Braz Dent J (1995) 6(2): 137-142 ISSN 0103-6440
| Introduction | Case
reoprt | Discussion | Conclusions
| References |
The authors report the case of a 6-month old girl treated at the Pediatric
Dentistry Clinic at the School of Dentistry of the Federal University of
Rio de Janeiro. The patient's breast feeding was interrupted prematurely
due to the presence of neonatal teeth. The authors have included a brief
review of previous reports of this pathology.
Key words:neonatal tooth, breast feeding and eruption chronology.
According to Massler and Savara (1950), teeth which are present in the oral cavity at birth are called natal teeth, and those which erupt during the first thirty days of life are called neonatal teeth. They have also been called fetal teeth, congenital teeth, or detitio praecox.
The incidence of neonatal teeth is very low, approximately 1 in every 2000 births (Massler and Savara, 1950). Wong (1987) reports 1 in every 3000 births. With respect to position, 85% of the natal or neonatal teeth are lower incisors, 11% are upper incisors, 3% are molars or lower cuspids, and only 1% are upper molars or upper cuspids (Bodenhoff, 1960; Stewart et al., 1982; McDonald and Avery, 1994). Gerald et al. (1991) reported the case of a 2-day old child with an upper primary molar. Masatomi et al. (1991) reported a case of multiple malformed natal teeth, and the absence of the majority of the permanent successors.
McDonald and Avery (1994) and Stewart et al. (1982) frequently refer to these structures as pre-deciduous teeth. According to Shafer et al. (1985), they must be distinguished from genuine primary teeth and neonatal teeth. Pre-deciduous teeth have been described as epithelial structures, corniform, without roots, which occur in the gingival region over the alveolar ridge, and which can be easily removed. It is believed that they originate from an accessory germ of the dental lamina of a primary germ or of a germ of an accessory dental lamina.
However, according to Spourge and Feasby (1966) the elements called pre-deciduous teeth are merely cysts of the dental lamina of the newborn. Normally they are white, project above the alveolar ridge, and are full of compact keratin, appearing corniform.
The etiology is obscure (McDonald and Avery, 1994), although it might seem familiar as Bodenhoff (1960), Hals (1957) and Shafer et al. (1985) suggested. One of the causes of early eruptions could be dental germs developing immediately below the gingiva, or early maturation inducing eruptions (Shafer et al., 1985). According to McDonald and Avery (1994), there is no conclusive evidence of a relationship between early eruption and any systemic condition or syndrome. However, others have suggested an association with pachyonychia congenita (a rare hereditary disorder characterized by nail hypertrophy and dyskeratoses of skin and mucosa) (Shafer et al., 1985), Ellis-Van Creveld syndrome (Chow, 1980; Shafer et al., 1985), Pierre-Robin anomaly, Hallermann-Streiff syndrome (Chow, 1980), craniofacial dysostosis and steatocystoma multiplex (Ohishi et al., 1986).
To be able to determine the stage of root development and the relationship between the early erupted root and adjacent teeth, an X-ray is needed. The majority of early erupted teeth are extremely mobile because of the limited development of the root. Ohishi et al. (1986) reported a case in which six natal teeth were revealed. These teeth became mobile and were extracted, and poor root development was noted. It has been postulated that mobility causes degeneration of the Hertwig epithelial sheath thereby inhibiting development and root stability (Gerald et al., 1991).
Macroscopic inspection revealed badly calcified, milky white structures in the cervical third region, which had a slightly irregular junction between the two areas. The structures eroded rapidly with use (Souza et al., 1987). Fourteen structures similar to teeth but with malformed coronary structures were reported by Masatomi et al. (1991). The radiopacity corresponded to that of the mandibular bone. There was no root development, pulp chamber, or permanent successors, except for the upper incisors.
Histologically, these structures can present primless enamel (Chow, 1980) with several degrees of hypomineralization and poor dentin. Nevertheless, neonatal teeth without any enamel are rare (Darwish et al., 1987).
The natal and neonatal teeth can be extracted when they interfere with breast feeding, when they show extreme mobility or when they offer risk of dislocation and aspiration (McDonald and Avery, 1994). Wong (1987) recommends prophylactic injection of vitamin K before the extraction of neonatal teeth to prevent excessive hemorrhage. Local anesthetic is unnecessary, the use of topical anesthetic is sufficient. Rarely are sutures needed, and simple pressure with gauze for one to two minutes controls any bleeding (McDonald and Avery, 1994). Post-operative procedures are usually uneventful (Ohishi et al., 1986; Souza et al., 1987).
To avoid ulceration beneath the tongue, biting of the opposite gingiva and to attenuate lesion injury to the mother's breast, any sharp edges of the teeth can be removed, and the mother advised to bottle-feed the child. The preferred procedure is to maintain the teeth in place, and explain to the parents the importance of the teeth in the development and normal eruption of adjacent teeth (McDonald and Avery, 1994).
Therefore, the objective of this report is to provide details of a case
that was seen at the Pediatric Dentistry Clinic at the Federal University
of Rio de Janeiro, in which the child's breast feeding was interrupted
due to neonatal elements.
Neonatal tooth was diagnosed. The mother confirmed that there was no
previous family history of this pathology. Clinical examination revealed
two dental structures in which the incisor borders had no enamel and had
exposed dentin (Figure 1A). Tactile examination of the elements revealed
mobility while the alveolar ridge remained firm. The gingiva texture around
them was very hyperemic. The X-ray (Figure 1B) revealed two slightly mineralized
structures, with dentinary remains on the incisor border. The pulp chambers
were wide and the apexes open. There was no bone support. Due to bleeding,
mobility and difficulty in feeding it was decided to extract the teeth.
1 - A, Clinical aspect of the two dental structures located in the
lower alveolar ridge without enamel at the incisor border exposing the
dentin to the oral environment. B, Lower anterior periapical radio-graph
showing two struc- tures hypomineralized with the remains of dentin in
the incisor border, wide pulp chambers and open apexes.
In a subsequent visit, the child was treated with the mother present.
The child was examined with the dentist and the parent seated face to face
with their knees touching. Their upper legs formed the examination table
for the child. The child's legs straddle the parent's body, allowing the
parent to restrain the child's legs and arms to comfort the child (McDonald
and Avery, 1994). A topical anesthetic was used, and the teeth (Figure
2) extracted with a periosteal elevator. Sterile gauze compression was
used for hemostasis.
2 - Neonatal teeth confirming the underdeveloped root structure, which
would not permit the maintenance of the structures in the dental arch.
Although the X-ray examination did not lead to a conclusive diagnosis
as to whether the teeth were primary incisors or supernumerary, a radical
intervention was carried out due to the symptomatology, and the clinical
aspect which would not permit the maintenance of the structures in the
dental arch. Although the child was chronologically in accordance with
the eruption phase of these specific teeth, the remainder of the teeth
had no enamel or bone support sustaining the root. In this case the probability
of aspiration was greatly increased, as confirmed in the literature (Massler
and Savara, 1950; Hals, 1957; Spourge and Feasby, 1966). The treatment,
exodontia, which has been widely reported (Massler and Savara, 1950; Souza
et al., 1987; Gerald et al., 1991; Masatomi et al., 1991; McDonald and
Avery, 1994), made it possible for the child to recommence breast feeding
for its better mental and physical development.
Chow MH: Natal and neonatal teeth. J Am Dent Assoc 100: 215- 216, 1980
Darwish S, Sastry KA, Ruprecht A: Natal teeth, bifid tongue and deaf mutism. J Oral Med 42: 49-56, 1987
Gerald WF, Mincer HH, Carruth KR, Jones JE: Natal primary molar: Case report. Ped Dent, 13: 173-175, 1991
Hals E: Natal and neonatal teeth. Oral Surg 10: 509-520, 1957
Masatomi Y, Abe K, Ooshima T: Unusual multiple natal teeth: case report. Ped Dent 13: 170-173, 1991
Massler M, Savara BS: Natal and neonatal teeth - a review of twenty-four cases reported in the literature. J Pediatr 36: 349-359, 1950
McDonald RE, Avery DR: Examination of the mouth and other relevant structures. In: Dentistry for the child and adolescent. 6th ed, 1-23, 186-215 Mosby Co., St. Louis 1994
Ohishi M, Murakami E, Haita T: Hallermann-Streiff syndrome and its oral implications. J Dent Child 53: 32-37, 1986
Poetsch HL: Habitos orais, RBO 25: 72-77, 1988
Ribble MA: Os direitos da criança: as necessidades psicológicas iniciais e sua satisfação. 2nd ed. Imago Editora Ltda, Rio de Janeiro 1975
Segovia ML: Interelaciones entre la odontoestomatologia y la fonoaudiologia, 1st ed. Panamericans, Buenos Aires 1977
Shafer WG, Hine MK, Levy BM: Distúrbios do desenvolvimento das estruturas bucais e parabucais. In: Tratado de patologia bucal. 4th ed. 1-79. Interameriana, Rio de Janeiro 1985
Souza IPR, Petersen SG, Oliveira NSF, Farinhas, JA: Dente neonatal - revisão da literatura e relato de um caso. RBO 44: 8-12, 1987
Spourge JD, Feasby WH: Erupted teeth in the newborn. Oral Surg, 22: 198-208, 1966
Stewart RE, Barber TK, Thouman KC, Wei SHY: Pediatric dentistry: foundations and clinical practice. 1st ed. Mosby Co., St. Louis 1982
Wong HB: Natal and neonatal teeth in Singapore. J Singapore Paediatr
Soc 4: 74, 1962 apud Souza IPR, Petersen SG, Oliveira NSF, Farinhas JA:
Dente neonatal - revisão da literatura e relato de um caso. RBO
44: 8-12, 1987
Correspondence:Laura Guimarães Primo, Disciplina de Odontopediatria,
Faculdade de Odontologia, Universidade Federal do Rio de Janeiro, Av. Brigadeiro
Trompowsky, s/n, Cidade Universitária, Ilha do Fundão, 21941-590
Rio de Janeiro, RJ, Brasil, Tel./Fax: (021) 290-8148.
Accepted September 25, 1995
Electronic publication: March, 1996