Natal and Neonatal Teeth
Definition: Teeth that are present at birth are natal teeth, and teeth that emerge through the gingiva during the first month of life are neonatal teeth.1 

Prevalence: 1:700 - 1:30,000 depending on the type of study; the highest prevalence is found in the only study that relies on personal examination of patients.2 Reports about significant differences between males and females are conflicting. Some studies show a higher incidence in females, this might be biased by greater parental concern about affected females. 

  

Fig 1. One week old boy with two neonatal teeth
The most commonly affected teeth are mandibular incisors. According to To (1991) all of the natal and neonatal teeth found in a study of 53,678 patients were mandibular central incisors.3 Other sources show that maxillary incisors (11%), mandibular cuspids and molars (3%), and maxillary cuspids and molars (1%) may be affected.4 The vast majority (90-99%) are primary teeth, only 1-10% are reported to be supernumerary teeth.1,3

Etiology: Several sources suggest a possible hereditary component.1,2,5,6 The Tlinget Indians in Alaska show a prevalence of 9% of their newborns having natal or neonatal teeth, 62% of them had affected relatives .6

Environmental factors, especially polychlorinated biphenyls (PCB) seem to increase the incidence of natal teeth .7,8,9 These children usually show other associated symptoms, such as dystrophic finger nails, hyperpigmentation, etc..

Other authors indicate correlations between natal teeth and various syndromes (Jadassohn-Lewandowsky-syndrome, Ellis-van Creveld syndrome, Hallermann-Streiff syndrome, etc.).10,11,12,13,14,15,16 Careful evaluation of infants with natal or neonatal teeth is recommended.

In most cases it is impossible to identify pathogenetic factors. Superior placement of the tooth germ resulting in premature eruption is a common explanation.17,18

Histologically the enamel in natal and neonatal teeth is normal for the age of the children, but when the teeth erupt prematurely the uncalcified enamel matrix wears off because mineralization is not complete. The teeth turn yellow-brown and the enamel continuously breaks down.2 The usually increased mobility causes histologic changes in the cervical dentin and cementum. Hertwig's sheath may degenerate and root formation will be prevented .17

Clinical implications: Massler and Savara1 recommend "leaving them alone, unless they are causing difficulty to the infant and mother". There are differing concerns about possible space loss after extraction. Hypothrombinemia should no longer be a concern, since newborns are routinely given Vitamin K to prevent this problem.2

Extraction during the first days of life seems to be atraumatic.2 Mobile teeth do not seem to require the use of local anesthesia. Newborn circumcisions (mean duration 7 minutes) are still frequently performed without local anesthesia.20
Indications for extraction include hypermobility, difficulties during breast-feeding, traumatic ulcerations on tongue/frenulum/lip (Riga-Fede's disease), inflammation, etc..2,3 Some authors recommend splinting or disking of the affected teeth to prevent traumatic injuries.2,19 Although no case is reported in the literature, there is usually great concern about possible aspiration or swallowing of hypermobile teeth.   

Fig 2. Natal teeth with ulceration of tongue. Treatment was smoothening of sharp incisal edges with a highspeed finishing bur 
Teeth that are stable beyond 4 months have a good prognosis. Esthetically they are not pleasing due to their discoloration.2   

Fig 3. Neonatal mandibular central incisors in a six year old girl shortly prior to normal exfoliation. Notice the extreme wear on the centrals compared to the primary lateral incisors 
References

1. Massler M., and Savara BS: Natal and neonatal teeth: a review of twenty-four cases reported in the literature. J Pediatr 36:349-359, 1950.

2. Kates GA, Needleman HL, Holmes LB: Natal and neonatal teeth: a clinical study.
J Am Dent Assoc 109:441-43, 1984.

3. To EW: A study of natal teeth in Hong Kong Chinese. Int J Ped Dent 1:73-6, 1991.

4. Bodenhoff J: Natal and neonatal teeth. Dent Abstr 5:485-86, 1960.

5. Hals E: Natal and neonatal teeth: histologic investigations in two brothers. Oral Surg 10:509-521, 1957.

6. Mayhall JT: Natal and neonatal teeth among the Tlinget Indians. J Dent Res 46:748-749, 1967.

7. Gladen BC, Taylor JS, Wu YC, Ragan NB, Rogan WJ, Hsu CC: Dermatological findings in children exposed transplacentally to heat-degraded polychlorinated biphenyls in Taiwan. Br J Derm 122(6):799-808, 1990.

8. Rogan WJ: PCBs and cola-colored babies: Japan, 1968, and Taiwan, 1979.
Teratology 26:259-61, 1982.

9. Miller RW: Congenital PCB poisoning: a reevaluation. Environ Health Perspect 60:211-14, 1985.

10. Chow MH: Natal and neonatal teeth. J Am Dent Assoc 100:215-16, 1980.

11. Leung AKC: Natal Teeth. Am J Dis Child 140:249-51, 1986.

12. Darwish S, Sastry KA, Ruprecht A: Natal teeth, bifid tongue, and deaf mutism. J Oral Med 42:49-56, 1987.

13. Feinstein A, Friedman J, Schewach-Millet M: Pachyonychia congenita. J Am Acad Dermatol 19:705-11, 1988.

14. Ohishi M, Murakami E, Haita T, Naruse T, Sugino M, Inomata H: Hallermann-Streiff syndrome and its oral implications. ASDC J Dent Child 53:32-37, 1986.

15. King NM, Lee AMP: Natal teeth and steatcystoma multiplex: a newly recognized syndrome. J Craniofac Genet Dev Biol 7:311-17, 1987.

16. Harris DJ, Ashcraft KW, Beatty EC, Holder TM, Leonidas JC: Natal teeth, patent ductus arteriosus and intestinal pseudo obstruction: a lethal syndrome in the newborn. Clin Genetics 9:479-82, 1976.

17. Southam JC: The structure of natal and neonatal teeth. Dent Pract Dent Rec 18:423-27, 1968.

18. King NM, Lee AMP: Prematurely erupted teeth in newborn infants. J Pediatr 114:807-9, 1989.

19. Tomizawa M, Yamada Y, Tonouchi K, Watanabe H, Noda T: Treatment of Riga-Fede's disease by resin coverage of the incisal edges and seven cases of natal and neonatal teeth. Jap J Pedodont 27(1):182-90, 1989.

20. Schoen EJ, Fischell AA: Pain in neonatal circumcision. Clin Pediatrics 30(7):429-32, 1991

© Dietmar A.J. Kennel 1996

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