JIDAM

CASE REPORT

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MANAGEMENT OF NATAL TEETH IN A

PRETERM INFANT: A CASE REPORT AND

REVIEW

Dr. Sowmya Sridhar, Dr. Rayen R, Dr.V S Hariharan

Kidz n Teenz-Exclusive Paediatric Dental Centre, Chennai, Tamilnadu, India.

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ABSTRACT

Website: jidam.idamadras.com

Teeth present at the time of birth are called natal teeth.

In premature infants, tooth eruption is generally

delayed. Therefore, it is unusual and interesting

to see such an anomaly of eruption in a 31-week

old preterm infant. Through this article, we wish

to discuss the management protocol for such natal

teeth along with the need for long term monitoring

and oral health guidance.

KEYWORDS: Natal teeth, infant, premature birth

Address for correspondence:

Dr. Sowmya Sridhar., MDS.,

G3, Govardhan Apartments, 47,

Dr. Ranga Road, Mylapore,

Chennai 600004

E-mail: sowsri06@yahoo.co.in

Received

: 9.11.2019

Accepted

: 30.11.2019

Published

: 27.12.2019

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Sowmya et al : Rare case of natal teeth in a preterm infant- A case report

INTRODUCTION:

32 weeks delivered by caesarean section, admitted

to the NICU for further management, was brought to

Congenital teeth, fetal teeth, predeciduous teeth,

our notice 1week post-parturition with the complaint

dentitia praecox. These are just a few terminologies

of inability to accept oral feeds along with loose

used to describe teeth that erupt at birth or shortly

lower front teeth. The infant was non-syndromic

thereafter. Massler et al¹ named these short, conical,

and underweight (1.5 kg) with reduced feed being

often hypoplastic structures as “natal” and “neonatal”

the probable reason for the deteriorating weight. The

teeth- terms which are still in popular use. It is to be

perinatal history was seen to be normal.

noted that these terminologies only give the time of

eruption with no consideration for the anatomy and

The intra-oral examination revealed two

the histology of the tooth. The incidence of natal and

whitish opaque teeth in the mandibular anterior

neonatal teeth is relatively rare and is somewhere

region (Fig 1). Both the teeth were grade II mobile

between 1:2000 and 1:3500². The incidence of natal

with the gum being edematous and erythematous.

teeth in preterm infants, as in this case, is rare and

Based on the above finding, a diagnosis of natal teeth

interesting since there is an established association

was made with the decision to extract immediately

in literature between gestational age and time of

as there was a definite risk of aspiration. The parents

eruption³. Preterm birth or birth occurring before

were informed regarding the possible complications

37 weeks of gestation and low birthweight (less

of retaining the teeth and their consent was taken.

than 2500g) is generally associated with delayed

eruption³.

Since

0.5mg Vitamin K was already

administered parenterally at birth as per the

Natal teeth or teeth present at the time of

recommendations of the American Academy of

birth are

3 times more likely to be encountered

Paediatrics(AAP)⁶, intramuscular injection was

than neonatal teeth or teeth erupting within 30 days

not given on the day of the extraction. Under local

from birth, with a definite female predilection⁴. The

anaesthesia, extraction was carried out successfully

prematurely erupted teeth may be either a part of

and the sockets were curetted carefully to remove

the deciduous dentition or may be a supernumerary,

any remnants of the dental papilla

(Fig.

2a,2b).

although studies indicate that more than 90% of natal

Initial haemostasis was achieved following which

and neonatal teeth are a part of the deciduous teeth

the mother was asked to breastfeed the infant, so as

series^4,5. Therefore, the decision to extract the mature

to achieve complete haemostasis due to the pressure

natal tooth should take into account local or general

on the gums, as well as to calm the baby (Fig. 3). The

complications and parental consent.

neonate tolerated the procedure well and on review

after 2 days, the healing was found to be uneventful.

The etiopathogenesis of such teeth is varied.

Clinical examination of the extracted teeth revealed

Chronic febrile states, syphilis, hypovitaminosis,

a shell-like crown with pitted hypoplastic areas and

trauma, environmental toxins like polychlorinated

devoid of root structure.

biphenyls (PCBs) are just some of the postulated

etiologies. Sometimes, it may be associated with a

syndrome like chondroectodermal dysplasia, Pierre

Robin, Down’s syndrome or in children with a cleft

lip or palate⁵. The superficial positioning of the tooth

germ is attributed to the premature eruption of these

teeth. Whatever the cause may be, there is definite

psychological and emotional component attached

with regard to the parents, particularly the mother, as

it may cause difficulties in feeding and is considered

an ill omen in most cultures.

Fig 1: Clinical examination

CASE REPORT:

A female neonate with a gestational age of

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Sowmya et al : Rare case of natal teeth in a preterm infant- A case report

varying thoughts by different authors regarding

anterior space loss, the general contention is that the

teeth be retained unless markedly mobile. Chawla et

al⁸, in their review concluded that although there was

some amount of arch collapse following extraction

due to the shift of the neighbouring teeth into the

extraction space, this was however not permanent

Fig 2a and 2b: Extraction following administration

as the successors erupted uncrowded. In such cases,

of local anaesthetic

radiographs play an important role as an auxillary

tool.

Any one factor alone, therefore, cannot play

a role in the decision making. Once the decision to

extract is made, the procedure itself may be deferred

till the child is atleast 10 days old or has appropriate

levels of Vitamin K⁶. This wait period is so that the

normal intestinal flora, essential in the production of

Vitamin K and consequently prothrombin, become

Fig 3: Post extraction haemostasis achieved

established. This minimizes the risk of post-operative

haemorrhage. Post-extraction, a thorough curettage

DISCUSSION:

is recommended as any remnants could lead to

the development of root structures⁹. There have

A significant retardation of eruption has been

been reports of reactive fibrous hyperplasias and

noted in preterm, low birth weight infants probably

pyogenic granuloma due to traumatic extraction of

because of the period of orotracheal intubation or the

natal teeth by the caregivers^9,10. A regular follow up

need for prolonged mechanical ventilation which can

is therefore advisable following the procedure. The

apply pressure on the gums and hinder development³.

American Academy of Paediatric Dentistry(AAPD)

The presence of natal teeth in a neonate is therefore

recommends that all infants should be referred to

an anomalous finding of interest to clinicians.

a dental provider as early as 6 months and no later

than 12 months of age¹¹. It is mandatory that we

The decision to extract or retain natal/neonatal

educate the parents and the medical community on

teeth is made after consideration of the following

the required treatment and the need for continued

factors: (1) degree of mobility, (2) interference while

monitoring and oral health guidance.

feeding, (3) if the teeth are supernumerary or not,

(4) ulcer in the ventral surface of the infant’s tongue

CONCLUSION:

(Riga- Fede’s ulcer)⁷.

Natal/neonatal teeth are rare conditions in the

Teeth that are extremely mobile, as in

infant mouth that can cause significant discomfort.

this case, have to be extracted as there is a risk of

The decision to retain/extract such teeth varies from

aspiration, although, there are actually no published

case to case, and is a matter of clinical judgement and

reports of this in literature. In general, a mature natal/

parental opinion.

neonatal tooth with adequate root development, that

does not develop any mobility even 4 months post

FINANCIAL SUPPORT AND

parturition has a good prognosis. Such teeth may

SPONSORSHIP:

be simply smoothened and left behind in the arch if

there is no interference while feeding or ulceration^5,7.

Nil

Applying a layer of composite resin has also been

suggested, although the enamel in these teeth is

CONFLICTS OF INTEREST:

severely hypoplastic and unfit for bonding⁴. The

main cause of doubt is when the teeth are a part of

There are no conflicts of interest.

the normal dentition and future space management

issues have to be considered. Although there are

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Sowmya et al : Rare case of natal teeth in a preterm infant- A case report

REFERENCES:

Massler M, Savara BS. Natal and neonatal

teeth: A review of twenty four cases reported in

literature. J Paediatr. 1950;36:349-59.

Bodenhoff J, Gorlin RJ. Natal and neonatal teeth:

Folklore and fact. Pediatrics, 1963; 32:1087-93.

Ramos SRP, Gugisch RC, Fraiz FC. The influence

of gestational age and birth weight of the newborn

on tooth eruption. J Appl Oral Sci 2006;14:228-

32.

Khandelwal V, Nayak UA, Nayak PA, Bafna Y.

Management of an infant having natal teeth. BMJ

Case Rep. 2013;2013: bcr2013010049.5. Kana

A, Markou L, Arhakis A, Kotsanos N. Natal

and neonatal teeth: a systematic review of

prevalence and management. Eur J Paediatr Dent.

2013;14:27-32.

Bhutta Z A, Darmstadt G L, Hasan B S, Haws R

A. Community based interventions for improving

perinatal and neonatal health outcomes in

developing countries: a review of the evidence,”

Pediatrics. 2005;115: 519-617.

Wang CH, Lin YT, Lin YJ. A survey of natal and

neonatal teeth in newborn infants. J Formos Med

Assoc. 2017;116:193-6.

Chawla HS. Management of natal/neonatal/early

infancy teeth. J Indian Soc Pedod Prev Dent.

1993;11:33-6.

Berendsen WJ, Wakkerman HL. Continued

growth of the dentinal papillae after extraction

of neonatal teeth: Report of case. ASDC J Dent

Child, 1988; 55:139-41.

Singh S, Reddy VV, Dhananjaya G, Patil R.

Reactive fibrous hyperplasia associated with a

natal tooth. J Indian Soc Pedod Prev Dent. 2004;

22:183-6.

10. American Academy of Pediatric Dentistry. Policy

on the dental home. Pediatr Dent 2015;37(special

issue):24-5.

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