viviparous teeth and neonatal teeth

OVERVIEW

What are natal teeth? What are neonatal teeth?

Natal teeth (natal tooth) refer to teeth that have already erupted at birth, also known as "birth teeth" or "newborn teeth."
Neonatal teeth refer to teeth that erupt within 28 days after birth, also called "neonatal teeth."

Both natal teeth and neonatal teeth are abnormal conditions of premature eruption of primary teeth. Once premature eruption of primary teeth is detected in a newborn, it must be promptly examined and treated.

Apart from differences in eruption time, natal teeth and neonatal teeth are essentially the same in terms of their manifestations and treatment methods. For simplicity, the following discussion will refer to both as natal teeth.

Are natal teeth and neonatal teeth common?

Natal teeth and neonatal teeth are quite rare, with an incidence rate of about one in a thousand. The incidence varies among different ethnic groups and regions. For example, according to literature reports, the overall incidence of natal teeth is 0.96‰, 1.65‰ among Koreans, and 0.31‰ among Han Chinese.

Are natal teeth and "horse teeth" the same thing?

No.

"Horse teeth" is a colloquial term referring to small, needle-sized white protrusions visible on the gums of newborns at birth. These are not actual tooth structures.

They are formed by the keratinization of residual epithelial tissue from the dental lamina (the initial tissue structure in tooth development). They are very small in size and will naturally fall off after some time, requiring no treatment.

In some regions, due to a lack of understanding about the cause of "horse teeth," some people may use sharp tools to remove them. This practice is highly inadvisable.

In contrast, natal teeth are the premature eruption of primary teeth at an abnormal time and often require obstetric and dental intervention and care. Improper handling or neglect may lead to certain issues, such as infection.

SYMPTOMS

What are the manifestations of natal teeth and neonatal teeth?

Natal teeth are mostly mandibular primary central incisors, and in very rare cases, both left and right primary central incisors erupt simultaneously.
Most natal teeth are normal primary teeth, while a few are supernumerary teeth (i.e., extra teeth).
Most natal teeth have a basically normal crown morphology, but the enamel and dentin are thin and poorly calcified, appearing hollow. The roots are undeveloped or minimally developed, with no alveolar bone support, resulting in significant tooth mobility. This can affect the baby's feeding and poses a risk of aspiration if the tooth falls out.
A small portion of natal teeth resemble normally erupted primary teeth, with minimal mobility and some root formation.
Babies with natal teeth may cry during early suckling, have difficulty latching onto the nipple, and the mother may experience discomfort in her nipple.
Examination of the baby's oral cavity may reveal localized gingival redness and swelling.

What adverse effects might natal teeth and neonatal teeth cause?

If a natal tooth falls out and is inhaled into the baby's trachea, it can cause choking or even death.
Due to the mobility of natal teeth, repeated friction can lead to ulcers on the ventral surface of the tongue, damage to periodontal soft tissues, and potential infection, affecting the normal development of teeth, the mandible, and the maxillofacial region.

CAUSES

What are the possible causes of natal and neonatal teeth?

The pathogenesis of natal teeth is not fully understood, but current research suggests the following potential factors:

The primary tooth germ is located too close to the oral mucosa, leading to premature eruption.
Thin or absent dental follicles surrounding the tooth germ before eruption may contribute to early tooth emergence.
Hyperemia of the tooth germ or inflammation of surrounding tissues may accelerate abnormal growth, causing premature eruption.
Family history, as some infants have a clear familial predisposition to natal teeth.

Are natal and neonatal teeth hereditary?

Possibly.

Some infants have a distinct family history of natal teeth. Investigations of such pedigrees reveal affected individuals in each generation, with both males and females impacted, consistent with autosomal dominant inheritance.

However, further research is lacking, and it remains uncertain whether the condition is definitively hereditary. Continued observation and genetic analysis are needed.

DIAGNOSIS

How to Detect Natal and Neonatal Teeth in Time?

In obstetrics, after clearing the newborn's airway and cutting the umbilical cord, doctors routinely perform an oral examination. Natal teeth exposed in the oral cavity are relatively easy to detect.

If neonatal teeth erupt within 28 days after birth, the baby may show signs of fussiness during feeding, and the mother may feel discomfort as if touching a hard object on her nipple. Careful observation of the oral cavity can reveal the teeth. If neonatal teeth are suspected, seek medical attention promptly.

What Conditions Should Natal and Neonatal Teeth Be Distinguished From?

Epstein pearls: Natal teeth and Epstein pearls differ in their causes, management, and outcomes, so it is essential to distinguish between them.
Normal primary teeth: The earliest eruption time for normal primary teeth is around 6 months after birth. Healthy primary teeth are not loose and are supported by alveolar bone.

What Examinations Are Needed for Babies with Natal or Neonatal Teeth?

An oral examination is required. The doctor will assess the specific condition of natal teeth through visual inspection, probing, palpation, and percussion to determine whether they should be retained.

TREATMENT

Which department should I visit for natal teeth and neonatal teeth?

Dental department.

How to handle natal teeth and neonatal teeth?

Either retain or extract them.

Retention: If examination shows the natal tooth is not loose, it can be retained but requires close monitoring. Since natal teeth mostly grow in the lower jaw, they may cause ulcers on the lingual frenulum due to friction during sucking. In such cases, the natal tooth can be adjusted or spoon-feeding can be used instead, with medication applied to the ulcer.
Extraction: If the natal tooth lacks root formation and is unlikely to develop a stable root, early extraction is recommended. Clinically, most natal teeth require extraction. Given that most natal teeth are very loose and lack alveolar bone support, they can be quickly extracted without anesthesia.

What treatments are needed after natal tooth extraction?

The extraction site can be sutured with fine silk thread to stop bleeding, reduce wound exposure, promote healing, and prevent infection.

Antibiotics (e.g., intramuscular penicillin) are routinely used post-extraction to prevent infection.

Does natal tooth treatment require hospitalization?

For natal teeth requiring extraction, hospitalization may be necessary if severe infection is present.

Will deciduous teeth erupt after natal tooth extraction?

Since natal teeth are prematurely erupted deciduous teeth, extraction means the deciduous tooth germ no longer exists, so no new tooth will grow, potentially leading to missing deciduous teeth. However, this generally does not affect normal permanent tooth eruption.

Missing deciduous teeth may cause misalignment of other deciduous teeth, so regular dental check-ups are needed to manage spacing and maintain proper occlusion to avoid affecting permanent tooth eruption.

DIET & LIFESTYLE

For babies with natal teeth and neonatal teeth that are retained, what should be noted during breastfeeding?

Natal teeth can easily interfere with sucking and may cause nipple injury, so mothers should adopt proper feeding positions to avoid difficulties or breast injuries.

Choose a quiet environment and find a comfortable sitting or lying position.
Hold the newborn with one hand and support the breast with the other, gently touching the baby’s lips with the nipple to trigger the rooting reflex.
Once the baby opens their mouth, quickly bring their head close to the breast, ensuring they latch onto the entire nipple and most of the areola. Position the nipple above the baby’s tongue, not underneath.
When ending the feeding, insert a finger into the baby’s mouth to release suction before removing the nipple to prevent injury or natal teeth from loosening.

For babies with natal teeth and neonatal teeth, how to manage potential oral ulcers?

Adjusting feeding methods may be necessary.

Natal teeth can cause ulcers on the underside of the tongue and bleeding in periodontal soft tissues. To minimize irritation to the frenulum and tongue, consider using a spoon for feeding instead of direct breastfeeding, reducing mechanical friction from the teeth.

Feeding with a spoon also allows monitoring of tooth mobility and surrounding soft tissues. Seek medical attention if signs of gum trauma or inflammation appear.

How to care for a baby after natal or neonatal teeth extraction?

Maintain oral hygiene by gently cleaning the mouth with a 1:5,000 chlorhexidine solution or saline, especially after feeding.
Monitor the extraction site closely. Seek immediate medical care if redness, swelling, or pus worsens.
Sutures are typically removed 5–7 days post-extraction, followed by continued oral cleaning for a few more days.

What daily care is needed for babies with retained natal or neonatal teeth?

Oral hygiene is crucial. Gently wipe the baby’s mouth daily with gauze to remove milk residue and prevent infections.