When teeth are present at the moment of birth, they are classified as natal teeth. Teeth that emerge through the gums within the first 30 days of life are called neonatal teeth. This early eruption is a rare phenomenon, with natal teeth occurring in approximately 1 in every 2,000 to 3,500 live births worldwide. Natal teeth are about three times more frequent than neonatal teeth, but both conditions share similar characteristics and management approaches. The presence of teeth so early is usually an isolated occurrence that poses no serious threat to the infant’s overall health.
Natal versus Neonatal Teeth: Defining the Types
Most often, the early tooth is one of the baby’s normal primary teeth that has simply erupted ahead of schedule, accounting for over 90% of cases. The remaining cases involve supernumerary teeth, which are extra teeth beyond the standard set of 20 primary teeth. Radiographic examination is necessary to definitively distinguish between a prematurely erupted primary tooth and a supernumerary tooth.
The teeth typically affected are the lower central incisors, making up about 85% of all cases. These early teeth often appear small, conical, and yellowish or brownish in color. Due to their premature arrival, they commonly have a poor root structure or are attached only loosely by gum tissue. This lack of robust root development means the teeth may be mobile, which is a significant factor in how they are managed.
The Underlying Reasons for Early Tooth Development
In most instances, the exact cause of a natal or neonatal tooth is not known, and the condition is considered idiopathic. However, a strong genetic component is suggested by a clear hereditary pattern. A family history is reported in up to 60% of cases, often following an autosomal dominant inheritance pattern, indicating a single inherited gene may be responsible.
One widely accepted hypothesis attributes the early eruption to the superficial positioning of the tooth germ during fetal development. The tooth germ may be located closer to the gum surface than normal, allowing it to break through earlier. This shallow positioning, possibly controlled by genetic factors, leads to the precocious eruption.
While most cases are isolated, natal teeth can occasionally be linked to rare congenital syndromes. These teeth are a recognized feature of conditions such as Ellis-van Creveld syndrome (affecting bone growth) and Hallermann-Streiff syndrome (craniofacial abnormalities). Other associations include Sotos syndrome and the Pierre Robin sequence. The connection to these syndromes necessitates a comprehensive medical evaluation when an early tooth is present.
When and How These Teeth Are Managed
Management is driven by two main concerns: the risk of injury to the infant and trauma to the nursing mother. If the tooth is firm, well-formed, and not causing problems, it is usually left in place, especially if it is a normal primary tooth. Retaining the tooth aids in speech development, chewing, and proper spacing for the permanent teeth.
Intervention is necessary if the tooth is excessively mobile, poorly mineralized, or causing trauma. A loose tooth presents a risk of aspiration if the infant accidentally inhales it. Sharp edges can also cause Riga-Fede disease, a painful ulceration on the underside of the infant’s tongue resulting from repeated rubbing during feeding.
Riga-Fede disease is characterized by a painful, chronic ulcer resulting from the tongue repeatedly rubbing against the tooth during feeding. For cases involving this disease or trauma to the nursing mother, treatment involves either extraction or conservative modification. Extraction is the most common approach for a highly mobile or poorly formed tooth, providing rapid resolution of symptoms.
A dental professional performs the extraction under local anesthesia and may wait four to five days afterward to ensure the risk of bleeding is minimal. For stable teeth causing minor irritation, a less invasive approach called ameloplasty may be chosen. This procedure involves smoothing or rounding the sharp edge of the tooth to eliminate friction and prevent ulcer formation. Following any intervention, a follow-up confirms the healing of any ulcers and the continuation of normal feeding.