Natal and neonatal teeth: Are they cause for concern?

Working in pediatric dentistry as a dental hygienist, I have encountered numerous exciting cases. I recently treated my youngest patient, a 12-day-old infant. Have you heard of neonatal or natal teeth? Neonatal teeth erupt within the first 30 days of life. Natal teeth are teeth already present in the oral cavity when babies are born. “Natal teeth are three times more common than neonatal teeth. The incidence of natal and neonatal teeth ranges from 1:2,000 to 1:3,500.”¹

Teeth have classifications

Natal or neonatal teeth have four classification types to determine the longevity and strength of the tooth. The most common area for these teeth is the mandibular region, followed by maxillary incisors, and then the molar region. The classifications are as follows:

1. Shell-shaped crown poorly fixed to the alveolus by gingival tissue and absence of a root.
2. Solid crown poorly fixed to the alveolus by gingival tissue and little or no root.
3. Eruption of the incisal margin of the crown through the gingival tissues.
4. Edema of gingival tissue with an unerupted but palpable tooth.”²

Natal or neonatal teeth present in different shapes and sizes, ranging from average size to small; they can also be very round or peglike. These teeth can vary in color from white to yellow to brown depending on how much the tooth developed and whether both layers are present; i.e., dentin and enamel layers. It is very uncommon for these teeth to have normal cementum; cementum is usually absent, or only a very thin layer is present. The pulp tissue is generally not present or developed.² While most cases have a low maturity rate, some teeth retain well and have proper root structure. Some teeth can be very hypoplastic and present with little to no enamel and little to no root formation. Research has shown this is due to how healthy the fetus and mother are and if they have any other syndromes or present with a congenital disability.

Why there might be reason for concern

There are many different names for neonatal/natal cases that have been used for decades—i.e., infancy, predeciduous, etc.—however, natal and neonatal are the correct terminology used to reduce confusion regarding the topic. When there is an early eruption of teeth, parents need to seek care from pediatricians and pediatric dentists to determine the proper course of action. The location and position of the tooth or teeth can cause deformities of the tongue, dehydration, inadequate nutrient intake, and growth retardation—the pattern and time of eruption of teeth and their morphology.¹

Commonly, nursing mothers voice concern that their infant isn’t latching on or nursing properly, which is why a concern about these teeth is taken so seriously. Another problem is that the tooth can cut into the nipple or the gums directly above or below that tooth based on its location in the infant’s mouth, causing discomfort to the infant when nursing and affecting their desire to eat.

What are the causes?

The causes of neonatal or natal teeth are unknown, but science has connected these cases to developmental abnormalities. Natal teeth and neonatal teeth are frequently found associated with developmental abnormalities and recognized syndromes.² These syndromes include Ellis-van Creveld (chondroectodermal dysplasia), pachyonychia congenita (Jadassohn-Lewandowsky), Hallermann-Streiff (oculo-mandibulo-dyscephaly with hypotrichosis), Rubinstein-Taybi, steatocystoma multiplex, Pierre Robin, cyclopia, Pallister-Hall, short rib-polydactyly type II, Wiedemann-Rautenstrauch (neonatal progeria), cleft lip and palate, Pfeiffer, ectodermal dysplasia, craniofacial dysostosis, Sotos, adrenogenital, epidermolysis bullosa simplex including van der Woude and Walker-Warburg syndromes.² Each of these developmental abnormalities is a gene mutation that involves skin, nails, teeth, and congenital disabilities.

Environmental factors can also cause neonatal or natal teeth to develop. Pollutants in the air can cross the placenta and cause these teeth to develop. The following are the most common pollutants that can cause natal/neonatal teeth to manifest in newborns or in the womb. “Polychlorinated biphenyls (PCBs), polychlorinated dibenzo-p-dioxins (PCDDs), and dibenzofurans (PCDFs) seem to cause the eruption of natal teeth. The only environmental factor that may be regarded as a causative factor of natal teeth is the toxic polyhalogenated aromatic hydrocarbons: PCBs, PCDDs, and PCDFs.”¹

Solutions are available

Most research shows that natal and neonatal teeth aren’t retained well due to limited root formation, making the teeth a choking hazard. It is recommended that if a tooth has a range of motion of more than 2 mm, it should be extracted to avoid the risk of choking and reduce irritability and malnutrition issues in the child; the chances of the tooth providing any degree of sustainability is low. The dentist should evaluate attachment to see if the tooth is retained only in the mucosa or if any alveolar attachment is present. Documentation is essential. The clinician should make a note of attachment level, mobility, size, color, and measurements of the teeth and take intraoral photos and radiographs when possible.¹

A recent case study

A 12-day-old male indigenous infant presented for a limited check and oral hygiene instruction for the parents. The tooth was present at birth and was located at the mandibular alveolar crest above the mental protuberance. The gingival tissue had edema and a palpable tooth where O would be coming in was present but not through the gingiva. The tooth was very long, about 10 mm in length, which means there could be a significant root formation. Whether the tooth is O or a supernumerary is still to be determined. Mom disclosed that she was concerned because the infant was not latching on and was having trouble breastfeeding, and she wanted to see if the tooth needed to be removed. After examination from the pediatric dentist, the patient will return when the tooth has erupted, and the dentist would then determine its strength and longevity. The patient was again referred to the pediatrician for breastfeeding and nutritional needs. The hygienist reviewed oral hygiene instructions with the parents, and gum baby wipes were given to help reduce the bacteria in the oral cavity.

Questions

After reviewing the case, is this:

1. Neonatal
2. Natal
3. Deciduous tooth
4. Supernumerary

What is the classification of this case?

1. 1
2. 2
3. 3
4. 4

If a tooth erupts after birth up to 30 days, it is called:

1. Neonatal
2. Natal
3. Deciduous tooth
4. Supernumerary

References
1. Mhaske S, Yuwanati MB, Mhaske A, Ragavendra R, Kamath K, Saawarn S. Natal and neonatal teeth: an overview of the literature. ISRN Pediatr. 2013;2013:956269. doi:10.1155/2013/956269
2. Rao RS, Mathad SV. Natal teeth: case report and review of literature. J Oral Maxillofac Pathol. 2009;13(1):41-46. doi:10.4103/0973-029X.44574

Katie Melko, MS, RDH, is from Connecticut and has been practicing dental hygiene for more than 10 years. She graduated in 2009 with an associate's degree from Briarwood College and received her master's in dental hygiene in 2016 from the University of Bridgeport. Katie works as a public health hygienist for CHC,INC. and has been president of the American Dental Hygienists' Association in Connecticut and is active in the ADHA. She also writes for RDH magazine and enjoys volunteering at dental events in her community.