1. Definition
· Natal teeth: Present at birth.
· Neonatal teeth: Erupt within the first 30 days of life.
· These are usually part of the normal dentition, most commonly the lower central incisors (Kates et al., 1984).
2. Prevalence
· Estimated incidence: 1 in 2,000 to 1 in 3,500 live births (Leung & Robson, 2006).
· Natal teeth are more common than neonatal teeth (~3:1 ratio).
3. Aetiology
· Hereditary factors – autosomal dominant transmission (Massler & Savara, 1950).
· Endocrine disturbances – particularly hyperthyroidism.
· Nutritional deficiencies – e.g. hypovitaminosis.
· Infections – congenital syphilis.
· Developmental abnormalities – Ellis-van Creveld syndrome, Hallermann-Streiff syndrome (Grahnen & Granath, 1961).
4. Classification Based on maturity (Hebling et al., 1997):
· Mature: Fully developed, with good prognosis.
· Immature: Poorly developed root structure, highly mobile.
Based on clinical appearance (Spouge & Feasby, 1966):
· Type 1: Shell-shaped crown, poorly fixed.
· Type 2: Solid crown, poorly fixed.
· Type 3: Eruption of incisal edge through gingiva.
· Type 4: Oedematous gingiva with tooth unerupted.
5. Associated Risks
· Aspiration risk – especially in mobile teeth.
· Feeding difficulties – due to discomfort during breastfeeding.
· Trauma to maternal breast – causing ulceration and pain.
· Riga-Fede disease – ulceration on the ventral tongue surface due to friction (Riga, 1881).
· Root hypoplasia – leading to early exfoliation or extraction.
6. Diagnosis
· Clinical examination.
· Radiographic evaluation – to differentiate between supernumerary and deciduous teeth.
· Assess mobility and root development.
7. Management
A. Conservative approach preferred when:
· Teeth are stable and part of the primary dentition.
· No interference with feeding.
· No ulceration or aspiration risk.
B. Extraction: Indicated if:
· Mobile with risk of aspiration.
· Feeding issues persist.
· Riga-Fede ulcers develop.
· Non-vital or supernumerary.
Important Note: Extraction should be delayed until 10 days after birth due to the risk of vitamin K deficiency-related bleeding unless vitamin K has been administered (Srinivasan & Aravindha Babu, 2013).
8. Relevance to Orthodontic Practice
Orthodontists may not be involved at the neonatal stage, but awareness is crucial for early diagnosis and long-term follow-up. Key considerations include:
A. Early Interceptive Planning:
· Monitor exfoliation timing of natal/neonatal teeth.
· Observe space changes in the anterior segment during mixed dentition.
· Use space maintainers if premature loss impacts arch length or symmetry.
B. Speech and Orofacial Development:
· Riga-Fede ulcers or early trauma may alter tongue posture or function.
· Early intervention may prevent compensatory habits or tongue thrust.
C. Dental Arch Development:
· Teeth lost before age 4 may affect alveolar bone development and incisor inclination.
· Orthodontists should document early exfoliation in records and reassess eruption paths.
D. Risk of Supernumerary Teeth or Syndromes: If natal/neonatal tooth is supernumerary, consider screening for:
· Cleidocranial dysplasia
· Gardner syndrome
E. Parental Counselling:
· Many parents fear that early extraction might affect permanent teeth.
· Orthodontists should reassure families with evidence-based explanations and follow-up plans.
Conclusion
Though rare, natal and neonatal teeth have meaningful long-term implications for occlusion, space management, speech, and psychosocial development. Orthodontists must be aware of these anomalies, track exfoliation status, and intervene early to mitigate risks related to midline deviation, space loss, or altered eruption paths. Collaborative care and early surveillance can ensure optimal outcomes.
References
· Kates, G. A., Needleman, H. L., & Holmes, L. B. (1984). Natal and neonatal teeth: a clinical study. Journal of the American Dental Association, 109(3), 441–443.
· Leung, A. K., & Robson, W. L. (2006). Natal teeth: a review. Journal of the National Medical Association, 98(2), 226–228.
· Massler, M., & Savara, B. S. (1950). Natal and neonatal teeth; a review of 24 cases reported in the literature. The Journal of Pediatrics, 36(3), 349–359.
· Grahnen, H., & Granath, L. E. (1961). Natal and neonatal teeth. Svensk Tandlakare Tidskrift, 54, 553–559.
· Hebling, J., Zuanon, A. C., & Vianna, D. R. (1997). Dente natal: relato de caso clínico. Jornal Brasileiro de Odontopediatria e Odontologia do Bebê, 1, 55–60.
· Spouge, J. D., & Feasby, W. H. (1966). Erupted teeth in the newborn. Oral Surgery, Oral Medicine, Oral Pathology, 22(2), 198–208.
· Srinivasan, S., & Aravindha Babu, N. (2013). Riga-Fede disease: Report of a rare case and review of literature. Contemporary Clinical Dentistry, 4(2), 253–255.
· Riga, F. (1881). Della ulcerazione della lingua nei bambini lattanti. Gazzetta degli Ospedali e delle Cliniche, 2, 51–55.
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