Background
Teeth present at birth are known as natal teeth, and are distinct from neonatal teeth, which are teeth appearing in the first 30 days after birth. Normally, teeth erupt from 6 months of age.
Around 1 in 2000 babies are born with teeth, with up to 60% of cases reporting a positive family history in an autosomal dominant pattern. Natal teeth are also associated with cleft lip/ palate.
Natal teeth are a known feature of the following syndromes:
- Ellis-van Creveld syndrome (chondroectodermal dysplasia)
- Jackson-Lawler syndrome (pachyonychia congenital 2)
- Steatocystoma multiplex with natal teeth
- Hallerman-Streiff syndrome (oculomandibulofacial syndrome with hypotrichosis)
Signs and Symptoms
Up to 75% of natal and neonatal teeth are lower central primary incisors (see DFTB image), likely because these are usually the first teeth to erupt.
Natal teeth can be similar in appearance to teeth erupting at the usual time, but are often:
- Smaller
- Conical
- Prone to wear and discolouration (yellow-brown).
Common symptoms of teething include:
- Drooling
- Sucking
- General irritability
- Coupled with a facial rash and ear or gum rubbing.
This can occur 4 days prior, the day of and 3 days after teeth erupting. Teething has been shown to raise one’s temperature, however only by around 0.6°C and dependent on how accurately it is measured.
Diagnosis
Diagnosis is often clinical, but X-rays may be performed to determine if the teeth are normal milk teeth (90%) or supernumerary, the extent of root development and relationship to other teeth.
Complications
Complications to the infant include:
- Feeding difficulties: malnutrition leading to low weight, small size, dehydration
- Loss of tooth (swallowed or aspirated)
- Pain and distress due to teeth erupting
- Riga-Fede disease: trauma to the tongue resulting in ulceration
Complications to the mother include painful breastfeeding, bitten or bleeding nipples.
Management
Conservative management is usually preferred:
- Solid, silicone based teething rings
- Smoothing sharp edges of teeth
- Changes in feeding technique
- dental hygiene including topical fluoride
- Over-the-counter teething gels (most containing lignocaine hydrochloride)
- Systemic analgesia eg weight-based doses of paracetamol
- Other parents swear by frozen vegetables
Extraction may be considered if the tooth is supernumerary, very loose or associated with cleft lip/palate and interfering with nasoalveolar molding appliances.
Read more on the myths of teething in Andrew Tagg’s DFTB post, Teething Trouble