.” Natal teeth are the more frequent occurrence, appearing approximately three times more often than neonatal teeth.
The overall incidence of this phenomenon is low, with estimates ranging from 1 in 2,000 to 1 in 3,500 live births worldwide. The vast majority of these early teeth (over 90%) are normal primary teeth that have erupted ahead of schedule. These teeth most commonly appear in the lower jaw and are typically the central incisors.
It is less common for these early teeth to be “supernumerary,” meaning they are extra teeth beyond the standard count of twenty primary teeth. Natal and neonatal teeth often differ structurally from teeth that erupt at the typical age. They can be smaller, conical, and may have poorly formed enamel and dentin, often resulting in a yellowish-brown appearance.
Understanding the Causes of Premature Teeth
The reasons why some infants are born with teeth are not fully understood; the cause is often considered idiopathic, meaning it arises from an unknown origin. Current research suggests that a combination of genetic and developmental factors contributes to this early eruption. One theory involves the tooth germ, the cluster of cells that forms the tooth, being positioned too close to the surface of the gum.
A significant number of cases suggest a hereditary link, with a positive family history reported in infants with natal teeth. This indicates a genetic predisposition that can be passed down, sometimes following an autosomal dominant pattern. Other factors considered include poor maternal health, malnutrition during gestation, and certain endocrine conditions.
While most occurrences happen in otherwise healthy infants, natal or neonatal teeth are sometimes associated with specific, rare medical conditions. Syndromes such as Ellis-van Creveld syndrome, Hallermann-Streiff syndrome, and Sotos syndrome have been linked to premature tooth eruption. The association with cleft lip and palate is also notable, where the incidence of natal teeth is significantly higher than in the general population.
Clinical Management and Parental Guidance
When a baby is born with a tooth, a pediatric dentist or healthcare provider will perform an evaluation to determine the appropriate course of action. A primary concern is the degree of mobility of the tooth, as an excessively loose tooth poses a risk of aspiration. X-rays may be used to assess root development and confirm whether the tooth is part of the normal primary dentition or an extra, supernumerary tooth.
Extraction is recommended if the tooth is overly mobile or causing complications. One complication is Riga-Fede disease, an ulceration that develops on the underside or tip of the infant’s tongue due to chronic irritation. If the tooth is causing trauma to the mother’s nipple during breastfeeding, removal may also be necessary to allow for successful feeding.
If the tooth is stable and not causing issues, the preferred treatment is observation and periodic monitoring. If a tooth has a sharp edge causing minor irritation, a dental professional can smooth and polish the edge to eliminate trauma. When extraction is required, it is often a simple procedure due to the underdeveloped root, but care is taken to avoid damage to the developing permanent tooth bud underneath.
If the extraction is performed within the first 10 days of life, the infant’s vitamin K levels may be checked or supplemented to ensure proper blood clotting before the procedure. For a tooth that is part of the normal dentition and is retained, regular follow-up with a pediatric dentist is important to maintain oral hygiene and track the health of the remaining primary teeth. Parents should watch for any signs of discomfort or feeding difficulties.