Seeing one or more teeth present at birth may alarm new parents. But these “natal teeth” are not as uncommon or problematic as once thought. Approximately 1 in every 2,000 babies are born with teeth already erupted. While some risks exist, natal teeth are usually harmless and no cause for serious concern.
Neonatal teeth are generally not dangerous with proper management by a pediatric dentist. The main risks that they pose relate to injury of the delicate oral tissues in a newborn, like tongue ulceration or interference with feeding. However, steps can be taken to smooth sharp edges of the teeth and cushion irritated areas to prevent harm.
Full or partial extraction is sometimes required if the teeth are poorly positioned or causing significant feeding problems. But in most cases, neonatal teeth can be safely monitored if they are not injuring the baby’s gums or tongue. With professional guidance, parents can ensure neonatal teeth do not pose a serious health danger.
Defining Natal Teeth
Natal teeth refer to teeth present in the mouth from birth. They may be visible already erupted through the gums or hidden under the gums and palpable on examination. Neonatal teeth, on the other hand, emerge within the first 4 weeks after birth, and are less common than natal teeth.
Despite their rarity, their reported incidence varies, occurring in both premature and term infants, with natal teeth being more common and twice as frequent in females. Typically occurring in pairs, they primarily appear as lower incisors, usually as a pair (85%).
In the vast majority of cases (90%), natal and neonatal teeth are primary teeth, while the rest are supernumerary (extra teeth that can disrupt normal eruption, meaning they should be extracted).
Natal and neonatal teeth can appear as “mature” teeth with fully developed shape and morphology, or “immature” teeth where the structure and development are incomplete. Depending on the degree of maturity, these may be small, conical, and hypoplastic or may even resemble a normal tooth
Causes of Natal Teeth
The reason some babies are born with teeth remains uncertain. Natal teeth likely result from excess hormones stimulating the fetus’s teeth to develop early and erupt before delivery.
Genetic and environmental factors also seem to play a role. Natal teeth occur more frequently:
- When parents had natal teeth
- In certain ethnic groups
- With some syndromes like Ellis-van Creveld
- With infants born with a cleft lip/palate
- When the mother had certain illnesses during pregnancy
But in most cases, natal teeth appear spontaneously without a known trigger. Proper prenatal care is still recommended to avoid complications.
Historically, natal teeth were viewed negatively as a sign of curses or evil spirits. While superstitions are unfounded, some risks do exist:
- Tongue injury – The fragile tongue of a newborn is prone to ulceration.
- Interference with feeding – Teeth may interfere with breastfeeding or cause gagging.
- Sublingual ulceration – Irritation and sores under the tongue.
- Aspiration – Swallowed teeth may partially obstruct airways.
- Discomfort – Teeth may irritate soft gums.
- Infection – Gum inflammation is possible.
- Inhalation of loose teeth
- Laceration of the mother’s breasts during feeding
However, these issues are relatively uncommon if the teeth are managed properly by a pediatric dentist.
Treatment and Management
It is suggested that a well-implanted natal or neonatal tooth should be left in the arch, with extraction being recommended only when it is extremely mobile, causes injury to the baby, or when there is a risk of aspiration.
The primary goal is protecting the infant’s tongue and gums. Treatment options include:
- Smoothing sharp edges – Emery boards or dental instruments round sharp tips.
- Extraction – Removing the teeth if causing significant issues with feeding or ulcers.
- Partial extraction – Reducing the tooth height if full removal is risky.
- Grinding – Filing the teeth down without anesthesia if eruption is incomplete.
- Monitoring – Letting the teeth remain if positioned properly with no soft tissue injury.
Parents can apply dental wax to cushion irritated areas. Pediatric dentists handle any grinding or extractions using analgesics.
Natal teeth are not necessarily good or bad inherently. While historically feared as ominous, they mainly require prudent monitoring and management to avoid problems. Work closely with your pediatrician and pediatric dentist if your newborn has natal teeth to ensure proper care. With professional guidance, you can respond appropriately and rest easy knowing they pose little long term risk. Focus on your baby’s health, not old superstitions.