In response to a question about some whitish lesions in the mouth, I wrote about Epstein pearls and their differentials.
One of the things that can be seen in the mouth of a newborn that can also be debilitating is the occurrence of tooth/teeth in the mouth of newborns. Once again, this should not be a source of worry since it can easily be dealt with. Newborns with a tooth or teeth are not an unusual observation in the labour wards. It is known in medical parlance as natal teeth when teeth are already present at the birth of a baby.
Closely related is another occurrence where babies are born with no tooth but they grow one within the first month of life. This is called neonatal tooth/teeth and must be differentiated from natal tooth. Natal teeth are usually present above the gumline at birth in contrast to neonatal teeth which emerge through the gum during the first month of life.Natal teeth are present in about 1 in every 2,000 to 3,000 births. T
hey most often develop on the lower gum, where the central incisor teeth will appear. They have little root structure and are attached to the end of the gum by soft tissue hence are often wobbly. Even though they are usually not well-formed, they may cause irritation and injury to the tongue of an infant when nursing. In addition, it may cause discomfort to a breastfeeding mother.
Newborns with teeth
Natal teeth are often removed shortly after birth while the newborn infant is still in the hospital. This is very often done if the tooth is loose. The most important reason for its removal lies in the fact that the tooth can dislodge and enter the lungs, a process called aspiration which is a medical emergency. The cause of natal and neonatal teeth is not known and usually is not related to any specific medical condition.
However, sometimes they are seen as a component of a constellation of specific signs called syndromes, some of which are Ellis-van Creveld and Pierre Robin syndrome syndromes. No special investigations are recommended for natal teeth, but dental X-rays may be done in some cases particularly if there are signs of another condition that may be linked with natal teeth.What to do for natal teeth is controversial.
Some advocate for it to be left alone if not wobbly whilst others recommend its removal at all costs because of the risk of it falling off and entering the lungs. The reason for those who advocate it to be left for as long as possible is to decrease the likelihood of removing permanent tooth buds with the natal tooth.
Those proposing its removal cite various reasons, including feeding problems for the baby, the uncomfortable feeling of the mother during breastfeeding, thus interfering with proper latching on and successful lactation as well as the fear of amputation of the tongue. But the greatest of risks, as has been said earlier is the baby aspirating it when it dislodges.Dentists are usually involved in its removal.
Certain precautions must be observed before its removal. It must be ensured that the child does not have any bleeding tendency to avoid excessive bleeding.If left to stay, the natal tooth needs cleaning by gently wiping the gums and teeth with a clean, damp cloth.
We also need to frequently examine the infant’s gums and tongue often to make sure the teeth are not causing injury. Consulting the dentist is the first step in dealing with natal or neonatal teeth.
Writer’s email: astom2@yahoo.com
A member of the Paediatric Society of Ghana.