Baby Born with a Tooth, here is What you can do?

“Recently I went through a parenting community where a lady posted about her neighbor’s daughter being born with a tooth!! The amusement among all the other group members was so much that the post was flooded with a whole lot of comments relating it to a bad omen as she was a girl and a good fortune had it been a boy. A little innocent girl just entered the world and was made a witch, a demon and the mother were surrounded by a plethora of superstitious views… Couldn’t digest right!”

Hence, this article is to clear the misconceptions and superstitions regarding ‘the natal tooth’. Yes, the natal tooth is the name given to such teeth, which are present in the baby at birth. The science calls it by other names too – fetal teeth, precocious teeth, predeciduous teeth, congenital teeth and dentition praecox. When the achievement of various milestones by a baby like sitting, standing or walking earlier than the expected time is welcomed with much appreciation and pleasure then why not the early appearance of teeth?

Infants born with natal teeth are usually perfectly normal. In fact, when the fetus is just four to six weeks old teeth formation starts within the developing jaws and all newborns already have a set of primary teeth under their gums. It’s just that in a few rare cases, the babies are born with the tiny teeth visible inside. The prevalence is so rare that you would find one such case in 2000-3000 babies. Reports suggest that these teeth have a slight predilection towards the female gender and, most commonly found natal teeth are the lower central incisors or the lower teeth that are present in the midline.

Classification of natal teeth

There are basically different types of natal teeth. One classification describes:

1. Natal teeth that are nearly fully developed and can be maintained in the gums.
2. Natal teeth that are incompletely developed with a substandard structure and need to be pulled out.

Other classification describes natal teeth according to the appearance as:

1. Shell shaped crown with absence of root loosely placed over the gums
2. Solid crown with little or no root loosely placed over the gums
3. The incisal margin of crown visible through the gums.
4. Swelling of the gums with an unerupted but palpable tooth.

Etiology

The cause behind the development of natal tooth is unknown. The most probable cause that is suggested is the superficial localization of the tooth germ caused due to familial inheritance with an autosomal dominant trait ( if one of the parent has it then there is fifty percent chance of the baby having it). Other causes that have been listed are hormonal disturbances like excessive secretion of thyroid, pituitary or gonadal hormones; infections like congenital syphilis, nutritional deficiency like vitamin deficiency due to poor maternal health, pyelitis during pregnancy or febrile state during pregnancy or environmental factors like polychlorinated biphenyls and dibenofuran.

Natal teeth are also associated with certain syndromes like – Pierre- Robin syndrome, Ellis Van Creveld syndrome, Rubinstein- Taybi syndrome, Van Der Woude syndrome; diseases like epidermolysis bullosa simplex and developmental anomalies like cleft lip and palate, ectodermal dysplasia

Complications of having natal teeth

Although natal teeth do not pose any serious threat to the baby they can sometimes cause some discomfort to the baby as well as the mother. Natal teeth can interfere in breastfeeding as the feeding time can be painful leaving the mother with sore, cracked nipples, baby can have ulcers on the underside of the tongue due to constant pressure from the incisal or cutting surfaces of the teeth. If they are loose or mobile in the cavity they can pose a choking hazard to the baby if the baby accidentally swallows it during feeding.

How can you identify natal teeth?

Natal teeth can be easily identified just by history and clinical examination of the baby’s oral cavity. Usually teeth start to appear in the baby at around 4-7 months of age but natal teeth are the ones that are present since birth. Sometimes they are part of the normal primary dentition while at few other times they are supernumerary in nature. Most of the times, natal teeth are poorly developed and are somewhat mobile in the oral cavity.

What to do when you find your baby with a natal tooth?

If you find your baby with one, no need to panic, just visit a pedodontist or a pediatric dentist. He/she would do clinical examination and would take some radiographs or x rays of that region where the teeth has erupted.

Radiographs are required to check whether natal teeth are a part of normal dentition or just a supernumerary tooth. If natal teeth belong to supernumerary ones then one would find a tooth germ underneath the natal teeth in the radiograph depicting the future primary teeth that would come out in place of the natal teeth. If no tooth germ is found underneath the natal teeth then such teeth are considered to be the part of primary dentition.

Treatment protocols:

1. Natal teeth, part of supernumerary teeth, mobile: call for extraction of such teeth as loose teeth can chock the baby if swallowed. After extraction, wait for the underlying primary teeth to come out.
2. Natal teeth, part of supernumerary teeth, immobile: unless they are causing any problem these teeth can be retained in the baby’s mouth till the underlying primary teeth erupts. However, periodic check up and radiographs are required to check the position of the primary tooth germ and whether the presence of supernumerary natal tooth is posing nay problem in the eruption of primary teeth. If they seem to cause some problem in the erupting process of primary teeth then they are extracted.
3. Natal Teeth, part of primary dentition, immobile: no extraction required for such teeth. If they interfere in breastfeeding or have caused ulcers in the baby’s tongue then the incisal edges of these teeth need to be grinded or smoothened or covered by composite resin and periodic check up.
4. Natal Teeth, part of primary dentition, mobile: this calls for extraction of natal teeth and periodic follow up to check for any space loss or developmental problems in the jaw until the permanent tooth appears in the oral cavity at around six to seven  years of age.

Usually the teeth that are extracted are already loose so they do not cause much trauma during the removal process. They are usually removed under topical or local anesthesia and the baby is prophylactically injected with vitamin K to reduce hemorrhage.

To conclude, natal teeth are not a cause of anxiety or a symbol of misfortune. They are just tiny winy teeth already present in the oral cavity when the baby is born. Parents need to be informed and educated about these teeth and the possible adverse effects that they can cause which can be easily