Braz Dent J (1998) 9(1): 53-56 ISSN 0103-6440

| Introduction | Case Report | Comments | References |

An unusual case of a newborn with 12 erupted teeth is presented. Epidemiological, etiological, and therapeutical aspects of this developmental disturbance of dentition is reviewed in order to establish guidelines for the dentist and neonatologist to manage this problem with minimal damage to the future teeth and the patient.

Key Words: natal teeth, newborn dentition.
 

The presence of teeth in newborns is uncommon, varying from 1:6000 to 1:800 cases, occurring, in general, of two or three teeth. The purpose of this report is to review the literature related to its epidemiology and discuss its possible etiology and treatment, since the responsibility of diagnosis of this manifestation is the dentist’s, who, depending on the present conditions, can maintain these teeth or not.
Natal teeth have been described by many names. Until revision proposed by Massler and Savara in 1950, the teeth observed in the oral cavity of a newborn were called fetal, congenital teeth or even premature dentition. This designation did not include the teeth which appeared some time after birth (neonatal). The structural aspects, maturity, anatomical and functional conditions of these uncommon teeth were not observed (Spouge and Feasby, 1966). They were considered to belong to a pre-deciduous dentition, since 90% of natal or neonatal teeth are the same elements as future deciduous dentition (Ronk, 1982). Thus, Spouge and Feasby (1966) differentiated natal and neonatal teeth based on the maturity of the structures, suggesting the term "premature teeth". The teeth or group of teeth which are present at birth are denoted as natal dentition, while neonatal teeth are those which erupt during the first month of life (Massler and Savara, 1950).
The occurrence of either natal or neonatal teeth is relatively rare. Its prevalence has been reported to be around 1 in 2000 to 3500 live births (Massler and Savara, 1950; Bodenhoff and Gorlin, 1963; Spouge and Feasby, 1966) varying from 1:6000 to 1:800 (Rusmah, 1991), with females, in general, being more affected (Allwright, 1958; Chow, 1980). Natal teeth are more frequent than neonatal teeth (Massler and Savara, 1950; Spouge and Feasby, 1966; Ronk, 1982) with the most common localization being the mandibular region of central incisors (85%). Natal or neonatal cuspids are extremely rare (Massler and Savara, 1950; Bodenhoff and Gorlin, 1963; Southam, 1968; Ronk, 1982; Kates et al., 1984; Rusmah, 1991)
These teeth are associated with some syndromes which are also congenital such as pachyonychia congenita (Jadassohn-Lewandowsky Syndrome) and others also associated to problems such as cleft palate or lip (Stewart and Prescott, 1976; Brandt et al., 1983; Poÿry and Ranta, 1985; Camm and Mourino, 1987; Nik-Hussein, 1990).
Many theories have been proposed to explain the possible etiology of the premature eruption of these teeth. Cases reported have been associated to endocrinological disturbances, nutritional deficiency, congenital syphilis, and even fever of the mother during pregnancy. The most acceptable theory has been based upon the result of a superficial localization of the dental follicles, probably related to a hereditary factor (Hals, 1957).

Clinical aspects

Clinically, in the majority of cases, both natal and neonatal teeth are characterized by small immature conical dental structures, of a brown-yellowish color, with an undeveloped root. These anomalous aspects permit great mobility, facilitating spontaneous loss or exfoliation, with gingival edema and inflammation, and some bleeding areas (Berman and Silverstone, 1975; Nik-Hussein, 1990; Rusmah, 1991).
X-ray examination showed the absence of enamel or a thin enamel capsule, dentin and radicular structures, as well as supranumerary teeth, providing the possibility to investigate if these elements are part of the deciduous dentition or not (Ronk, 1982; Brandt et al., 1983).
Histologically, decalcified sections showed an immature tooth with an irregular pattern of dentin related to the orientation of the dentinary tubules. The enamel was hypomineralized or hypoplastic and the incipient Hertwig’s sheath was associated with little root development. (Berman and Silverstone, 1975; Kates et al., 1984)

A white male child, born by cesarean delivery, weighing 4200 g, presented 12 teeth on the maxillary and mandibular ridges. Eight of them were located on the anterior area with anatomical appearance of incisors (Figure 1), the remaining were posterior on the left and the right sides, including both jaws with clinical aspect of molars. Their color varied from milky white to dark gray. In view of mobility and deficient implantation, which might cause difficulties in nursing and risk of aspiration, two elements were removed immediately (Figure 2). However, six days after delivery, the child was taken to another hospital, where the other teeth were extracted, except one upper molar.
The mother reported that only her sister presented a similar problem, with few teeth involved, revealing a familial trait of this manifestation.
Two years and seven months from birth, the child was re-evaluated and the presence of only two deciduous, one upper canine and one lower molar were observed. X-ray examination showed that the permanent dentition was normal in relation to number and structural development.

Figure 1 - Top, Clinical aspect of upper natal incisors. Bottom, Clinical aspect of lower natal incisors.

Figure 2 - Extracted natal teeth. Very little root formation is evident.

This case exhibited a great number of teeth similar to that reported by Masatomi et al. (1991). However, differing from the reviewed literature, our case revealed a correlation between the problems of affected deciduous dentition and normal permanent dentition.
It is necessary to investigate the possible local or systemic factors that could be related to eruption of natal teeth, their association with other pathologies and the basis of differential diagnosis, in order to promote a better oral condition for cases similar to the present one. Our study revealed that dentists should be aware of these problems. The extraction of anomalous teeth should be postponed until the tenth day postpartum, in order to avoid hemorrhage. Teeth which have good support do not need to be removed, since experience has shown that these elements will probably compound the deciduous dentition. We also have to consider that natal teeth are not the only oral alteration that can be observed in neonates, remembering other lesions such as cysts and developmental disturbances. An accurate oral examination is recommended in newborns, in order to establish the differential diagnoses.

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Correspondence: Dr. Esther Goldenberg Birman, Faculdade de Odontologia, Universidade de São Paulo, SP, Brasil.

Accepted November 11, 1997
Electronic publication: October, 1998