The presence of an erupted tooth at the time of birth, or shortly thereafter, is a recognized biological phenomenon, though most infants begin teething around six months of age. This early eruption is uncommon, occurring in a small fraction of live births worldwide, but it warrants attention due to potential functional and health considerations. Understanding this condition involves distinguishing between the timing of eruption and the factors that lead to this occurrence.
Natal Versus Neonatal Teeth
The timing of a tooth’s appearance determines its classification, which helps guide early medical discussions. A tooth present at birth is specifically termed a natal tooth. Conversely, a neonatal tooth is one that erupts through the gum line within the first 30 days of life. Natal teeth are the more frequent finding, occurring about three times more often than neonatal teeth.
The combined prevalence of both types is generally reported to be between one in 2,000 and one in 3,500 live births. In the vast majority of cases, these early teeth are the mandibular central incisors (lower front jaw). The tooth is usually a prematurely erupted member of the normal primary set; less than 10% are extra, or supernumerary, teeth.
Factors Contributing to Early Tooth Eruption
The direct cause for this accelerated eruption is often not fully determined in individual infants. One proposed mechanism involves the superficial positioning of the tooth germ, the cluster of cells that eventually forms the tooth. If this germ is located closer than usual to the gum surface, it may require less time and tissue breakdown to push through.
A strong association exists with inherited factors, as a positive family history is reported in a significant percentage of cases. This suggests a genetic predisposition, sometimes following a pattern consistent with autosomal dominant inheritance. Early tooth eruption is occasionally linked with certain rare genetic syndromes, such as Ellis-van Creveld syndrome and Hallermann-Streiff syndrome, which involve broader developmental anomalies.
Immediate Risks and Clinical Implications
The presence of a tooth without a fully formed root structure presents functional challenges for the newborn. Since these teeth often lack robust root development, they can be loose or highly mobile. The greatest risk associated with a mobile tooth is that it could detach and be accidentally inhaled or swallowed by the infant. This potential for aspiration is the primary reason immediate medical evaluation is necessary.
The sharp or rough edges of an early tooth can cause traumatic injury to the infant’s delicate oral tissues. Repeated friction from the tongue during feeding can result in an ulceration on the underside of the tongue, a condition known as Riga-Fede disease. This painful ulcer can interfere with the infant’s ability to suck effectively, leading to feeding difficulties and inadequate nutrient intake. Nursing mothers may also experience nipple pain and lacerations during breastfeeding.
When and How to Handle Early Teeth
A pediatric dentist or physician must examine the tooth to determine the course of action. If the tooth is firmly attached and not causing complications, the best approach is typically retention and observation. Conservative management may involve polishing the tooth’s incisal edge to create a smoother surface if it is causing minor irritation or a small ulceration. This procedure reduces the risk of trauma to the tongue and mother.
Extraction is reserved for teeth that are excessively loose, presenting a clear aspiration risk, or those causing persistent, severe injury. If removal is necessary, it is usually performed under local anesthetic. Before extraction, special consideration is given to the infant’s blood clotting ability; a pediatric provider may recommend a Vitamin K supplement if the infant is less than ten days old. If the extracted tooth was part of the normal primary dentition, the permanent tooth will eventually erupt at its expected time.