Natal teeth are a rare occurrence where a baby is born with one or more teeth already present in the mouth. This phenomenon occurs in approximately 1 in every 2,000 to 3,000 live births. These prematurely erupted teeth are typically the lower central incisors, which are the first teeth to normally appear around six months of age. Because of their unexpected and early appearance, natal teeth raise immediate questions about their stability, their potential to cause injury, and whether they should be removed.
Natal Versus Neonatal Teeth
The term “natal teeth” specifically refers to teeth that are visible in the mouth at the exact moment of birth. This is distinct from “neonatal teeth,” which are teeth that erupt through the gums during the first 30 days of life, known as the neonatal period. Natal teeth are about three times more common than neonatal teeth, though both conditions are considered rare.
The precise cause for this early eruption remains generally unknown, but it is thought to be related to the tooth bud’s superficial position within the jaw. Genetic factors likely play a part, as a family history is present in a significant percentage of cases, suggesting a possible inherited tendency. While most of these teeth are part of the child’s normal primary dentition, about 10% may be extra or “supernumerary” teeth.
Stability and Associated Risks
Natal teeth frequently lack the full root structure of a typically developed tooth, which is the primary reason they are often loose or highly mobile. This insufficient root development means the tooth has poor anchorage in the gum tissue, making it unstable and sometimes prone to premature loss.
A major concern is the risk of the tooth dislodging and being swallowed or aspirated into the infant’s airway. The sharp edges of the prematurely erupted tooth can also cause trauma to the infant’s tongue, leading to painful sores or ulcers. This condition is known as Riga-Fede disease, which occurs from the repetitive friction of the tongue against the tooth during the sucking motion.
The presence of natal teeth can also interfere with feeding, sometimes causing discomfort or abrasions to the mother’s breast tissue during nursing. If the tooth is causing trauma to the baby’s mouth, the resulting pain can lead to feeding difficulties, potentially causing poor nutrition and dehydration. The structural weakness and the potential for injury are the main factors driving the decision for intervention.
Clinical Assessment and Management
The presence of natal teeth necessitates a prompt consultation with a pediatric dentist or oral surgeon. The dental professional will assess the tooth’s stability by checking its degree of mobility and examining the surrounding soft tissues for signs of trauma. A radiographic examination, such as an X-ray, is important to visualize the extent of root formation and confirm if the tooth is a normal primary tooth or an extra one.
The management decision follows one of two paths: retention or removal. If the tooth is stable, not causing trauma, and is part of the normal dentition, it is typically retained, and the baby is closely monitored. However, if the tooth is excessively mobile, is causing Riga-Fede disease, or presents a clear aspiration risk, extraction is usually the recommended treatment.
If extraction is necessary, it is generally a straightforward procedure often performed using a topical anesthetic cream due to the tooth’s minimal root structure. The procedure may be delayed until the infant is at least 10 days old to ensure adequate levels of Vitamin K are present for blood clotting. For minor irritation, a conservative approach like smoothing the sharp edges of the tooth may be attempted first to prevent soft tissue injury.