Presenter

Nikhil Prasad

Under guidance of Dr. Sandeep Tandon Prof & HOD 1

 Massler and Savara suggested that natal teeth are present in the oral

cavity from birth; on the other, neonatal teeth erupt during neonatal period, i.e., within 30 days after birth.(1,2)
Incidence of neonatal teeth is very low. In previous studies, it has been

estimated to be between 1: 1,000 and 1: 30,000.(3,4)

Natal and neonatal teeth erupt in the same position as that of deciduous

teeth in the arch, - more common in mandibular than maxillary arch, and - more in the incisor region than the canine and molar regions.
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 Various investigators noted that

- 85% erupt in mandibular incisor region, - 11 % in maxillary incisor region, - 3% in mandibular canine region - 1% in maxillary canine and molar regions

 Highlight that these predeciduous teeth can sometimes lead to

dangerous consequences about which the general dentist must be aware of and must take prompt action.

 A 15 day old infant visited the clinics with a large swelling below

the chin and high grade fever Case history : - The mother gave history of single tooth eruption in the anterior part of lower jaw when he was 7 days old. - child birth at home - no difficulty in breast feeding - sudden appearance of swelling & increased within 2-3 days

 Clinical examination:

1)A small rudimentary tooth resembling an incisor was seen attached to the anterior mandibular alveolar ridge loosely by the mucosa. 2)A swelling was present associated with the chin, red in color, filled with pus. 3)The infant had high grade fever and breathing difficulties

 Treatment :

Emergency drainage of the abscess to provide respiratory clearance

and Removal of the neonatal tooth was done under general anesthesia The fluid was sent for biochemical evaluation. The extracted tooth was only a crown resembling incisor with no root formed . A ground section of the tooth showed layers of normal enamel and dentin The biochemical report stated it to be a sterile abscess.
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 Several terms have been used in the literature to designate teeth

that erupt at a much earlier age or those present at birth are called congenital teeth, fetal teeth, predecidual teeth and dentitia praecox (1,2,3)
If the primary teeth erupt during the third to the fifth month of

life, they are termed precocious dentition.

Natal teeth are more frequent than neonatal teeth, ratio being

approx. 3: 1.
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 Spouge and Feasby, classified natal and neonatal teeth as mature or

immature; Mature when they are fully developed in shape and comparable in morphology to the primary teeth and Immature when their structure and development are incomplete

Hebling (1997) recently classified natal teeth into 4 clinical categories:

Shell-shaped crown poorly fixed to the alveolus by gingival tissue and absence of a root. Solid crown poorly fixed to the alveolus by gingival tissue and little or no root. Eruption of the incisal margin of the crown through gingival tissue. Edema of gingival tissue with an unerupted but palpable tooth.
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 Etiology : unknown

Various views of investigators

- During initiation and proliferation stage excessive development -

causes formation of natal teeth Hyperactivity of osteoblastic cells within the tooth germ Superficial positioning of tooth germs during developmental period Endocrinal disturbances Association with various syndromes Increased rate of eruption during or after febrile states, Inheritance, congenital syphilis and dietary deficiencies
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 Morphology : natal and neonatal teeth are conical or normal in size and shape Color : opaque, yellowish brown Crowns of these teeth are normal without any radicular portion due to lack of

root formation

Ground section: hypomineralized enamel,

irregular arrangement of enamel rods, irregular dentino-enamel junction, irregular dentinal tubules, pulp :more cellular and numerous vascular channels with large pulp chamber (Massler et al,1950; Bodenoff J,1963)

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 Complication : 1) 2)

3)
4) 5)

When the teeth are not fully erupted, pressure on them maybe painful (the infant to refuse the nipple) The teeth may lacerate the breasts during feeding. The teeth are loose and movable in the early stages(danger of aspiration or swallowing) Natal teeth may cause sublingual ulcerations (Riga-Fede) Periapical abscess is also possible if enamel breakdown leads to caries

Treatment may include grinding to smooth the teeth, or in some cases, extraction.
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 After seeing the serious complications, special care

must be taken regarding neonatal teeth

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Definition Natal teeth are that group of teeth present at the birth due to abnormal premature development in the dental lamina of primary teeth. They are different from neonatal teeth, which erupt in during the first 30 days after birth.
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 England- children born with

teeth will grow into famous soldiers France and Italy- they will get on in the world Sweeden- they can cure an injured finger if placed in the mouth

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 China- If a baby is born with

teeth, it is an ill omen for the family. When the precocious teeth begin to bite, one of the parents will die. If it is a boy, the father, if a girl, the mother.

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 Denmark-

Old age dentition is a rare thing, just as are children born with teeth Hallager
Italian and German proverb: The

one whose teeth grow early, will sink early into the grave

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 In some native African tribes,

the child was put to death shortly after birth, as it was believed that natal teeth not only foretell disaster to the child, but to anyone with whom it comes into contact.

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Epidemiology
1:2,000-3,000 More common in American Indian Natal teeth > Neonatal teeth >60% family history

: = 3 to 1

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Frequencies in the mouth (Approximately)

Supernumerary Teeth Primary Teeth Lower Central Primary Incisors Maxillary Incisors Mandibular Canines And Molars Maxillary Canines And Molars 10% 90% 85% 11% 3% 1%

To sum up MORE COMMON AS PREMATURELY ERUPTED PRIMARY TEETH COMMONLY IN LOWER AND ANTERIOR AREA.

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1.

Completely erupted with little or no root.

2.

Partially erupted.

3.

Swelling of the gum tissue with an unerupted but palpable tooth.

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 A- Intra-uterine enviromental factors: 1.

2.
3. 4. 5.

Exposure to high levels of chemicals like polychlorinated biphenyls. Infection. Fever. Malnutrition including hypovitaminosis. Trauma.

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1.

Commonly Genetically determined congenital (sometime environmentally determined-CAUSED BY

FAULTY PRESSURE AGAINST THE MANDIBLE INTRAUTERINE)

2. 3. 4. 5. 6.

Mandibular micrognathia Posterior displacement of the tongue (glossoptosis) Upper airway obstruction cleft palate Mandibular hypodontia in children with PRS can be considered an indicator of an unfavorable longterm mandibular growth pattern.
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Chondroectrodermal dysplasia (Ellis-van Creveld syndrome )

Cleft palate Peg-shaped Spaced Delayed eruption Missing teeth Extra fingers Missing or deformed nails.

Common among Old Amish population of Lancaster County, USA

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Other rare syndromes are:

Cerebral gigantism (Soto syndrome ) Rare genetic with familial background Mild mental retardation Hypotonia & macrodontia Macrocephaly

Oculomandibulofacial syndrome (HallermannStreiff syndrome ) VERY rare. 200 people with the syndrome worldwide Commonly supernumerary, natal or hypodontia.

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 To the mother:

painful bitten or bleeding nipples.

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To the infant :
Pain resulting in Malnutrition Riga-Fede disease (trauma to the tip or undersurface of the tongue) Inhalation or swallowing Possible development of dental caries, as the enamel is often absent or poorly developed.

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"leaving them alone, unless they are causing difficulty to the infant and mother".
Massler and Savara

1. Paedodontic Consultation .
2. Radiographical evaluation

to determine:
The teeth are normal primary or supernumerary teeth The extent of root development, enamel and dentin The relationship to other teeth.

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3. EXTRACTION
Extraction may be considered if the tooth is: supernumerary very loose associated with cleft lip/palate because of interference with the

nasoalveolar molding appliance

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 Topical anesthetic cream

Vitamin K supplement before extraction in a neonate under the age of

10 days.

NB: Extraction (or spontaneous loss) can be complicated by the development of residual neonatal teeth
Consideration during extraction 1) 2)

Use of gauze at back side of mouth or use of Spencer wells forceps for firm grasp to prevent aspiration Check medical history for sinificant jaundice to prevent post operative bleeding

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4. CONSERVATIVE MANAGEMENT :
Grinding/smoothing sharp edges of the tooth Composite resin to form a dome shape over the edge Stomahesive Wafers were used to cover the teeth and provide a smooth

surface for the tongue to pass over during suckling. Stomahesive Wafers have the advantage that they are a home treatment which can be applied by the childs parents.
Changes in feeding technique(use of breast pump or storing of milk)

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 Dental hygiene including topical fluoride application, gently

wiping the gums and teeth with a clean, damp cloth.

Examine the infant's gums and tongue frequently to make

sure the teeth are not causing injury.

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1.

2.

3.

Buchanan S, Jenkins CR, Riga-Fedes syndrome: Natal or neonatal teeth associated with tongue ulceration. Case report. Australian Dental Journal 1997; 42: 225-227. de Almeida CM, Gomide MR. Prevalence of natal/neonatal teeth in cleft lip and palate infants. Cleft Palate Craniofac J 1996; 33: 297299. Dyment H, Anderson R, Humphrey J, Chase I. Residual neonatal teeth: A case report. J Can Dent Assoc 2005; 71: 394397

4. Ash, Major M.; Nelson, Stanley J. (2003). Wheeler's dental anatomy, physiology, and occlusion. Philadelphia: W.B. Saunders. p. 53.

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