Management of Natal and Neonatal Teeth

Priyanshi Ritwik

Kimberly K. Patterson

Robert J. Musselman

Introduction

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 artificial and not relevant to clinical decision making. 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 61.1) (Figs. 61.1, 61.2, 61.3).

FIGURE 61.1 Normal (edentulous) alveolar ridge in neonate.

FIGURE 61.2 Hebling classification #3 neonatal tooth; not indicated for extraction.

TABLE 61.1 Hebling Classification of Natal Teeth

1. Shell-shaped crown poorly fixed to the alveolus by gingival tissue with absence of a root

2. Solid crown poorly fixed to the alveolus by gingival tissue with little or no root

3. Eruption of the incisal margin of the crown through the gingival tissue

4. Edema of gingival tissue with an unerupted but palpable tooth

The reported incidence of natal and neonatal teeth varies from 1 in 2,000 to 3,500 (3). Overall, natal teeth occur more frequently than neonatal teeth at a 3:1 ratio (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), but natal teeth may also occur in the posterior regions of the alveolar process (Figs. 61.4 and 61.5) (3, 8, 9, 10). Most (95%) of natal and
neonatal teeth are part of the normal complement of the deciduous dentition (11, 12); this indicates that supernumerary natal and neonatal teeth are rare. Hence, natal and neonatal teeth should be retained if possible. In certain instances, such teeth may need to be removed (see C).

Natal and neonatal teeth have been reported in preterm infants (13, 14). The incidence of natal and neonatal teeth is higher in infants born with cleft lip and/or palate (15, 16). The reported incidence ranges from 2% to 7%, with a higher incidence in cases of bilateral cleft lip and palate (15). In cases with unilateral cleft lip and palate, the natal/neonatal teeth are usually found to be present on the side of the cleft (15). This is important to identify, since the presence of natal/neonatal teeth in the cleft site will require modifications in the presurgical treatment. One study also noted the presence of natal/neonatal teeth in the mandible, not in the site of the cleft, emphasizing the evaluation of maxillary as well as mandibular arches in infants born with cleft lip and palate. An example of a natal tooth in the site of the cleft is illustrated in Figure 61.6.

FIGURE 61.3 Hebling classification #2 natal tooth; this tooth was extracted.

FIGURE 61.4 Hebling classification #1 mandibular natal teeth extracted by emergency room physician.

FIGURE 61.5 Maxillary posterior natal tooth in 9-day-old infant, Hebling classification #1 indicated for extraction, emphasizing evaluation of the posterior oral cavity in newborns. (Image courtesy Dr. Benjamin Hanks.)

FIGURE 61.6 Hebling classification #2 natal tooth; indicated for extraction. The natal tooth was present at the site of alveolar cleft in this 3-day-old girl. This tooth was extracted with topical anesthetic.

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