The appearance of a tooth in a newborn’s mouth, known as natal teeth, is a rare occurrence that often causes anxiety for new parents. Natal teeth are defined as those present at birth, distinguishing them from neonatal teeth, which erupt within the first thirty days of life. This early eruption happens in approximately 1 out of every 2,000 to 3,500 live births. The presence of a tooth requires careful professional evaluation to determine whether it is a harmless variation or one that may cause problems for the infant or the mother.
Defining Natal Teeth and Their Origin
Natal teeth are typically the lower central incisors, which are the first teeth to normally erupt around six months of age. These teeth are generally not fully developed and often appear small, conical, and yellow-brown, sometimes having a shell-like crown structure with little to no root formation. In the majority of cases (90% to 99%), the natal tooth is simply a premature eruption of a normal primary tooth. The small percentage of cases that are not part of the normal set are known as supernumerary teeth, which are extra teeth that could cause crowding later on.
The exact cause of this early eruption is not fully understood, but it is thought to be linked to the tooth germ being positioned too close to the surface of the gum. There is evidence suggesting a genetic predisposition, as up to 60% of cases report a positive family history. In rare instances, natal teeth can be a feature of certain genetic conditions, such as Ellis-van Creveld syndrome or Hallermann-Streiff syndrome. However, most cases are isolated occurrences in otherwise healthy infants.
Potential Complications for the Infant and Mother
The primary concern with natal teeth is the potential for local trauma they can inflict. For the infant, the sharp edges can cause painful ulceration or laceration on the underside of the tongue. This injury is known as Riga-Fede disease and can lead to feeding difficulties, dehydration, and poor weight gain if left unaddressed. The constant friction from the tongue moving against the tooth during suckling creates an open sore that can occasionally develop into a fibrous mass.
A serious, though rare, risk for the infant is aspiration, especially if the tooth is extremely mobile due to a lack of root structure. If a loose tooth dislodges, it could be inhaled into the baby’s airway, causing respiratory issues. The underdeveloped structure of these teeth, often with thin or poorly mineralized enamel, also makes them prone to wear and discoloration.
For the mother, the presence of a sharp natal tooth can make breastfeeding a painful experience. Mothers may experience significant discomfort, including painful biting or bleeding nipples, due to the tooth’s contact during latching. This pain can sometimes lead to the premature cessation of breastfeeding, impacting the infant’s nutritional intake.
Management and Treatment Options
The management of natal teeth focuses on eliminating the risk of trauma and aspiration while preserving the tooth whenever possible. If the tooth is stable, causing no pain, and not interfering with feeding, the initial approach is observation and monitoring. Regular check-ups with a pediatric dentist are essential to track the tooth’s mobility and ensure it is not causing injury. Intervention is warranted if the tooth is causing trauma, such as Riga-Fede disease, or presents a high risk of aspiration due to excessive mobility. For sharp edges causing minor trauma, smoothing the tooth surface using a dental handpiece can reduce friction and often resolve the local trauma without removal.
Extraction is reserved for teeth that are excessively loose, presenting a genuine aspiration risk, or those causing severe, persistent trauma that cannot be managed by smoothing. When extraction is necessary, it is often a simple procedure performed under local anesthesia due to the tooth’s poor root development. Because newborns have a limited ability to produce Vitamin K, a factor needed for blood clotting, it is often advised to ensure the infant has received a Vitamin K prophylactic injection, or to wait until the infant is older than ten days before extraction. Following removal, the infant’s mouth is monitored for proper healing and to assess the need for future space maintenance if a primary tooth was lost.