Teeth at Birth! Everything You Need to Know About Natal and Neonatal Teeth

Imagine this scenario playing out: You receive an urgent call at your clinic from a new mother, just a few days postpartum. Her voice is filled with worry as she exclaims, “Help, Doctor! I just found a tooth erupting from my baby’s gums!”

Your initial, perfectly natural reaction might be utter astonishment. We’ve all studied that Deciduous Teeth typically begin to emerge around six months of age. So, what’s the story behind a tooth appearing right at birth? Is this a normal occurrence? Is it dangerous? And how should you, as a dentist, manage such a case if it walks (or rather, is carried) into your practice?

This phenomenon, though rare, is very real and has its own scientific classification and name. In this article, we’ll thoroughly dissect everything you need to know about “birth teeth”—from their initial diagnosis to making the right treatment decision. Our goal is to ensure that when you encounter such a case, you’ll be fully prepared to handle it with complete professionalism and calm.

What Exactly Are “Birth Teeth”? (The Definition)

The precise scientific terminology for this condition isn’t a single term; there are actually two, depending on when the tooth makes its appearance:

• Natal Teeth: These are teeth already present in a baby’s mouth at the moment of birth.

• Neonatal Teeth: These are teeth that erupt into the baby’s mouth within the first 30 days of life.

Typically, clinicians tend to use these terms interchangeably because the management approach for both is largely the same. This condition is considered uncommon, occurring in approximately 1 out of every 2,000 to 3,000 births (1). While it can simply be an isolated phenomenon, it occasionally presents as a feature of certain medical syndromes, which is why a thorough examination is so critical.

Where Do They Appear, and What Do They Look Like? (Location and Appearance)

Most Common Location: Around 85% of these cases involve the mandibular incisors. It’s exceptionally rare to find them in the maxilla or in the molar regions.

Appearance and Structure: Don’t expect to see a perfectly formed, typical primary tooth. Often, these teeth possess a distinctive morphology:

• Small and Conical: They are frequently smaller and more cone-shaped than regular teeth.

• Yellowish-Brown Hue: Their color might appear off, often yellowish-brown.

• Weak Structure: Both the Enamel and Dentin layers are commonly weak and poorly formed (hypoplastic).

• Highly Mobile: Crucially, they are very often highly mobile, primarily because they are usually rootless or possess a root that is either incompletely developed or extremely weak.

The Most Important Question: Is It an Extra Tooth or the Primary Tooth Itself?

This distinction is the cornerstone of both diagnosis and the entire treatment plan. When you encounter such a tooth, you absolutely need to determine its identity:

• In 90% of Cases: The tooth is indeed the Primary tooth itself, but it has simply erupted much, much earlier than expected.

• In 10% of Cases: This tooth is a Supernumerary tooth, meaning it’s an extra tooth unrelated to the regular primary dentition. If it falls out or is extracted, the natural primary tooth will still erupt in its place at the appropriate time.

So, How Do You Tell the Difference? It’s impossible to know simply by looking. The only reliable solution is a radiograph.

What Problems Can These Teeth Cause? (Potential Problems)

While their appearance might seem benign, the presence of these teeth can genuinely lead to significant issues for both the mother and the infant:

For the Mother: These teeth can cause severe pain and trauma to the mother’s nipple during breastfeeding, which might unfortunately lead her to abandon natural breastfeeding altogether.

For the Infant:

• Feeding Difficulties: The baby itself might struggle to latch and feed effectively.

• Tongue Lacerations: The continuous rubbing of the infant’s tongue against the sharp edge of the tooth can cause a very painful ulcer or laceration underneath the tongue. This condition has a well-known name: Riga-Fede Disease (2).

• The Greatest Risk: Aspiration: Because these teeth are often highly mobile, there’s a serious risk that one could dislodge at any moment. The baby could either swallow it or, more dangerously, aspirate it into the airway, potentially causing an Airway Obstruction—a critical and life-threatening emergency.

Clinical Management Protocol: What Are the Steps? (The Management Protocol)

When you encounter such a case, resist the urge to make a hasty decision. Follow these steps methodically:

Step One: Reassure the Parents and Gather Information

Your very first action should be to alleviate the parents’ anxiety by reassuring them that this is a recognized condition with established solutions. Take a complete medical history, and specifically inquire if anyone else in the family was born with teeth (as there can sometimes be a genetic component).

Step Two: Examination and Radiograph

Clinical Examination: Thoroughly examine the tooth. The most critical assessment is its degree of mobility. Is the tooth somewhat stable, or does it move with the slightest touch?

Radiograph: This step is mandatory and non-negotiable. You must take a periapical radiograph of the area. The radiograph will reveal crucial information:

• Is it a primary tooth or a supernumerary tooth? (If it’s primary, you won’t see another tooth bud underneath. If supernumerary, you’ll observe the primary tooth bud awaiting its turn).

• Does it have a root? If so, what is its morphology and size?

Step Three: The Big Decision… To Extract or To Keep?

This crucial decision hinges on your answers to two fundamental questions after the examination and radiograph:

1. Is the tooth mobile to the point where it might dislodge?

2. Is the tooth causing problems with feeding or lacerations for the infant?

Based on these answers, your treatment plan will fall into one of two categories:

Indications for Immediate Extraction:

• If the tooth is very mobile and presents a genuine risk of dislodgement. This is the paramount reason for extraction, primarily to avert the aspiration risk.

• If the tooth has caused a significant, painful injury to the infant (Riga-Fede Disease), or if it’s completely preventing feeding.

• If the radiograph conclusively proves it is a Supernumerary tooth and it’s causing issues. Extraction here is safe because the primary tooth is still on its way.

Indications for Observation (Possibly Keep):

• If the tooth is relatively stable (Not excessively mobile).

• If it is not causing any problems with feeding or lacerations.

• If the radiograph confirms it is the Primary tooth itself. In this scenario, we strive to preserve it whenever possible, because extracting it means the child will lack that tooth until the permanent successor erupts years later, which could impact spacing and jaw development.

Step Four: If You Decide to Extract… The Safe Extraction Protocol

Extracting a tooth from a newborn isn’t like any routine extraction. There’s a critically important point you absolutely must consider.

Vitamin K Injection: Newborns typically exhibit a physiological deficiency in Vitamin K, which is essential for the synthesis of clotting factors in the liver. Any extraction performed without the infant receiving Vitamin K can potentially lead to severe, difficult-to-control hemorrhage (3).

The Correct Procedure: You must first coordinate with the infant’s Pediatrician. They will administer an intramuscular Vitamin K injection to the baby. Approximately 24 hours later, you can safely proceed with the tooth extraction. Never, under any circumstances, perform the extraction without this crucial coordination.

The Extraction Itself: The actual extraction is usually quite straightforward, often requiring no more than a simple topical anesthetic, as the tooth typically isn’t firmly attached.

Step Five: If You Decide to Observe… The Follow-Up Protocol

Should you determine that the tooth will remain in place, you must provide the parents with clear, precise instructions:

Smoothing Sharp Edges: If the tooth has any sharp edges, use a polishing disc with extreme gentleness to smoothen them. This prevents potential injury to the infant’s tongue.

Hygiene Instructions: The mother must maintain excellent oral hygiene for the baby. This involves gently wiping the tooth and gums with a clean, moist gauze after every feeding.

Regular Follow-Up: It is imperative to monitor this condition regularly to ensure the tooth remains stable and isn’t causing any new problems.

The Takeaway: What to Do When This Case Arises?

• Don’t panic, and reassure the parents. This is a rare but well-documented condition.

• Diagnose correctly: Perform a thorough clinical examination (paying special attention to mobility) + a mandatory radiograph.

• Determine the tooth’s identity: Is it primary or supernumerary? Stable or mobile?

• Make the decision:

  • Very mobile or causing problems? Extract.

  • Stable and not causing issues? Observe and monitor.

• If extracting: First, coordinate with the pediatrician for the crucial Vitamin K injection.

• If observing: Smooth any sharp edges, provide clear hygiene instructions, and schedule regular follow-ups.

By diligently following this clear protocol, you’ll be able to confidently and professionally manage one of the rarest and most intriguing cases you might encounter in your dental practice.