Chapter 55 ■ Management of Natal and Neonatal Teeth 391

night after the last feeding. The infant should not be

put to sleep in a crib with a feeding bottle containing

formula, milk, or juice.

Extraction Case

Extraction is indicated if there is hypermobility of the tooth

or if the tooth is of the immature type (malformed, discolored, lacking root development). These would be classified

as class 1 or 2 by Hebling et al. (2).

a. Equipment

(1) 2- × 2-inch gauze piece

(2) Topical anesthetic

Lidocaine 2% gel is the local anesthetic of

choice. Topical oral anesthetic agents containing

benzocaine should be avoided due to the risk of

methemoglobinemia in children under 2 years

of age (17).

(3) Blunt-nosed sterile surgical scissors

Fig. 55.3. Patient 3: Hebling classification #2 natal tooth; this

tooth was extracted.

Fig. 55.4. Patient 3: The natal tooth—which was removed by

grasping the tooth with gloved fingers—holding the tooth with a

2- × 2-inch gauze square.

Fig. 55.5. Patient 4: Hebling classification #2 natal tooth; indicated for extraction. The natal tooth was present at the site of alveolar cleft in this 3-day-old Hispanic girl. This tooth was extracted

with topical anesthetic.

Fig. 55.6. Patient 4: Extracted natal tooth that was removed

with 2- × 2-inch gauze after topical anesthetic application.

392 Section IX ■ Miscellaneous Procedures

b. Technique

(1) Apply a pea-size amount of topical anesthesia to

the tissue attachment of the tooth, after the

gingiva around the tooth has been dried by gauze.

(2) Hold the tooth between thumb and index finger

in gauze square and gently remove the tooth.

(3) Blunt-nosed scissors can be used to cut the connecting tissue if it is very fibrous or tenacious.

If in the physician’s clinical judgment, the

tooth cannot be removed by the above technique, then the infant needs to be referred to a

pediatric dentist for evaluation and possible

extraction.

F. Complications of Extraction

1. Tissue tags comprising dental papilla and/or Hertwig’s

epithelial root sheath remain in the extraction socket

(18). These tissues may continue to form dental hard

tissues, that is, dentin and root structure (18). These

aberrant dental hard tissues may interfere with the normal eruption of adjacent primary teeth (18).

2. The development of postextraction pyogenic granuloma (19) and hamartoma (20) have been reported.

3. In 9% of patients with natal/neonatal teeth associated

with alveolar cleft, a second toothlike structure may

develop later. This emphasizes the necessity to maintain regular dental appointments for these patients.

References

1. Spouge JD, Feasby WH. Erupted teeth in the newborn. Oral Surg

Oral Med Oral Pathol. 1966;22:198.

2. Hebling J, Zuanon ACC, Vianna DR. Dente natal—a case of

natal teeth. Odontol Clin. 1997;7:37.

3. Brandt SK, Shapiro SD, Kittle PE. Immature primary molars in

the newborn. Pediatr Dent. 1983;5:210.

4. Haberland C, Persing J. Neonatal teeth in a 6-week-old baby with

bilateral cleft lip and palate: Case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;

110:e20.