Discussion
The etiology of natal and neonatal teeth remains undetermined. They may appear as an isolated dental finding but are sometime associated with developmental anomalies like cleft lip and palate, and syndromes such as chondroectodermal dysplasia, Hallermann-Streiff (Mandibulo-oculo-facial dyscephaly with hypotrichosis) and ectodermal dysplasia (3, 5). Environmental factors, particularly polychlorinated biphenyls, appear to increase the incidence of natal teeth (3)
Even though a clear causative factor is yet to be determined for natal teeth, it was found to be related to various conditions, including: superficial position of the tooth germ, increased eruption rate due to pyretic incidents, hormonal stimulation, developmental abnormalities, syndromes, family history, and osteoblastic activity within the germ zone related to the remodeling phenomenon. The presence of relatives with a history of natal or neonatal teeth was found in 15% of cases (3).
The appearance of each natal tooth into the oral cavity can be classified according to Hebling into four categories as the teeth emerge into the oral cavity (4).
  1. Shell-shaped crown poorly fixed to the alveolus by gingival tissue and absence of a root.
  2. Solid crown poorly fixed to the alveolus by gingival tissue and little or no root.
  3. Eruption of the incisal margin of the crown through the gingival tissues.
  4. Edema of gingival tissue with an un-erupted but palpable tooth
If the degree of mobility is more than 2 mm, the natal teeth of category (1) or (2) usually need extraction.
If extraction is the treatment of choice, it can be deferred till the child is 10 days of age or more and has appropriate blood levels of vitamin K to prevent risk of bleeding. This 10-day waiting period is to allow the normal flora of the intestine to become established to produce vitamin K, an essential factor for prothrombin production in the liver. Since parenteral vitamin K prevents a life-threatening hemorrhagic disease of the newborn, the American Academy of Pediatrics recommends that all newborns be given a single intramuscular dose of
0.5 to 1 mgof vitamin K (1).
After extraction is done, gentle curettage of the socket is generally recommended. This is necessary to prevent Hertwig’s epithelial root sheath from forming root structures.

Conclusions

The occurrence of natal and neonatal teeth is not uncommon. Early consultation with the pediatric dentist is recommended to prevent complications such as risk of aspiration, deformity or mutilation of the tongue. The decision to maintain or remove these teeth should be considered on a case-to-case basis and tailored according to patients’ situation. To our knowledge, this is the first reported case of the presence of multiple natal teeth in Ectodermal dysplasia child as confirmed by genetic testing.
Why this paper is important to pediatric dentists?
  1. To present unusual case of abnormal teeth development
  2. To present Different treatment modalities
  3. To share clinical knowledge in management of such cases
Ethical approval the manuscript was reviewed by the ethical committee at King Faisal Specialist: Hospital before the submission. No funding was obtained for this case report.