Natal teeth and cleft lip and palate

Natal Teeth in Cleft Lip and Palate Patients: A Scanning Electron Microscopy Study

Luis Cesar Jum MOTOYAMA1 Lucy Dalva LOPES1 Ii-Sei WATANABE2 1Hospital de Cirurgia Plástica Crânio-Facial e Sociedade Brasileira de Pesquisa e Assistência para Reabilitação Crânio-Facial (SOBRAPAR), Campinas, SP, Brasil 2Departamento de Anatomia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, SP, Brasil

Braz Dent J (1996) 7(2): 115-119 ISSN 0103-6440

Natal and neonatal teeth may occur in patients up to 30-days after birth. The presence of two neonatal teeth in cleft lip and palate patients is reported in this study describing the structural aspects of the enamel and the dentin, using scanning electron microscopy.

Key Words: natal teeth, cleft lip and palate, scanning electron microscopy.

Introduction

The cleft lip and palate lie within the four most common forms of congenital anomalies in newborns and may be unilateral or bilateral and/or palatal. They are of multifactorial etiology with environmental and genetic factors interacting or acting alone. The incidence in Brazil is nearly 1:673 (Fonseca and Rezende, 1971). The purpose of this paper is to describe the natal teeth, using scanning electron microscopy.

Material and Methods

The neonatal teeth of two patients with cleft lip and palate from the “Hospital of Craniofacial Plastic Surgery” were used in this study. The first tooth was from a 60-day-old newborn female, presenting bilateral cleft lip, pre-foramen incisor and non-syndromic. The second tooth, sent by the Speech Department for analysis of inflamed gingival tissue in the cleft region, belonged to a 5-day-old female, with left unilateral cleft lip and palate, transforamen incisor, non-syndromic (Figure 1). The teeth were extracted with forceps, using topical 10% xylocaine spray. The tooth was rinsed and immersed in a 70% ethanol solution for several days at 4°C. For the removal of soft tissue, the tooth was treated with 3% sodium hypochlorite for two days at 4°C, then rinsed and sonicated in distilled water for approximately 10 min.. The tooth was then frozen, fractured longitudinally in a bucco-lingual direction within liquid nitrogen, dehydrated in graded ethanol and dried with a critical point (Balzers, CPD-010). The samples were mounted on studs, sputter-coated with gold (Balzers, SCD-040) and examined under the scanning electron microscope (Jeol, JSM-6,100), at Instituto de Ciências Biomédicas da Universidade de São Paulo.

Results

In the first case a neonatal tooth was observed in the cleft region between the pre-maxilla and the maxilla, presenting a conic form, yellowish color, hypoplasia and hypermobility. In the second case, a neonatal tooth was observed at the back of the pre-maxilla, in the cleft region, presenting a yellowish color, hypoplasia and hypermobility. Its incisal edge was turned toward the opposite side of the cleft, involved in inflamed gingival tissue having a peduncular shape (Figure 1). Using scanning electron microscopy, the superficial enamel layer presented irregular characteristics with hypoplastic traits, interspersing between prismatic and aprismatic areas (Figure 2A). The enamel presented irregular superficial characteristics with hypoplastic traits interspersing between prismatic and aprismatic areas (Figure 2B). The dentin layer was regularly arranged, delimiting a pulpar chamber with a triangular aspect (Figure 2C) and a broad lower space (Figure 2D). Structurally, the dentin surface presented dentinal tubules arranged similarly to those of normal deciduous teeth (Figure 2E). At the enamel-dentin limit a root formation of nearly 300 micrometers was found (Figure 2D).

Discussion

These two cases confirm the presence of neonatal teeth in infants having morphological characteristics similar to those observed in normal deciduous teeth. The incidence of natal and neonatal teeth reported in the literature shows that it varies from 1:716 (Kates et al., 1984) to 1:6,000 (Gardiner, 1961), predominantly in females. A frequency of 3:1 natal teeth compared to neonatal teeth was reported by Biodenhoff-Gorlin (1963). Diaz-Romero et al. (1991) state that the presence of neonatal teeth presented a higher rate in the Mexican population. The teeth involved most often are the lower incisors (Jasmin and Clergeau-Guerithault, 1991), pairs (95%), rare in the posterior region, with the possibility of eruption of multiple elements (Masatomi et al., 1991). In most cases they are hypoplastic, hypocalcified elements of normal deciduous teeth (85% to 95%) (Roberts et al., 1992). The etiology is hereditary, associated with syndromes such as Jadassohn-Lewawsky, Hallermann-Striff, Congenital Pachyonnychia II, or Ellis-van Creveld reported by Jasmin and Clergeau-Gueritault (1991), Meckel Syndrome and cleft lip and palate described by Diaz-Romero et al. (1991) and transplacental exposure to polychlorinated biphenyls and to dibenzofurans, as occurred in Thailand and described by Gladen et al. (1990). During the eruption of lower permanent incisors, elements with a smaller mesiodistal measurement were found (Marcushamer et al., 1992). Long et al. (1994) reported that if they remain until the fourth month root formation of the tooth can be observed radiographically. However, Masatomi et al. (1991) reported a case in which the teeth exfoliated from the fifth month onwards. In patients with cleft lip and palate, there is the presence of supranumerary teeth either of a normal shape or conical (Lopes et al., 1991).The presence of neonatal teeth observed in our study shows that they occur more often in the maxilla in the cleft region interfering in the orthopedic treatment with obturating plates aimed at directioning and guiding the palatal blade growth toward the medium palate region (Lopes, 1986). It is recommended that the tooth be extracted to prevent the child from swallowing it or inhaling it, to avoid difficulties during breast feeding and to avoid interfering with treatment. In normal patients we agree with most authors favoring tooth maintenance by making the parents aware of the need for adequate hygiene. Periodical follow-up by the dental surgeon is necessary to apply fluoridated resin from time to time. Structurally, the enamel layer presented numerous irregular forms which are different from those reported by Fava et al. (1991) and Kodaka et al. (1989). The enamel surfaces in normal deciduous teeth are quite regular (Fava et al., 1991, Costa, 1994) differing from those observed in our results.

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Correspondence: Luis César Jum Motoyama , Hospital de Cirurgia Plástica Crânio-Facial (SOBRAPAR), Rua Adolfo Lutz 100, Cidade Universitária, Caixa Postal 6028,UNICAMP, 13081-970 Campinas, São Paulo, Brasil.

Accepted November 22, 1995
Electronic publication: February, 1997

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