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 Table of Contents  
CASE REPORT
Year : 2013  |  Volume : 3  |  Issue : 2  |  Page : 182-184

Natal tooth in a seven months premature male child: A rare case report


1 Department of Pedodontics and Preventive Dentistry, Surendera Dental College and Research Institute, Sriganganagar, Rajasthan, India
2 Department of Oral Medicine and Radiology, Surendera Dental College and Research Institute, Sriganganagar, Rajasthan, India
3 Department of Oral Pathology and Microbiology, Surendera Dental College and Research Institute, Sriganganagar, Rajasthan, India

Date of Web Publication13-Dec-2013

Correspondence Address:
Kanika G Verma
Department of Pedodontics and Preventive Dentistry, Surendera Dental College and Research Institute, H.H Gardens, Power House Road, Sriganganagar, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-9596.122982

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  Abstract 

The child development from conception through early years of life is marked by many changes. Tooth eruption follows the chronology corresponding to the date, when tooth erupts into the oral cavity. These dates have been established in the literature and are subject to small variations depending upon hereditary, endocrine, and environmental factors. However, the chronology of tooth eruption suffers a more significant alteration in terms of onset and the first tooth or teeth may be present at birth, called as natal teeth. Natal teeth are rare in extremely preterm infants. In this paper we present a rare case regarding the eruption of mandibular natal tooth in a 10-day old, 7-month preterm normally delivered infant.

Keywords: Mandibular incisor, natal teeth, preterm infant


How to cite this article:
Verma KG, Verma P, Singh N, Sachdeva SK. Natal tooth in a seven months premature male child: A rare case report. Arch Int Surg 2013;3:182-4

How to cite this URL:
Verma KG, Verma P, Singh N, Sachdeva SK. Natal tooth in a seven months premature male child: A rare case report. Arch Int Surg [serial online] 2013 [cited 2019 Feb 16];3:182-4. Available from: http://www.archintsurg.org/text.asp?2013/3/2/182/122982


  Introduction Top


The eruption of first tooth in child's oral cavity is associated with a plethora of emotions, but early eruption may sometimes lead to a lot of delusions. The incidence of natal teeth ranges from 1:2000 to 1:3500 live births with female predominance. [1] Natal teeth are rare in extremely preterm infants. [2] Their morphology might resemble normal primary teeth, however, they are often smaller, conical, and yellowish due to hypoplastic enamel and dentin with poor or no root development. [3] Today these teeth are stimulating the interest of both parents and health professionals because of pain on suckling, refusal to feed and their great mobility which raises the concern about the possibility of their being swallowed or aspirated during nursing. The diagnosis of these teeth is based on complete history, physical examination of the infant and by clinical and radiographic findings to rule out whether these are supernumerary or part of normal dentition. Gentle curettage is required to remove the underlying dental papilla and Hertwig's epithelial root sheath to inhibit the root development after the extraction of natal tooth. [4] The aim of this paper is to present a rare case regarding the eruption of mandibular natal tooth in a 10-day old, 7-month preterm normally delivered infant.


  Case Report Top


A 10-day old, 7-month preterm male infant was referred to the Surendra Dental College and Hospital with complaint of mobile tooth in the lower jaw since birth. The child was continuously crying and refusing to suck milk since birth. The child was born normally with no complications during delivery. No significant prenatal illness in the mother. After birth the child refused to suck milk due to pain because of chronic irritation on the ventral surface of tongue from mobile erupted lower tooth. The child was put on Ryle's tube for feeding. He was the first child born to the parents with non-consanguineous marriage. Examination showed that the child was small and weighed 2.6 kg. His vitals signs were normal. Extraoral examination showed no abnormality. Intraoral examination revealed a whitish opaque tooth in mandibular anterior region that exhibits grade III mobility [Figure 1]. The crown size was normal and the gingiva was of normal appearance. There was no history of a similar finding in his family. Based upon the history and clinical examination a provisional diagnosis of natal tooth was made and differential diagnosis of Ellis-van Creveld syndrome, Hallermann-Streiff syndrome and Jadassohn-Lewandowski syndrome were considered.
Figure 1: Intraoral examination revealing a natal tooth in mandibular anterior region

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Hematological examinations including full blood count and clotting profile were normal. Abdominal ultrasound revealed no abnormality. Intraoral periapical radiograph showed a hollow calcified cap of enamel and dentin without root, which excluded it to be a part of normal dentition or supernumerary. Following thorough clinical evaluation a final diagnosis of non-syndromic natal tooth was made. The pediatrician was consulted and tooth extraction was planned. Before extraction, 1 ml of vitamin K was administered intramuscularly as a part of immediate medical care to prevent hemorrhage; and extraction was done under topical local anesthesia, which was well tolerated by patient. The healing of the socket was normal, without any complications, when patient was followed-up after 2 days [Figure 2]. The extracted tooth had a crown but was devoid of roots [Figure 3] and was sent for histopathological examination, which showed enamel rods with a bizarre pattern of atypical dentinal tubules [Figure 4] and incomplete root formation.
Figure 2: Intraoral examination revealing normal recovery

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Figure 3: Extracted tooth having a crown but was devoid of roots

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Figure 4: H & E stained histopathological report revealed that tooth contains enamel rods with a bizarre pattern of dentinal tubules at 40×

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  Discussion Top


At birth the teeth that erupts in the oral cavity, either isolated or in pairs, is known as natal teeth. There are various local and systemic factors that are associated with the eruption of natal teeth. In order to promote a better oral condition, it is necessary to investigate the possible etiology, their association with other pathologies and the related differential diagnosis. [4] Extraction is contraindicated for those natal teeth with good support, as they will probably compound the future deciduous dentition. Hence, it is recommended to establish a thorough differential diagnosis, after a complete oral examination of the newborn. [5] As in the present case, there is a strong predilection for mandibular central incisors to erupt as natal teeth, as they are first to erupt in oral cavity. A better prognosis is considered for mature natal tooth, as timing of eruption is not nearly as important as their degree of maturity. [6] The superior placement of tooth germ is considered to be the prime etiology behind the eruption of tooth in perinatal period, but exact pathogenetic factors are still to be identified. [7] The present case is reported in a male child, who is a 10-day old, 7-month premature child. This is reported to be the 3 rd case to the best of our knowledge. The first case was reported in the neonatal unit of department of Pediatrics, in a baby born at 24-weeks gestation with one natal tooth at the region of the lower central incisors.­ [8],[9] Cizmeci et al., reported the first case of neonatal tooth in male infant at 31-weeks gestation in neonatal division of department of paediatrics. They reported the eruption of neonatal tooth after one week at the region of the left lower central incisor. [9]

Rarely, the natal tooth is found in a preterm baby and especially in a male child. No evidence of hereditary influence, and any congenital defects found in our patient. Based on the hematological and radiological examination, and abdominal ultrasound, the differential diagnosis of Ellis-van Creveld syndrome, Hallermann-Streiff syndrome, and Jadassohn-Lewandowski syndrome were ruled out and the final diagnosis of natal tooth in non-syndromic patient was made. [10]

It is necessary to educate the parents and the medical community regarding the treatment of natal teeth by pediatric dentists. If the natal teeth are not causing any trouble, every effort should be made to retain them in oral cavity. The acute incisal margin can be relieved by smoothing or covering the incisal portion of the natal tooth with photopolymerizable composite resin. [11] Extraction should be indicated only when they interfere with feeding or when they are highly mobile, with the risk of aspiration. The removal should be done shortly after birth while the newborn infant is still in the hospital. Teeth that are stable beyond four months have a good prognosis. [12] Periodic follow-up is indicated to ensure preventive oral health.

The complications during management of natal teeth can be prevented by correct early diagnosis and proper treatment planning. In the present case, removal of natal tooth was indicated with prophylactic administration of vitamin K to avoid the risk of hemorrhage as the commensal flora of the intestine might not have been established until the child is 10-days old, and since vitamin K is essential for the production of prothrombin in the liver. [4] After the extraction, gentle curettage of the socket was done under same anesthesia to ensure the complete removal of cells of dental papilla and Hertwig's epithelial root sheath as root development can continue if these structures are left in situ. [13]


  Conclusion Top


Infants with prematurely erupted teeth must be carefully examined for further treatment planning, and parent counseling to bring about awareness is also equally important. Long term studies are required to substantiate the exact etiology and nature of natal teeth to prove their differentiation from supernumerary teeth.

 
  References Top

1.Goncalves FA, Birman EG, Sugaya NN, Melo AM. Natal teeth: Review of the literature and report of an unusual case. Braz Dent J 1998;9:53-6.  Back to cited text no. 1
    
2.Leung AK, Robson WL. Natal teeth: A review. J Natl Med Assoc 2006;98:226-8.  Back to cited text no. 2
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3.Galassi MS, Santos-Pinto L, Ramalho LT. Natal maxillary primary molars: Case report. J Clin Pediatr Dent 2004;29:41-4.  Back to cited text no. 3
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4.Rao RS, Mathad SV. Natal teeth: Case report and review of literature. J Oral Maxillofac Pathol 2009;13:41-6.  Back to cited text no. 4
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5.Nik-Hussein NN. Natal and neonatal teeth. J Pedod 1990;14:110-2.  Back to cited text no. 5
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6.Alvarez MP, Crespi PV, Shanske AL. Natal molars in Pfeiffer syndrome type 3: A case report. J Clin Pediatr Dent 1993;18:21-4.  Back to cited text no. 6
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7.Masatomi Y, Abe K, Ooshima T. Unusual multiple natal teeth: Case report. Pediatr Dent 1991;13:170-2.  Back to cited text no. 7
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8.Sureshkumar R, McAulay AH. Natal neonatal teeth. Arch Dis Child Fetal Neonatal Ed 2002;87:F227.  Back to cited text no. 8
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9.Cizmeci MN, Kanburoglu MK, Uzun FK, Tatli MM. Neonatal tooth in a preterm infant. Eur J Pediatr 2013;172:279.  Back to cited text no. 9
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10.Chow MH. Natal and neonatal teeth. J Am Dent Assoc 1980;100:215-6.  Back to cited text no. 10
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11.Cunha RF, Boer FA, Torriani DD, Frossard WT. Natal and neonatal teeth: Review of the literature. Pediatr Dent 2001;23:158-62.  Back to cited text no. 11
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12.Anegundi RT, Sudha R, Kaveri H, Sadanand K. Natal and neonatal teeth: A report of four cases. J Indian Soc Pedod Prev Dent 2002;20:86-92.  Back to cited text no. 12
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13.Tsubone H, Onishi T, Hayashibara T, Sobue S, Ooshima T. Clinico-pathological aspects of a residual natal tooth: A case report. J Oral Pathol Med 2002;31:239-41.  Back to cited text no. 13
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


This article has been cited by
1 Nonsyndromic extremely premature eruption of teeth in preterm neonates – a report of three cases and a review of the literature
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Case Reports in Perinatal Medicine. 2018; 7(2)
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2 Natal tooth in preterm newborn: a case report
Jenifer Garcia ROCHA,Lilian Citty SARMENTO,Ana Maria Martins GOMES,Marly Almeida Saleme do VALLE,Elāine Cristina Vargas DADALTO
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