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Year : 2023  |  Volume : 7  |  Issue : 1  |  Page : 39-41

Management of early infancy tooth following natal tooth extraction: An unusual case report

Department of Pedodontics and Preventive Dentistry, Sri Ram Chandra Bhanja Dental College and Hospital, Utkal University, Cuttack, Odisha, India

Date of Submission03-Sep-2022
Date of Decision12-Jan-2023
Date of Acceptance05-Feb-2023
Date of Web Publication17-May-2023

Correspondence Address:
Santoshni Samal
Department of Pedodontics and Preventive Dentistry, Sri Ram Chandra Bhanja Dental College and Hospital, Cuttack, Odisha 753007
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/SDJ.SDJ_40_22

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Natal teeth are those that are present at birth, whereas neonatal teeth, also called as “early infancy teeth,” appear within 30 days after birth, which is an unusual and rare situation. The exact etiology of neonatal, or early infancy teeth, is unknown, and various factors may be related to these teeth. Both natal and early infancy teeth are important for pediatric dentists and pediatricians. This case report describes the management of a 24-day-old infant with a mobile mandibular natal tooth related to Riga–Fede disease. After 45 days, an early infancy tooth was diagnosed, followed by extraction of the tooth, so correct diagnosis and management is important.

Keywords: Early infancy teeth, natal teeth, Riga–Fede disease

How to cite this article:
Samal S, Baliarsingh RR, Ray P, Pattanaik S. Management of early infancy tooth following natal tooth extraction: An unusual case report. Sci Dent J 2023;7:39-41

How to cite this URL:
Samal S, Baliarsingh RR, Ray P, Pattanaik S. Management of early infancy tooth following natal tooth extraction: An unusual case report. Sci Dent J [serial online] 2023 [cited 2023 Jun 2];7:39-41. Available from: https://www.scidentj.com/text.asp?2023/7/1/39/377190

  Background Top

The normal age for eruption of a deciduous mandibular incisor tooth is 6–7 months.[1] Massler and Saveral[2] termed teeth present since birth “natal teeth” and those erupting within the first 30 days of life “neonatal teeth.” Neonatal teeth are also called “early infancy teeth.” Mandibular incisors are the most generally affected teeth, with a prevalence rate of 66% for girls.[3] The prevalence rate of natal tooth varies from 1:716 to 1:3500 live births.[4] Most natal and neonatal teeth are considered to be premature erupting teeth of the normal primary dentition and are supernumerary.[5] An exact etiology is not recognized. Hereditary components, endocrinal abnormalities, and environmental elements may play roles.[6] Sometimes, developing teeth germs of both natal and neonatal teeth are present in an unusual location under the alveolar bone.[7] Both natal and neonatal teeth are usually associated with Riga–Fede syndrome, which is trauma to the undersurface (the ventral surface) and tip of the tongue. The prevalence rate of Riga–Fede disease is 6%–10% of the total number of cases of natal and neonatal teeth.[8] Careful analysis and evaluation of these infants are recommended to prevent aspiration and trauma to the tongue and to the mother’s breast. Extraction of natal teeth followed by the occurrence of early infancy teeth has not been previously reported. This case report describes the occurrence of an early infancy tooth following the extraction of a natal tooth.

  Case Report Top

A 24-day-old male newborn was referred with his mother to the Department of Pedodontics and Preventive Dentistry with the chief complaint of oral wound of the tongue and difficulty with breastfeeding. The medical history was not relevant. The patient’s mother reported that a tooth was present in lower gum pad at birth. An extraoral examination confirmed a normal, healthy face without lymphadenopathy. An intraoral examination revealed a single mandibular crown in the anterior gum pad with respect to 81 region [Figure 1]A, with a faint opaque whitish color, smaller than a primary tooth, and exhibiting a grade III mobility of more than 2 mm. The crown size was smaller than normal teeth. The lips, palate, gingiva, floor of the mouth, and surrounding buccal mucosa were healthy and normal in appearance. An examination of the tongue revealed an ulcerated area of 1 × 1 cm on the ventral surface, which was tender on palpation [Figure 1]A. A diagnosis of natal tooth associated with Riga–Fede disease was made based on clinical history and examination. Since the tooth was grade III mobile, immediate extraction under topical local anesthesia in a knee-to-knee position was carried out [Figure 1]B, which the patient tolerated well. No vitamin K supplement was given to the child, since the mother had already taken a vitamin K dose. The extracted tooth had a crown without a root [Figure 1]C. The patient was followed up half an hour after the extraction. The bleeding was controlled, and there were no complications [Figure 1]D.
Figure 1: (A) Natal tooth w.r.t. 81 region associated with tongue ulceration on the ventral surface of the tongue. (B) Extraction done in the knee-to-knee position. (C) Natal tooth devoid of root. (D) Post extraction

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After 45 days, the patient reported once again to the Department of Pedodontics and Preventive Dentistry with a fresh complaint of reappearance of tooth in lower gum pad region [Figure 2]A, which was causing difficulty in feeding and painful breast in the mother. On extraoral examination, the patient was normal in appearance. On intraoral examination, a single crown of whitish color was present in the lower arch with grade I mobility with respect to 71 region. Radiographic examination revealed a lower crown in 71 region without a root [Figure 2]B. A diagnosis of early infancy tooth was made. The mother gave consent to have the tooth extracted since it was causing her pain during breastfeeding. The extraction was done with a gauge placed lingually to prevent aspiration of the tooth [Figure 2]C. The extracted tooth had a crown with no root [Figure 2]D. The follow-up examination was uneventful [Figure 3]. Both parents consented to the publication of photographs, as long as the identity of their child was not revealed.
Figure 2: (A) Early infancy tooth w.r.t. 71 after 45 days. (B) Radiograph showing crown w.r.t. 71. (C) Extraction in the knee-to-knee position. (D) Extracted early infancy tooth

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Figure 3: Postextraction

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  Discussion Top

Natal and neonatal teeth range in form, length, and color. They can be of normal or conical shape, with an opaque yellow-brownish color. They are generally smaller than normally developed primary teeth.[9] In normal deciduous teeth, the thickness of the enamel layer is between 1000 and 1200 mm, whereas the enamel thickness of natal teeth is less than 300 mm and of neonatal teeth is less than 135 mm.[10] The etiology of natal and neonatal teeth is not determined and may be related to several factors, including the superficial position of the tooth germ, hormonal fluctuations, developmental abnormalities, heredity, an increased eruption rate due to recurrent fevers, and osteoblastic activity related to the remodeling phenomenon.[11]

To differentiate supernumerary teeth from normal dentition, a proper clinical and radiographic diagnosis is necessary. Before providing any treatment, several factors should be considered, including (1) the degree of mobility, (2) the chance of aspiration, (3) pain associated with breastfeeding, (4) difficulty in feeding milk, (5) whether the tooth is of normal dentition or supernumerary, and (6) any injury to the tongue/soft tissue. According to some investigators, extraction is the treatment of choice if the tooth is associated with Riga–Fede disease. However, others do not recommend removal and, instead, advise trimming and smoothing of the sharp incisal margin.[12]

No extraction should be done before the age of 10 days because an appropriate level of vitamin K is not yet present. This 10-day period is essential for prothrombin production by the liver, after which normal gut flora becomes established and the production of vitamin K begins. The American Academy of Pediatrics recommends that all infants be given a single intramuscular dose of 0.5–1 mg of vitamin K.[13] Since our patient was 24 days old and his mother had already taken vitamin K, no additional vitamin K was advised for the child.

  Conclusion Top

Pediatricians are usually the first to detect natal and neonatal teeth in infants. Early consultation and reference to a pediatric dentist can prevent complications. Proper diagnosis and evaluation of such cases are important to provide the best treatment options. The decision to preserve or remove these teeth must be made in each case based on the parents’ informed consent. A radiographic exam is an essential diagnostic aid. To date, no previous studies have mentioned the occurrence of early infancy teeth following the extraction of natal teeth.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Leung KC, Robson WLM. Natal teeth: A review. J Natl Med Assoc 2006;98:226-8.  Back to cited text no. 1
Massler M, Savara BS. Natal and neonatal teeth: A review of twenty-four cases reported in the literature. J Pediatr 1950;36:349-59.  Back to cited text no. 2
Zhu J, King D. Natal and neonatal teeth. ASDC J Dent Child 1995;62:123-8.  Back to cited text no. 3
Chow MH. Natal and neonatal teeth. J Am Dent Assoc 1980;100:215-6.  Back to cited text no. 4
Kates GA, Needleman HL, Holmes LB. Natal and neonatal teeth: A clinical study. J Am Dent Assoc 1984;109:441-3.  Back to cited text no. 5
Cunha RF, Boer FAC, Torriani DD, Frossard WTG. Natal and neonatal teeth: A review of the literature. Pediatr Dent 2001;23:158-62.  Back to cited text no. 6
Nik-Hussein NN. Natal and neonatal teeth. J Pedodont 1990;14:110-2.  Back to cited text no. 7
Chawla HS. Management of natal/neonatal/early infancy teeth. J Indian Soc Pedod Prev Dent 1993;11:33-6.  Back to cited text no. 8
[PUBMED]  [Full text]  
Mhaske S, Yuwanati MB, Mhaske A, Ragavendra R, Kamath K, Saawarn S. Natal and neonatal teeth: An overview of the literature. ISRN Pediatr 2013;2013:111-11.  Back to cited text no. 9
Bigeard L, Hemmerle J, Sommermater JI. Clinical and ultrastructural study of the natal tooth: Enamel and dentin assessments. ASDC J Dent Child 1996;63:23-31.  Back to cited text no. 10
Southam JC. The structure of natal and neonatal teeth. Dent Pract Dent Record 1968;18:423-7.  Back to cited text no. 11
Buchanan S, Jenkins CR. Riga–Fede syndrome: Natal or neonatal teeth associated with tongue ulceration. Case report. Aust Dent J 1997;42:225-7.  Back to cited text no. 12
Bhutta ZA, Darmstadt GL, Hasan BS, Haws RA. Community-based interventions for improving perinatal and neonatal health outcomes in developing countries: a review of the evidence. Pediatrics 2005;115:519-617.  Back to cited text no. 13


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