Natal Teeth

Rini Sahewalla, MD
Children’s Hospital of Michigan, Detroit

This healthy newborn was noted to have 2 natal teeth fully encased by the lower gums. The teeth had a fair amount of mobility anteriorly and posteriorly. The mother said that when the infant’s tongue moved during breastfeeding it pressed the teeth against her nipple causing pain.

Natal teeth erupt most commonly in the mandibular incisor area and rarely in the maxillary incisor area and canine or molar regions. They often present in pairs. The reported incidence is 1 in 2000 to 6000 births.1 Natal teeth are usually part of the primary dentition and poorly attached to the bony structure; they often feel free-floating in the gum line because of an underdeveloped root system. The tooth enamel is hypoplastic and soft. This is unlike neonatal teeth, which erupt during the first 30 days after birth, have a firm root structure, and are more securely anchored.

Although often an isolated finding, natal teeth may be associated with certain syndromes2:

Ellis-van Creveld syndrome (chondroectodermal dysplasia).

Hallermann-Streiff syndrome (oculomandibulofacial syndrome with hypotrichosis).

Pierre Robin syndrome.

Soto syndrome (cerebral gigantism).

Natal teeth may cause irritation and injury to the infant’s tongue and pain for the mother during breastfeeding. Highly mobile natal teeth are often extracted shortly after birth to reduce the risk of aspiration.3 Referral to a pediatric dentist may be needed in some infants, such as those with tongue injury or bleeding.4 Asymptomatic teeth that do not interfere with breastfeeding require no treatment.