Case report
A One-week-old Saudi male was referred from neonatal intensive care unit to the section of pediatric dentistry at King Faisal Specialist Hospital and Research Center’s dental department due to the presence of multiple intraoral structures.
He is a full-term baby, productive of elective cesarean section with APGAR score of 6, 7and 8 in 1st,5thand 10th minutes respectively. One hour after birth, he was admitted to NICU due to respiratory distress, and then he was discharged one day later.
He is known to have significant family history of ectodermal dysplasia from his mother Side. He has one older sibling who is medically fit and who had not experienced natal or neonatal teeth in infancy.
On general examination, the child appeared to have a symmetrical face without any obvious dysmorphic features (figure 1). Intraoral examination revealed eight shell shaped crowns located in the right, left and anterior mandible as well as the left posterior maxilla (figure 2). They exhibited grade III mobility (mobility of more than 1 mm in each direction and depressed in the socket). The lips, gingivae palate, tongue, floor of the mouth, and buccal mucosa were clinically normal in appearance and within normal limits.
The mobility of the teeth posed a risk for the child; thus, the treatment plan was discussed with the parents and they agreed to extract all the teeth to avoid possible aspiration However parent was aware that the chance their child will have primary teeth is seldom after removal of those natal teeth. Primary pediatrician clears the child for dental extraction. Also, he was evaluated by the genetic department to exclude ectodermal dysplasia since the mother was a known case. The Genetic report revealed that diagnosis is not exclusive due to patient age, however they recommended follow up.
Child was booked one week later and dental extraction was done by tweezer without anesthesia and gentle curettage was performed on the extraction socket. The infant tolerated procedure very well. The extracted teeth had a crown but were lacking in roots. On his 1 – week follow up appointment two natal teeth were found and they were mobile in posterior maxilla and were removed. At his 2 weeks and 3 months follow up, the child was well and no abnormalities were reported. The child missed his regular recall appointment for few years then he presented to the dental clinic at age 4 years with his mother, she was concerned about missing teeth.
During extraoral clinical examination child growth was normal to his age , he did not reveal any feature of ectodermal dysplasia although it was confirmed by genetic testing , He has thick hair, normal facial skin with no pigmentation.
Intra oral examination shows absence of primary dentition except upper primary canines and lower second primary molar which were fully erupted, resorption of alveolar ridge was also noted (Figure 3).
Child has regular followed up appointment in dental department to evaluate his condition and to formulate a treatment plan that may include option of constructing removable denture in order to enhance esthetic and function.