International Scholarly Research Notices

International Scholarly Research Notices / 2013 / Article

Review Article | Open Access

Volume 2013 |Article ID 956269 | https://doi.org/10.1155/2013/956269

Shubhangi Mhaske, Monal B. Yuwanati, Ashok Mhaske, Raju Ragavendra, Kavitha Kamath, Swati Saawarn, "Natal and Neonatal Teeth: An Overview of the Literature", International Scholarly Research Notices, vol. 2013, Article ID 956269, 11 pages, 2013. https://doi.org/10.1155/2013/956269

Natal and Neonatal Teeth: An Overview of the Literature

Academic Editor: K. Tokiwa
Received11 May 2013
Accepted24 Jun 2013
Published18 Aug 2013

Abstract

The occurrence of natal and neonatal teeth is an uncommon anomaly, which for centuries has been associated with diverse superstitions among different ethnic groups. Natal teeth are more frequent than neonatal teeth, with the ratio being approximately 3 : 1. It must be considered that natal and neonatal teeth are conditions of fundamental importance not only for a dental surgeon but also for a paediatrician since their presence may lead to numerous complications. Early detection and treatment of these teeth are recommended because they may induce deformity or mutilation of tongue, dehydration, inadequate nutrients intake by the infant, and growth retardation, the pattern and time of eruption of teeth and its morphology. This paper presents a concise review of the literature about neonatal teeth.

1. Introduction

Natal teeth are teeth present at birth, and “neonatal teeth” are teeth erupted within the first month of life. Premature eruption of a tooth at the time of birth or too early is combined with many misconceptions. They are further accompanied by various difficulties, such as pain on suckling and refusal to feed, faced by the mother and the child due to the natal tooth/teeth. Some families are so superstitious that the afflicted child may be deprived of parental love. The family hopes that the offending teeth be removed as soon as possible.

Natal and neonatal teeth have been a subject of curiosity and study since the time it was first documented by Titus Livius, in 59 BC. Gaius Plinius Secundus (the Elder), in 23 BC, believed that a splendid future awaited male infants with natal teeth. In some countries, the child is considered to be monstrous and bearer of misfortune for example. As per Chinese tradition it is considered as a bad omen for girls [1].

2. Terminology and Synonyms

Dentitia praecox, dens connatalis, congenital teeth, fetal teeth, infancy teeth, predeciduous teeth, and precocious dentition are some of the terminologies used previously [1, 9, 12, 21, 65]. Lack of specificity and accuracy in description of the condition leads to subsequent discontinuity of these terms. The analogous terms of “natal” and “neonatal” teeth described by Massler and Savara are now most accepted [4]. These terms broadly describe the teeth that are erupted at birth or shortly thereafter. Although these terms only define the time of eruption and give no hint whether the tooth is a component of primary dentition or whether it is supernumerary, newer synonyms should be explored.

3. Proposed Classifications

The natal and neonatal teeth that do not confirm the criteria described for them and erupt within one to three and a half months are called early infancy teeth [66]. Few authors have tried to resolve the controversies in such cases. Spouge and Feasby [66] in 1966 classified, the natal & neonatal tooth on the basis of developmental stages whereas, Hebling et al. in 1997 classified according to the appearance of each natal tooth into the oral cavity [67, 68] (Table 1).


AuthorsPrevalence Number of children in the sample

Magitot, 1876 [2] 1 : 600017,578
Puech, 1876 1 : 3000060,000
Ballantyne, 1896 [3] 1 : 600017,578
Massler and Savara, 1950 [4]1 : 20006,000
Allwright, 1958 [5] 1 : 34086,817
Bodenhoff, 1959 [6] 1 : 3000
Wong, 1962 [7] 1 : 3000
Bodenhoff and Gorlin, 1963 [8]1 : 3000
Mayhall, 1967 [9]1 : 112590
Chow, 1980 [10] 1 : 2000 to 3500
Anderson, 1982 [11] 1 : 800
Kates et al., 1984 [12]1 : 36677,155
Leung, 1986 [13] 1 : 339250,892
Bedi and Yan, 1990 [14] 1 : 1442
Rusmah, 1991 [15]1 : 23259,600
To, 1991 [16]1 : 111853,678
De Almeida and Gomide,
1996 [17]
1 : 21.61,019
Alaluusua et al.,* 2002 [18]1 : 100034,457 (1997–2000)
El Khatib et al., 2005 [19]1 : 340017000 (1984 and 2001)

Exposed to toxin Finnish population-correlation with exposure to toxin and prevalence of neonatal teeth and natal teeth.

4. Incidence and Prevalence

Natal teeth are three times more common than neonatal teeth. The incidence of natal and neonatal teeth ranges from 1 : 2,000 to 1 : 3,500 [19, 23] (Table 2). The radiographic examination is essential to differentiate the premature eruption of a primary deciduous tooth from a supernumerary tooth [69]. Only 1% to 10% of natal and neonatal teeth are supernumerary. More than 90% of natal and neonatal teeth are prematurely erupted deciduous series of teeth, whereas less than 10% are supernumerary [17, 70, 71]. The supernumerary teeth should always be extracted, but the decision to extract a normal mature natal tooth should be done by taking into account local or general complications and parental opinion.


Sr. numberAuthorSexAgeNumber of teethTeeth position and numberMacroscopic featuresChief symptoms/complaintTreatment

(1) Ruschel H C
et al., 2010 [20]
Male14 days1Maxillary first molar right sideCalcified only at occlusal portion, no mobilityNo complaintExtraction

(2) Deep et al.,
2011 [21]
Female22 days1Mandibular anteriorUlceration over the ventral surface of tongue, no mobility, pain during sucking and feedingGrinding and placement of composite over the teeth

(3) Nandikonda, 2010 [22]Female10 days2MaxillaWhitish opaque in color with a size similar to mandibular anterior region, crown portion was noted without any root structuresCleft palate, causing feeding difficulty to the babyExtraction

(4)Dyment et al., 2005 [23]Female3 days271 and 81The teeth did not appear to be excessively mobileFeeding without difficultyExtraction

(5) Shrestha, 2011 [24]Female infant12 days2Mandible, anterior teethTwo teeth in the lower jaw since birth, whitish opaque in color and exhibiting grade III mobilityMother complaining of pain on suckling and refusal to suck milkExtraction

(6) Chandra, 2011 [25]Male5 days271, 81 mandibular anterior (natal)Mobile, whitish opaqueDiscomfort in feedingExtraction
Female18 days181 (neonatal)Mobile, whitish opaqueDifficulty in breast feedingExtraction
Female7 days181 (natal)Mobile, whitish opaqueDifficulty in breast feedingExtraction

(7)Female gender6 hours2Primary central incisors (71 and 81) withRoot formationTwo injuries cyst (swelling small tissue soft/small nodule diameter 1 mm color translucent white) at the central region of the jaw
Female48 hours2Ulcer on the tongue
Feeding difficulty
Extraction
Gina et al.,
2008 [26]
Male9 days1Maxillary 51(Small swelling of soft tissue/pellet 1 mm diameter small whitish translucent) at the central region of the mandible
no uncomfortable and fed showed no complication (breastfeeding)
Male 3 months181 incisorsAppearance hypoplastic or hypomineralized (milky white ||)
Mobility grade type II, there was no associated injury
Periodic inspections and recommendations to the mother in relation to the hygiene and eating habits
Female 5 months171 mandibular incisorsExtraction

(8)Marakoglu et al., 2004 [27]MaleStillborn2Two maxillary first incisors

(9)Kaur et al.,
2003 [28]
Male4 months1Ulcer on ventral surface of tongueConservative t/t

(10)Ndiokwelu et al., 2004 [29] Female4 days1Upper and lower teethAssociated with Down syndrome

(11)Martinez,
2003 [30]
2 months271, 81Small root, hypoplastic enamel Tooth mobilityExtraction

(12)Rdos et al.,
2011 [31]
Male11Prosthetic rehabilitation

(13)Agostini et al., 2008 [32]Male4 months271, 81Nodular growth after exfoliation of teeth

(14)Tomaki, et al.,
2005 [33]
Male27 days181Milky white and the other half yellowish brown with incomplete tooth crown-like hard tissueMobile mass with tooth-like hard tissueExtraction

(15)J. Kovac and D. Kovac, 2011 [34]Female5 weeks271, 81HypoplasticExtraction

(16)Sibert and Porteous,
1974 [35]
Female (6)3 days–6 months871, 81Extraction

(17)Bartholin*2 molars

(18)Thomas*8 incisors
1 molar

(19)Bouchet*2 mandibular incisors
1 mandibular molar

(20)Jacobi*1 max molar
1 mandibular molar
2 mandibular incisors

(21)Kaufman*4 mand molars
4 max molars

(22)M lin*2 molars

(23)Oriola*2 mand molars

(24)Allwright*2 mand molars

(25)Bodenhoff*2 inciosrs
4 mand molars
4 max molars (1, 2nd)

(26)Wong*4 inciosrs
2 mand molars
2 max molars (1st)

(27)Soni*1 mand molar (1st)

(28)Tay*1 max molar (2nd)

(29)Bernick*1 max molar (1st)

(30)Ajagebe*1 mand molar (2nd)

(31)Anderson*2 max molars (1st)

(32)Ronk*multiple incisors and molars

(33)Primo et al.,
1995 [36]
Female6 months271, 81Two dental structures in which the incisor borders had no enamel and had exposed dentin. MobilityThe child cried during feeding, indicating pain and bleeding around two erupted teethExtraction

(34)Basavanthappa et al., 2011 [37]Female15 days181Mobile, yellowish color, enamel hypoplasiaDifficulty in sucklingExtraction
Female19 days181Mobile, white colorDifficulty in sucklingExtraction
Male16 days151Mobile, white colorCleft lip and palateExtraction
Female14 days181Mobile, white colorSublingual ulcerationExtraction
Male8 days181Mobile, white colorDifficulty in feeding Extraction
Female18 days171Mobile, white colorRefusal to suck Extraction
Female30 days271, 81Mobile, gingival inflammationRefusal to suck, gingival inflammationExtraction
Male25 days181Mobile, white colorDifficulty in feeding Extraction
Male18 days171Mobile, white colorSublingual ulcerationExtraction
Female17 days171Mobile, white colorRefusal to suck Extraction
Male23 days181Mobile, white colorRefusal to suck Extraction
Female21171Mobile, white colorRefusal to suck Extraction
Male7 days181Mobile, yellowish colorDifficulty in sucklingExtraction
Male20 days181Mobile, white colorDifficulty in feeding Extraction
Female21 days171Mobile, white colorRefusal to suck Extraction

(35) McDonald et al., 2004 [38]Female271, 81Small, opaque, yellow, dysmorphic crownsNo difficulty to mother and childExtraction (at age of 7 years)

(36) Friend et al., 1991 [39]Male2 days1 molar54A pale, globular tooth-like structure on the maxillary left alveolar ridge, rootless, mobileExtraction

(37)Kurian et al., 2007 [40]Female

(38) Taghi and Motamedi, 2009 [41]Male8 months Mandibular incisor Ulceration over ventral surface of tounge, difficulty in feedingGrinding and placment of composite over the teeth

(39)Sogi et al.,
2011 [42]
Female21 days3 maxillary incisors 51, 61, 62MobileDifficulty in feedingExtraction

(40) Venkatesh and Adhisivam, 2011 [43]Female3 months271, 81Yellowish with conical edgesCongenital hyperthyroidism, associated symptoms Extraction

(41)Roshan et al.,
2009 [44]
2251, 61Hyper-IgE syndrome

(42)Veena et al.,
2011 [45]
Female2 weeks271, 81Ellis van Creveld syndromeExfoliated

(43)Rao et al.,
2001 [46]
Female25 days271, 81Whitish opaque in colour, mobility. The crown size was normal with no roots. Hypomineralized Ulcer over ventral surface of tongueExtraction

(44)Anegundi et al., 2002 [47].Female30 days171Mobile, whitish opaque in colourLocalized inflammation, difficulty in feedingExtracted
Female7 days271, 81Mobile, small yellowish brown in colorDifficulty in feedingExtracted
Male10 days274, 84 MobileDifficulty in feedingExtracted
Female5 days271, 81Mobile, small, conical, yellowish brown, opaque teethDifficulty in feeding and refusal to suckExtracted

(45)Singh et al.,
2004 [48]
Male 4 and months1Pedunculated mass in relation to mandibular anterior toothExtraction

(46)Ziai et al.,
2005 [49]
Male4 weeks1 (premaxillary region-RT side)Bilateral Cleft lip and palate, severe feeding difficulties and recurrent bleeding from movement of the loose toothExtraction
5 days1 (premaxillary region-RT side)Difficulty in fabrication of deviceExtraction

(47) Hegde, 2005 [50]Female28 days271, 81 Mobile, whitish in colorUlceration over tongue, difficulty in suckingExtraction

(48)S. Sarkar and S. Sarkar, 2007 [51]Male3 months154RootlessDifficulty in feedingExtraction

(49)Kumar et al.,
2011 [52]
Female3 months354, 64, 65Rootless Early eruption and difficulty in feeding, cryingExraction

(50) Rao and Mathad, 2009 [53]Female2 days271, 81Whitish opaque in color, mobileDifficulty in feeding and refusal to suck, cryingExtraction

(51)Muraleekrishnan et al., 2011 [54]Male271, 81Extraction

(52)Masatomi et al., 1991 [55]Male18 monthsMultipleExtraction

(53)Gonçalves et al., 1998 [56]Male1–6 days12 (multiple)—8 in mandibular anterior region. 2 molars (max/mand)Very little root formationExtraction

(54)Prabhakar et al., 2009 [57] Female (twin)1 month1
1
71,
81
MobilityDifficulty in feeding and suckling, and also the mother experienced discomfort feeding themExtraction

(55)Agostini et al., 2008 [58] Male4 months271, 81Nodular growthExfoliated

(56)Dubois et al., 2010 [59]Male6 months271, 81Ulcer over ventral surface of tongueExtraction

(57)Eley et al.,
2010 [60]
Female11 months271, 81Ulceration over tip of tongueExtraction

(58)Samadi et al.,
2011 [61]

(59) Slayton, 2000 [62]Male10 months271, 81Down syndromeSmoothing of the incisal edge

(60)Padmanabhan
et al., 2010 [63]
Male20 days181Large whitish lesion was observed on the undersurface of the tongue, difficulty in feedingNeonatal tooth was smoothened to eliminate the sharp traumatizing edges followed by extraction teeth

Data from 19 to 34 is adapted from [64].

The most commonly occurs in the mandibular region of central incisors, followed by maxillary incisors, mandibular cuspids or molars, and maxillary cuspids or molars in descending order [23, 72] (Table 3). Natal or neonatal cuspids are extremely rare.


Case numberSexAgeTeeth position and numberMacroscopic featuresChief symptoms/complaintTreatment

1Male5 months2 teeth (71 and 81) (neonatal)Yellowish white. Partially formed root. Size as compared to normal deciduous central incisor, foraminaNeither the child nor the mother had any problem during breast feedingExtraction
2Male3 days2 teeth (71 and 81) (natal)Yellowish white, smaller in sizeDifficulty in feedingExtraction
3Male2 months2 teeth (71 and 81) (neonatal)Yellowish white, open apical foramina, smaller in sizePain and difficulty in feedingExtraction

There was no difference in prevalence between males and females. However, a predilection for female was cited by some authors. Anegundi et al. reported a 66% proportion for females against a 31% proportion for males [47].

5. Multifactorial Etiology

Exact etiology for the premature eruption or for appearance of natal and neonatal teeth is not known. In the past, neonatal teeth were merely considered cysts of the dental lamina of the newborn [67]. Normally they appear corniform, white in colour, composed of compact keratin, and projected above the alveolar ridge [73].

It was also suggested that they occur due to inheritance as dominant autosomal trait. Endocrine disturbance resulting from pituitary, thyroid, and gonads also may be one of the key factors. Another hypothesis suggested is that excessive or increased resorption of overlying bone results in early eruption of the natal or neonatal teeth. Poor maternal health, endocrine disturbances, febrile episodes during pregnancy, and congenital syphilis are some of the contributing predisposing factors for the occurrence of natal and neonatal teeth suggested in the literature. However, according to Štamfelj et al. the occurrence of natal teeth associated with agenesis of their primary successors appears to be related to an accelerated or premature pattern of dental development rather than to superficial positioning of the tooth germs [74].

6. Environmental Predisposing Factors

Environmental factors could play an important role in eruption of neonatal teeth. Polychlorinated biphenyls (PCBs), polychlorinated dibenzo- -dioxins (PCDDs), and dibenzofurans (PCDFs) seem to cause the eruption of natal teeth [74]. The only environmental factor that may be regarded as a causative factor of natal teeth is the toxic polyhalogenated aromatic hydrocarbons: PCBs, PCDDs, and PCDFs. They are among the most widespread environmental pollutants. They cross the placenta, and concentrations of PCDD/Fs in the adipose tissue of a newborn are correlated with those in mother’s milk. The children with natal or neonatal teeth usually show other associated symptoms [38].

7. Syndromes Associated

Few syndromes are reported to be associated with natal teeth and neonatal teeth [8]. These syndromes include Ellis-Van Creveld (Chondroectodermal Dysplasia) [75], Pachyonychia Congenital (Jadassohn-Lewandowsky), Hallermann-Streiff (Oculomandibulodyscephaly with Hypotrichosis) [76], Rubinstein-Taybi, Steatocystoma Multiplex, Pierre-Robin, Cyclopia, Pallister-Hall, Short Rib-Polydactyly (type II), Wiedemann-Rautenstrauch (Neonatal Progeria), Cleft Lip and Palate, Pfeiffer, Ectodermal Dysplasia, Craniofacial Dysostosis, Multiple Steatocystoma, Sotos, Adrenogenital, Epidermolysis-Bullosa Simplex including Van der Woude, Down’s Syndrome [77], and Walker-Warburg Syndromes [78].

8. Clinical Presentation

The natal teeth or neonatal teeth manifest usually with variable shape and size ranging from small, conical and may also resemble normal teeth. The appearance of these teeth is dependent on the degree of maturity, but most of the time they are loose, small, discoloured, and hypoplastic as in the cases presented here. They may show enamel hypoplasia/hypomineralization [79] and a small root formation suggestive of an immature nature. The majority of natal teeth may exhibit a brown-yellowish-/whitish-opaque colour [12].

They are attached to the oral mucosa in many instances as the root development is incomplete or defective. This leads to the mobility in teeth, with the risk of being swallowed or aspirated by the child. The mobility also may lead to degeneration of Hertwig’s sheath which is responsible for the formation of root, thus resulting in further incomplete root development and stabilization.

Increase in mobility could also cause changes in the radicular part of teeth such as cervical dentin, pulp cavity, and cementum as well.

9. Histology

In a study of natal teeth, Hals [80] observed normal pulp tissue, except for the presence of inflammatory areas in some regions; moreover, Weil’s basal layer and the cell-rich zone were absent [81]. Histologically, the thin layer of enamel or in extremely rare conditions absence of the enamel layer may be seen [77]. The enamel hypoplasia could be attributed to the disturbance/variation in amelogenesis process which was due to premature exposure of the tooth to the oral cavity. This may cause metaplastic alteration of the epithelium of the normally columnar enamel to a stratified squamous [80].

Dentino-enamal junction is not scalloped which similar to that found in deciduous teeth. Cervically dentin becomes atubular with spaces and enclosed cells [82]. Irregular dentinal tubules through the dentin along with calcospherites and predentin of various thicknesses could be present [33]. Atypical dentin was also observed in the natal/neonatal teeth which could have been the result due to the response to irritant stimulus from oral cavity.

Developing teeth often had no cementum, and in those cases where acellular cementum could be observed it was thinner than normal.

Pulp canal and pulp chamber become wider in most of the cases. Vascularised pulps along with few inflammatory cells were also reported [83].

10. Ultrastructure Findings

Jasmin and Clergeau-Guerithault [81] studied the surface topography of mandibular natal and neonatal incisors at the ultrastructural level using the scanning electron microscope (SEM). They observed that enamel of the teeth exhibited hypoplastic, depressed areas, and the incisal edge of natal tooth lacked enamel [81]. According to Uzamis et al., the thickness of enamel was around 280 microns compared to up to 1200 microns in normal teeth. This shows the retarded development of natal and neonatal teeth, because of incomplete mineralization at the time of birth [82].

In one of such extensive studies on natal and neonatal teeth, Masatomi et al. [55] reported that enamel has a normal prism structure and mineralization except in few cases where the prism structure was absent in the cervical part of the enamel. They also noticed that the cervical and apical dentin was tubular, and in developing teeth the dentin in these regions changed to an irregularly formed hard tissue of osteodentin character, in which enclosed cells could be observed.

11. Complications

A major complication from natal/neonatal teeth is ulceration on the ventral surface of the tongue caused by the tooth’s sharp incisal edge. This condition is also known as Riga-Fede disease or syndrome [47]. Possibility of swallowing and aspiration which has already been described previously should also be one of the major concerns in complications. Other complications stated are injury to mother’s breast and inconvenience during suckling. The consequences seen with the teeth include carious lesions, pulp polyp, or premature eruption of successor teeth.

12. Conclusion

Natal and neonatal teeth diagnosis requires detailed case history accompanied by thorough clinical and radiographic examination of the infant. It is important to rule out by radiographic examination whether they are components of normal dentition or supernumerary to decide the treatment plan. The clinician should also assess the risk of haemorrhage due to the hypoprothrombinemia commonly present in newborns.

Classification

(i)The appearance of each natal tooth in the oral cavity can be classified into four categories given as follows, as the teeth emerge in the oral cavity:(1)shell-shaped crown poorly fixed to the alveolus by the gingival tissue and absence of a root;(2)solid crown poorly fixed to the alveolus by the gingival tissue and little or no root;(3)eruption of the incisal margin of the crown through the gingival tissues;(4)edema of the gingival tissue with an unerupted but palpable tooth.(ii)Spoug and Feasby have suggested that, clinically, natal and neonatal teeth are further classified according to their degree of maturity.(1)A mature natal or neonatal tooth is the one which is nearly or fully developed and has relatively good prognosis for maintenance.(2)The term immature natal or neonatal teeth, on the other hand, implies a tooth with incomplete or substandard structure; it also implies a poor prognosis.(iii)If the degree of mobility is more than 2 mm, the natal teeth of category (1) or (2) usually need extraction.

Conflict of Interests

The authors declared that there is no conflict of interests.

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