By Suparn V Kelkar4th 1st

Roll no 27

Management Of Natal and Neonatal Teeth

IntroductionNatal teeth

Teeth that are present at birth are known as Natal teeth

Neonatal teeth

Teeth which errupt during neonate period, from birth to 30 days are called Neonatal teeth

Natal teethThey are also referred to as Congenital teeth, Fetal teeth or Dentition Praecox

Neonatal Teeth

Kates (1984) reporting a 66% proportion for females against a 31%proportion for males.

Natal teeth > Neonatal teethAccording to Bodenhoff and Gorlin (1963),

the teeth most affected are 1. Mandibular Incisors 85%

Prevalence

1. Maxillary Incisors 11%

Mandibular Canines and Molar 3%Maxillary Canines or Molars 1%

The presence of natal and neonatal teeth is definitely a disturbance of biological chronology whose etiology is still unknown.

HypovitaminosisHormonal stimulationTraumaFebrile statesSyphilisThe current concept suggest that natal and neonatal

teeth are attributed to the superficial position of the developing tooth germ which predisposes the tooth to erupt early

Etiology

Boyd and Meles used and anatomical section and a radiograph of the fetal mandible to demonstrate that the tooth was not localized in an alveolus but slightly below the surface of the alveolar bone, very much above the germ of its permanent successor

Hereditary transmission of a dominant autosomal gene

Osteoblastic activity inside the germ area related to the remodeling phenomenon

Leung (1986) in a 17-year retrospective study of 50,892records for children born at the Foothills Provincial

Hospital,Calgary, Canada, detected the occurrence of natal teeth

in 15infants, 5 of whom presented one of the following

anomalies:cleft palate, Pierre Robin syndrome. Ellis-van Creveld

syndrome,hypocalcemia with fracture of the ribs and rickets, andadrenogenital syndrome with 18-hydroxylase deficiency.

Fauconnier and Gerardy (1953)24 presented an excellentdiscussion of the difference between “early eruption” and

“prematureeruption” in which they also proposed an etiology ofnatal and neonatal teeth. They considered “early eruption” tobe that occurring because of changes in the endocrine system,whereas “premature eruption” would be a clearly pathologicalphenomenon with the formation of an incomplete rootlesstooth that would exfoliate within a short period of time. Thisstructure, designated “expulsive Capdepont follicle,” may resultfrom trauma to the alveolar margin during delivery, withthe resulting ulcer acting as a route of infection up to the dentalfollicle through the gubernacular canal, causing prematureloss of the tooth.

1. Ellis Van Creveld Syndrome or Chondroectodermal dysplasia

2. Hallermann-Streiff Syndrome

Associated Syndromes

Riga Fede Syndrome or neonatal sublingual traumatic ulceration

Pachyonychia Congenita

Natal and neonatal teeth may resemble normal primary teeth but in many instances they are

1. Poorly develpoed2. Small3. Conical4. Yellowish5. With hypoplastic enamel and dentin6. Poor or Total Failure of development of roots

Clinical Findings

Extracted mandibular central incisor

Category 1A shell like crown structure loosely attached to the alveolus by a rim of oral mucosa, no roots

Category 2A solid crown loosely attached to the alveolus by oral mucosa, little or no root

Category 3

The incisal edge of the crown just erupted through the oral mucosa

Category 4

A mucosal swelling with the tooth unerrupted but palpable

It has been recommended that natal teeth of category 1 2 are candidates for extraction if mobility is moretan 2 mm as the could become hypermobile and may be danger of Aspiration

1. Traumatic ulceration on the ventral surface of tongue

2. Ulceration on the Sublingual area (Riga Fede disease)

Complications

The importance of a correct diagnosis of natal and neonatalteeth has been pointed out by several investigators1,9,26,31,32,33who used clinical and radiographic findings in order to determinewhether these teeth belonged to the normal dentition orwere supernumerary, so that no indiscriminate extractionswould be performed.A radiographic verification of the relationship between anatal and/or neonatal tooth and adjacent structures, nearbyteeth, and the presence or absence of a germ in the primarytooth area would determine whether or not the latter belongsto the normal dentition.33 It should be pointed out that mostnatal and neonatal teeth are primary teeth of the normal dentitionand not supernumerary teeth.6 These teeth are usuallylocated in the region of the lower incisors,5, 34 are double in 61%of cases 4, 14 and correspond to teeth of the normal primarydentition in 95% of cases, while 5% are supernumerary.29Ooshima et al (1986)35 emphasized that multiple natal teethare extremely rare

Diagnosis

After clinical diagnosis Radiographs must be taken to determine root development

King and Lee recommended that inflamed gingival tissue around teeth should be controlled by applying chlorhexidine gluconate gel 3 times a day

Management

In some cases sharpe incisal edge of tooth may cause laceration of the lingual surface of the toungue and selective grinding of tooth is advised in such conditions

Most prematurely erupted teeth are hypermoblie because of the limited root formation and development

Some teeth may be mobile to the extent that there is a danger of aspiration in which case removal of the tooth is indicated

If extraction is indicated, after the tooth is removed, careful Curttage of Socket is indicated

In an attempt to remove all odontogenic cellular remnants that may otherwise be left in the extraction site

Such remnants may subsequently develop a typical tooth like structure that requires additional treatment

Earlier it was recommended to delay surgical procedures untill after 10th postpartum due to inability of clotting in newborns

Now a prophylactic dose of Vit K is given as standard procedure

Eruuption of neonatal teeth may cause difficulties for a mother who wishes to breastfeed her infant

If breastfeeding is painfull initially, breast pump and bottling the milk are indicated

The preferable approach is however to leave the tooth in place and to explain to the parents the desireability of maintaining this tooth in the mouth because of its importance in the growth

Adjascent teeth would erupt within a short time and the prematurely erupted teeth will become stabilized as the others teeth in the arch will erupt

ThankYou!!!!!!!!!!!

McDonalds

Biblography