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Under guidance of

Dr. Sandeep Tandon Prof & HOD

PRESENTATION

PresenterNikhil Prasad

Title: Neonatal Tooth—How Dangerous Can it Be?

Journal: Journal of Clinical Pediatric DentistryYear: 2009 Volume: 34

Pages: 59-60

Authors: Mala Kamboj/ Rahul B Chougule

JOURNAL REVIEW

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Massler and Savara suggested that natal teeth are present in the oral cavity from birth; on the other, neonatal teeth erupt during neonatal period, i.e., within 30 days after birth.(1,2)

Incidence of neonatal teeth is very low. In previous studies, it has been estimated to be between 1: 1,000 and 1: 30,000.(3,4)

Natal and neonatal teeth erupt in the same position as that of deciduous teeth in the arch,

- more common in mandibular than maxillary arch, and - more in the incisor region than the canine and molar

regions.

INTRODUCTION

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• Various investigators noted that - 85% erupt in mandibular incisor region, - 11 % in maxillary incisor region, - 3% in mandibular canine region - 1% in maxillary canine and molar regions

INTRODUCTION

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Highlight that these predeciduous teeth can sometimes lead to dangerous consequences about which the general dentist must be aware of and must take prompt action.

AIM & OBJECTIVE

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A 15 day old infant visited the clinics with a large swelling below the chin and high grade fever

Case history : - The mother gave history of single tooth

eruption in the anterior part of lower jaw when he was 7 days old.

- child birth at home - no difficulty in breast feeding - sudden appearance of swelling & increased

within 2-3 days

CASE REPORT

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Clinical examination: 1)A small rudimentary tooth resembling an

incisor was seen attached to the anterior mandibular alveolar ridge loosely by the mucosa.

2)A swelling was present associated with the chin, red in color, filled with pus.

3)The infant had high grade fever and breathing difficulties

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Treatment :Emergency drainage of the abscess to provide

respiratory clearance and Removal of the neonatal tooth was done under

general anesthesiaThe fluid was sent for biochemical evaluation. The extracted tooth was only a crown resembling

incisor with no root formed . A ground section of the tooth showed layers of

normal enamel and dentin The biochemical report stated it to be a sterile

abscess.

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Several terms have been used in the literature to designate teeth that erupt at a much earlier age or those present at birth are called congenital teeth, fetal teeth, predecidual teeth and dentitia praecox (1,2,3)

If the primary teeth erupt during the third to the fifth month of life, they are termed precocious dentition.

Natal teeth are more frequent than neonatal teeth, ratio being approx. 3: 1.

DISCUSSION

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Spouge and Feasby, classified natal and neonatal teeth as mature or immature;

Mature when they are fully developed in shape and comparable in morphology to the primary teeth and

Immature when their structure and development are incomplete

Hebling (1997) recently classified natal teeth into 4 clinical categories:

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

• Solid crown poorly fixed to the alveolus by gingival tissue and little or no root.

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

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

DISCUSSION

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Etiology : unknownVarious views of investigators- During initiation and proliferation stage excessive

development causes formation of natal teeth- Hyperactivity of osteoblastic cells within the tooth

germ- Superficial positioning of tooth germs during

developmental period- Endocrinal disturbances- Association with various syndromes- Increased rate of eruption during or after febrile states, - Inheritance, congenital syphilis and dietary deficiencies

DISCUSSION

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Morphology : natal and neonatal teeth are conical or normal in size and shape

Color : opaque, yellowish brown

Crowns of these teeth are normal without any radicular portion due to lack of root formation

Ground section: hypomineralized enamel, irregular arrangement of enamel rods, irregular dentino-enamel junction, irregular dentinal tubules, pulp :more cellular and numerous vascular channels

with large pulp chamber (Massler et al,1950; Bodenoff

J,1963)

DISCUSSION

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Complication : 1) When the teeth are not fully erupted, pressure

on them maybe painful (the infant to refuse the nipple)

2) The teeth may lacerate the breasts during feeding.

3) The teeth are loose and movable in the early stages(danger of

aspiration or swallowing)4) Natal teeth may cause sublingual ulcerations

(Riga-Fede)5) Periapical abscess is also possible if enamel

breakdown leads to caries

Treatment may include grinding to smooth the teeth, or in some cases, extraction.

DISCUSSION

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After seeing the serious complications, special care must be taken regarding neonatal teeth

CONCLUSION

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Natal and Neonatal Teeth

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Natal teeth

DefinitionNatal teeth are that group of teeth present at the birth due to abnormal premature development in the dental lamina of primary teeth. They are different from neonatal teeth, which erupt in during the first 30 days after birth.

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Born Heroes

England- children born with teeth will grow into famous soldiers

France and Italy- they will “get on in the world”

Sweeden- they can cure an injured finger if placed in the mouth

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Ill Omen

China- If a baby is born with teeth, it is an ill omen for the family. When the precocious teeth begin to bite, one of the parents will die. If it is a boy, the father, if a girl, the mother.

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Premature death

Denmark- “Old age dentition is a rare thing, just as are children born with teeth” Hallager

Italian and German proverb: “The one whose teeth grow early, will sink early into the grave”

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Even Death

In some native African tribes, the child was put to death shortly after birth, as it was believed that natal teeth not only foretell disaster to the child, but to anyone with whom it comes into contact.

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Epidemiology1:2,000-3,000

More common in American Indian

Natal teeth > Neonatal teeth

>60% family history

♂ : ♀ = 3 to 1

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Frequencies in the mouth (Approximately)

10% Supernumerary Teeth

90% Primary Teeth

85% Lower Central Primary Incisors

11% Maxillary Incisors

3% Mandibular Canines And Molars

1% Maxillary Canines And Molars

To sum up “MORE COMMON AS PREMATURELY ERUPTED PRIMARY TEETH COMMONLY IN LOWER AND ANTERIOR AREA”.

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1. Completely erupted with little or no root.

2. Partially erupted.

3. Swelling of the gum tissue with an unerupted but palpable tooth.

Clinical Presentation

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A- Intra-uterine enviromental factors:

1. Exposure to high levels of chemicals like polychlorinated biphenyls.

2. Infection. 3. Fever.4. Malnutrition including

hypo-vitaminosis.5. Trauma.

Aetiology

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1. Commonly Genetically determined congenital (sometime environmentally determined-CAUSED BY FAULTY PRESSURE AGAINST THE MANDIBLE INTRAUTERINE) 

2. Mandibular micrognathia

3. Posterior displacement of the tongue  (glossoptosis)

4. Upper airway obstruction

5. cleft palate

6. Mandibular hypodontia in children with PRS can be considered an indicator of an unfavorable long-term mandibular growth pattern.

B- Genetically factors & association with certain syndrome Pierre Robin syndrome

Aetiology , continue

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Chondroectrodermal dysplasia (Ellis-van Creveld syndrome ) Cleft palate

Peg-shaped Spaced Delayed eruption Missing teeth Extra fingers Missing or

deformed nails.

Common among Old Amish population of Lancaster County, USA

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Other rare syndromes are:

Cerebral gigantism (Soto syndrome )

Rare genetic with familial background

Mild mental retardation Hypotonia & macrodontia Macrocephaly

Oculomandibulofacial syndrome (Hallermann-Streiff syndrome )

VERY rare. 200 people with the syndrome worldwide

Commonly supernumerary, natal or hypodontia.

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To the mother: painful bitten or

bleeding nipples.

Complications

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To the infant :

Pain resulting in Malnutrition

Riga-Fede disease (trauma to the tip or undersurface of the tongue)

Inhalation or swallowing Possible development of

dental caries, as the enamel is often absent or poorly developed.

Complications

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1. Paedodontic Consultation .

2. Radiographical evaluation to determine:

The teeth are normal primary or supernumerary teeth

The extent of root development, enamel and dentin

The relationship to other teeth.

Management "leaving them alone, unless they are causing difficulty to the infant and

mother". Massler and Savara

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3. EXTRACTION

Extraction may be considered if the tooth is: supernumeraryvery looseassociated with cleft lip/palate because of

interference with the nasoalveolar molding appliance

Management

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Topical anesthetic creamVitamin K supplement before extraction in a

neonate under the age of 10 days.

NB: Extraction (or spontaneous loss) can be complicated by the development of ‘residual neonatal teeth’

Consideration during extraction1) Use of gauze at back side of mouth or use of

Spencer wells forceps for firm grasp to prevent aspiration

2) Check medical history for sinificant jaundice to prevent post operative bleeding

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4. CONSERVATIVE MANAGEMENT :Grinding/smoothing sharp edges of the

tooth

Composite resin to form a dome shape over the edge

Stomahesive Wafers‡ were used to cover the teeth and provide a smooth surface for the tongue to pass over during suckling. Stomahesive Wafers have the advantage that they are a home treatment which can be applied by the child’s parents.

Changes in feeding technique(use of breast pump or storing of milk)

Management

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Dental hygiene including topical fluoride application, gently wiping the gums and teeth with a clean, damp cloth.

Examine the infant's gums and tongue frequently to make sure the teeth are not causing injury. 

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1. Buchanan S, Jenkins CR, Riga-Fedes syndrome: Natal or neonatal teeth associated with tongue ulceration. Case report. Australian Dental Journal 1997; 42: 225-227.

2. de Almeida CM, Gomide MR. Prevalence of natal/neonatal teeth in cleft lip and palate infants. Cleft Palate Craniofac J 1996; 33: 297-299.

3. Dyment H, Anderson R, Humphrey J, Chase I. Residual neonatal teeth: A case report. J Can Dent Assoc 2005; 71: 394–397

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

References