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).
- Shell-shaped crown poorly fixed to the alveolus by gingival tissue and
absence of a root.
- Solid crown poorly fixed to the alveolus by gingival tissue and little
or no root.
- Eruption of the incisal margin of the crown through the gingival
tissues.
- 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?
- To present unusual case of abnormal teeth development
- To present Different treatment modalities
- 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.