Priyanshi Ritwik

Robert J. Musselman

Management of Natal

and Neonatal Teeth

55

The occurrence of teeth in the oral cavity at birth or within

the first 30 days of life is uncommon. Such teeth have been

called natal and neonatal teeth, respectively. This distinction, however, is temporal and artificial. Relevant clinical

inferences can be made by further describing these teeth as

mature or immature based on the quality of dental tissue and

degree of dental development (1). Hebling et al. (2) classified

natal teeth into four clinical categories (Table 55.1).

The reported incidence of natal and neonatal teeth varies; a range of 1 in 2,000 to 3,500 is widely accepted (3).

Overall, natal teeth occur more frequently than neonatal

teeth (3:1) (4). However, in a study of 18,155 infants, the

reported incidence of natal and neonatal teeth was 1:716 (5).

Most (85%) of natal and neonatal teeth are mandibular

incisors (6,7). There are also case reports of natal teeth in the

posterior regions of the alveolar process (3,8–10), thereby

necessitating an examination of the posterior region of the alveolar processes at birth for the presence of teeth. Approximately,

95% of natal and neonatal teeth are a member of the normal

complement of the deciduous dentition (11); this indicates that

supernumerary natal and neonatal teeth are rare. Hence, natal

and neonatal teeth should usually be retained.

A. Etiology

1. Superficial positioning of the primary tooth germ (12)

2. Infection and malnutrition (12)

3. Febrile illness (12)

4. Maternal exposure to toxins (polychlorinated bisphenol, polychlorinated dibenzofuran, polychlorinated

dibenzo-p-dioxin) (13)

5. Syndrome/medical condition (Table 55.2) (12)

B. Clinical Presentation (Figs. 55.1

through 55.6)

There is variability in the presentation of natal and neonatal teeth. Although some have normal crown shape and

color and are held firmly in the alveolar process, others

present as discolored microdonts with hypermobility. The

latter are the immature type of teeth. The management of

the patient depends on the clinical presentation.

C. Clinical Assessment

Clinical assessment should include an assessment of the

tooth, oral soft tissues, and the systemic disposition of the

patient.