Neonatal and natal teeth

What are they?

A baby’s first tooth usually erupts when he is about 6 months of age. Until then, they are toothless. However, in some individuals, teeth may erupt at a much earlier age, such as from birth. Natal teeth are teeth that are present or have already erupted when the baby is born. Neonatal teeth are teeth that erupts within the 1st30 days of life.


Is it normal?

Though it may not be typical of a tooth to erupt so early on in their life, there are about 1 in 2000 to 3000 of such occurrences. They are not usually indicative of any medical condition, but they are sometimes associated with some syndromes such as:

i) Ellis-van Creveld syndrome or chondroectodermal dysplasia

ii) Pierre Robin syndrome

iii) Soto syndrome

iv) Hallermann-Streiff syndrome

v) Pachyonychia congenita or Jadassohn-Lewandowski syndrome

vi) Cleft lip and palate

vii) Cyclopia

What are the causes?

There is no known cause for this condition, though there has been incidences whereby members of the same family have neonatal or natal teeth. Some other causes such as infection, febrile states, trauma, malnutrition, superficial position
of the tooth germ, hormonal stimulation and maternal exposure to environmental toxins have also been documented.

Lower central incisors commonly involved

What are the teeth that are usually involved?

As the lower central incisors are the 1st dentition to erupt be it primary or permanent dentition, similarly neonatal or natal teeth usually involves the lower central incisors. Hence usually 2 teeth are found in natal teeth or neonatal teeth (right and left central incisor). The second most commonly involved is the upper central incisors. Incidents of other teeth erupted in birth or in the 1st 30 days has also been reported.


Folklore and superstition

Superstitions regarding natal and neonatal teeth have existed since a long time ago, and ranges from the individual being super intelligent or highly favoured to the person being a killer. In England, infants born with natal teeth

were considered destined to be famous soldiers, while those born in France and Italy were considered future conquerors of the world.3 In China, Poland, India and Africa, affected children were considered monsters and bearers of misfortune.6 Allwright reported a Chinese patient in whom extraction was requested so that the tooth, together with the “attending evil spirits”, could be disposed of in the middle of Hong Kong Harbor.


What are unwanted effects that can be imposed by these teeth?

i) Discomfort during suckling-Neonatal or natal teeth do not have sufficiently developed roots, hence they tend to be wobbly and not supported by the jaw bone. This can cause discomfort during suckling

ii) Laceration of the mother’s breasts-though these teeth are not well or fully formed, they are sufficiently firm, such that thay can cause pain to the mom as they feed on breast milk.

iii) Sublingual ulceration-Just as how these teeth may cause injury to the mother, it can cause injury to the infant’s own tongue.

iv) Ingestion or aspiration of the teeth, or breathing in of the tooth into the lungs. This will become a medical emergency.


Should it be extracted?

Tooth extraction is indicated if the tooth is supernumerary or excessively mobile. If the tooth does not interfere with breast feeding and is otherwise asymptomatic, no treatment is necessary. Some parents may rather have it removed to avoid any future problems, or rather now than to have to come back another time in the future. Bear in mind, however, that it is even more risky to operate on a newborn baby than on a baby of a few months.


Is it extra teeth or part of the milk dentition? Will there be a gap there if it were extracted?

Normally it is part of your child’s milk dentition. This means that if these teeth were extracted, when the rest of the milk dentition has erupted, there will be a gap where the neonatal or natal once was. In some cases (less than 10%), they are supernumerary teeth, hence even after extraction, they will have their normal lower 2 front teeth present.

Should I choose to have my baby’s teeth retained, how should I care for his teeth?

If the teeth are retained, keep the teeth clean by regularly cleaning the teeth with clean, damp gauze or cloth. Regularly check that the teeth are not causing any trauma or injury to him or herself. Should any problem occur with regards to the teeth, such as bleeding and mobility, trauma to baby or mother, or the tooth falling out (especially if you have no idea where the tooth has gone to), seek professional help as soon as possible!