TITLE: Natal and Neonatal Teeth
SOURCE: Grand Rounds Presentation, University of Texas Medical Branch (UTMB= ),
Dept. of Otolaryngology
DATE: November 22, 2010
RESIDENT PHYSICIAN: Regina Rodman, MD
FACULTY PHYSICIAN: Harold Pine, MD
SERIES EDITOR: Francis B. Quinn, Jr., MD
ARCHIVIST: Melinda Stoner Qui= nn, MSICS

"This material was prepa= red by resident physicians in partial fulfillment of educational requirements established for the Postgraduate Training Program of the UTMB Department of Otolaryngology/Head and Neck Surgery and was not intended for clinical use = in its present form. It was prepared for the purpose of stimulating group discussion in a conference setting. No warranties, either express or implie= d, are made with respect to its accuracy, completeness, or timeliness. The material does not necessarily reflect the current or past opinions of membe= rs of the UTMB faculty and should not be used for purposes of diagnosis or treatment without consulting appropriate literature sources and informed professional opinion."

What are natal and neonatal teeth? Children that are born with teeth!= Natal teeth are teeth that are alr= eady present at the time of birth, and neonatal teeth are teeth which erupt in t= he first 30 days of life. They a= re most commonly the mandibular central incisors, = which are the teeth that usually erupt first.&nb= sp; In an average child, the mandibular inci= sors erupt at about 8 months of age. The next teeth to erupt at 10 months are the maxillary central incisors. Similarly, these are the next most commonly seen natal teeth. Te= eth that erupt in the 3-5^th month of life are called precocious dentition.

Natal teeth have been seen in babies for centuri= es, and have been documented throughout literature. Shakespeare describes in Richard t= he Third, “Marry they say that my uncle grew so fast that he could gnaw a crust of bread at two hours old.”&nb= sp; In Henry the Sixth, Richard says about himself, “The midwife wondered; and the women cried, ‘O Jesus bless us, he is born with teeth!’ And so I was; which plainly signified that I should snarl and bite and play the dog.” The reaction of parents to children born with teeth has been varied, some cultu= res thought the children would be heroes and were selected by fate. An example of this is Cajus Plinius Secundus “The Elder” thought a splendid future awaited male children born with teeth and cited Manius Curius, who owned his nickname of “Dentatus”= ; to this occurrence. “Born = with two teeth in his mouth an omen that he will be strong, fierce and harsh, but without fear.” In Engla= nd they believed children born with teeth will grow into famous soldiers. In France and Italy it was assumed= they will “get on in the world.”&nb= sp; Swedish people once held the belief that they could cure an injured finger if placed in the mouth of a child born with teeth.

However, in other cultures, children born with t= eeth were considered an ill omen. = In China, if a baby is born with teeth, it is an ill omen for the family. When thought that when the precoci= ous teeth begin to bite, one of the parents will die. If it is a boy, the father, if a g= irl, the mother. From Denmark comes the quote, “Ol= d age dentition is a rare thing, just as are children born with teeth.” Hallager. From the Italian and German prover= b, “The one whose teeth grow early, will sink early into the grave.” In extreme cases in some African t= ribes, the child was put to death shortly after birth, as it was believed that nat= al teeth not only foretell disaster to the child, but to anyone with whom it c= omes into contact.

The incidence of natal and neonatal teeth is dif= ficult to determine, and reports vary widely, most certainly under reported becaus= e in some cultures great fear and negativity was associated with natal teeth. Natal teeth are relatively uncommo= n, one review of 359 recorded cases suggests an incidence of 1 in at least 3,000 births. To put that into perspective, Ob/Gyn residency programs average 2,000-7,000 deliveries/ year. In example, 2007 UTMB did 7,100. So this is something most of us will see in our careers. Natal teeth are more common that neonatal teeth, with a ratio about 3:1.&nb= sp; 85% are deciduous mandibular incisors. <.01% lateral mandibular incisors, 2.5% other mandibular teeth, 4% upper central incisors, <.01% other maxillary teeth. There has been some debate about w= hether these teeth are deciduous or supernumerary teeth. In analysis of 116 natal teeth don= e by Bodenhoff , he found 103 were prematurely erupted dec= iduous teeth, 13 were supernumerary teeth., Aka “hyperd= ontia” Of the supernumerary teeth, they a= re usually permanent , 0.8% were deciduous, and 2.1% permanent overall.

To review the embryology of tooth formation, tee= th are derived from the ectomderm of the first branchial arch, and the ectomese= nchyme of the neural crest. For human teeth to have a healthy oral environment, enamel, dentin, cementum, and the periodontium must all develop during appropriate stages of fetal development. Primary (baby) teeth start to form between the sixth and eighth weeks. Permanent teeth begin to form in the twentieth week. When examining natal teeth, there = has been good agreement among histologic investigat= ions. There is NO root formation, despite eruption. Increased size of p= ulp with increased number of dilated blood vessels in the = pulpal tissue as well as the odontoblasts, and no cementum formation.&= nbsp; The straight course of the dentinal tubules in the incisal part has an irregular course of the dentinal tubules in the cervical area. = In the cervical part proper, the de= ntin is without tubules.

The etiology of tooth eruption is unknown. Although researchers agree that to= oth eruption is a complex process, there is little agreement on the identity of= the mechanism that controls eruption. Some commonly held theories t= hat have been disproven over time include: the tooth is pushed upward into the= mouth by the growth of the tooth's root, the tooth is pushed upward by the growth= of the bone around the tooth, the tooth is pushed upward by vascular pressure,= and the tooth is pushed upward by= the cushioned hammock. Similarly,= the etiology of natal teeth eruption is unknown. There is a possible genetic link, = as it often occurs in same family. Howeve= r, no clear genetic pattern has been identified.= Gates thought it may be an irregular dominant trait, perhaps associa= ted with an inhibitor gene, or the presence of two genes.

Natal and Neonatal teeth are not, in themselves problematic. The problems are= arise with feeding the infant. Natal teeth are usually not well formed, but they are firm enough that, because of their placement, they may cause irritation and injury to the infant's tongue when nursing. Natal teeth may= also be uncomfortable for a nursing mother.&nbs= p; Frequently, natal teeth are removed shortly after birth while the newborn infant is still in the hospital.&n= bsp; They must be removed if the tooth is loose and the chi= ld runs a risk of aspiration, or "breathing in" the tooth.

Most of the time, natal teeth are not related to= a medical condition. However, sometimes they may be associated with:

<= span style=3D'mso-list:Ignore'>¡<= span style=3D'mso-list:Ignore'>¡<= span style=3D'mso-list:Ignore'>¡<= span style=3D'mso-list:Ignore'>¡àtaller, heavier, disproportionately large = and long head with a slightly protrusive forehead

In summary,&nbs= p; natal teeth are relatively rare (1:3000 births), but you WILL likely= see it in your career. We donR= 17;t know what causes it, possibly genetics.&nb= sp; It’s awesome or scary, depending where you come from. The teeth are usually the lower incisors, and those are the first teeth to erupt normally (8 mo). They are usually premature deciduous teeth and will fall out, they have no roots, and are not well for= med. You can pull them out if they are causing mouth ulcers, or pain to mother.&n= bsp; They may be associated with syndromes, so a good physical exam is necessary.

WORKS CITED

¡ Ash, Major M.; N= elson, Stanley J. (2003). Wheeler's dental anatomy, physiology, and occlusion. Philadelphia: W.B. Saunders. p. 53.

¡ Bodenhoff, J. Dentitio connatalis et neonatalis. Odont, Tidskr., 67:645, 1959.

¡ Bodenhoff, J and Gorlin, R. Natal and Neonatal Teeth: Folklore= and Fact. Pediatrics 1963;32;1087= -1093.

¡ Gates, RR. Human Genetics, New York, Macmillian, 1:367, 1946.

¡ Harris, Crani= ofacial Growth and Development, pp. 1–3.

¡ Riolo and Avery, Essentials for Orthodontic Practice, p. 142.