PowerPoint Presentation

Natal & Neonatal TeethUnder the guidance of, Presented by,Dr. Manohar bhat Dr. vishakha mittalDr. Rajesh sharmaDr. Abhishek khairWa

1CONTENTS Definitions History PrevalenceEtiology Clinical features Histological characteristicsRadiographic featuresDiagnosisComplicationsManagementConcernsTooth eruption follows a chronology corresponding to the time When tooth erupts into the oral cavity. These timings have been described in literature and are subjected to small variations depending on hereditary, endocrine and environmental factors.At times, however the chronology of tooth eruption suffers a more significant alteration in terms of onset and the first teeth may be present at the time of birth or arise during the first month of life.2DefinitionsMASSLER & SAVARA (1950)Teeth present at birth are called Natal Teeth (Dentes Connatales).

Those Which erupt during first month are called Neonatal Teeth (Dentes neonatales).

Pre-erupted teeth teeth Which had erupted during the 2nd or 3rd month of life.

HistorySynonyms Congenital teeth Fetal teeth Pre decidual teeth Dentitia praecox

Titus Livius, in 59 B.C., considered natal teeth to be a prediction of disastrous events. Caius Plinius Secundus (the Elder), in 23 B.C., believed that a splendid future awaited male infants with natal teeth In Poland, India, and Africa children born with teeth were murdered soon after birth. The presence of teeth at birth was considered a bad omen by the family of Chinese children. In England, the belief was that babies born with teeth would grow to be famous soldiers

Several terms have been used in the literature to designate teeth that erupt before the normal time s/a -4PrevalenceLow prevalence.Acc to Leung, 1986

Acc to Kates et al, 1984

Almeida & Gomide (1996) Reported high prevalence in Children With cleft lip-palate.

EtiologyPresence of natal & neonatal teeth has been related to several factors s/a Superficial position of the germ Infection or malnutrition Febrile states Eruption accelerated by febrile incidents or hormonal stimulation hereditary transmission of dominant gene Osteoblastic activity inside the germ area Hypervitaminosis

Natal teeth may be associated With some syndromes : Ectodermal Dysplasia Hallerman Steriff Ellis Van crevald syndrome Craniofacial Dystosis Multiple Steacytoma Congenital Pachyonychia Sotos Syndrome Riga Fede Syndrome Pierre Robin syndromeWedemann Rautenstrauch (Neonatal Progeria)(Journal of Oral and Maxillo Facial Pathology Vol. 13 Issue 1 Jan - Jun 2009)

There is no conclusive evidence of a correlation between early eruption and som e systemic condition or syndrome.7Leung (1986) in a 7 year Retrospective study of 50,892 records for children, detected the occurrence of natal teeth in 15 infants, 5 of Whom presented one of the following anomalies : Cleft palatePierre robin syndromeEllis-van Crevald syndromeHypocalcemia With fracture of the ribs & ricketsAdrenogenital syndrome With 18- hydroxylase deficiency.

Various hypothetical etiological factors include :1. Heredity Hereditary transmission of a dominant autosomal gene.Bodenhoff & Gorlin have verified that 15% of children With natal & neonatal teeth had parents, siblings, or close relatives With history of having presented same condition.Massler & Savara (1950) traced hereditary factor in 10 out of 24 cases.Gardener (1971) : 7 out of 19 cases.

2. Endocrine Disturbances Excessive secretion of the Pituitary, thyroid or gonads.

The rate at Which babys teeth come through Will depend on his genetic blueprint, i.e., hereditary transmission of a dominant autosomal gene appears to be an important factor.93. Osteoblastic activity Within the area of the tooth germ could be responsible for eruption Jasmin & Clergeau Guerithault.

4. Infection E.g., Congenital syphilis has varying effects.

5. Nutritional deficiency E.g., HypovitaminosisHypovitaminosis ( Which in turn is caused by poor mental health, Endocrine disturbances, febrile episodes, pyelitis during pregnancy, & congenital syphilis ).

106. Febrile status Fever, Exanthema during pregnancy tend to accelerate eruption.

7. Superficial position of the tooth germ

8. Environmental factors Polychlorinated biphenyls (PCB) & Dibenzofurans Usually show associated symptoms s/a Dystrophic finger nails, hyperpigmentation.Polychlorinated biphenyls (PCB) & Dibenzofurans seem to increase the incidence of natal teeth. These children usually show associated symptoms s/a Dystrophic finger nails, hyperpigmentation.

11ClassificationSpouge & Feasby (1966) classified these teeth clinically according to their degree of maturity. Mature ImmatureMature natal or neonatal teeth nearly or fully developedGood prognosis

Immature natal or neonatal teeth Tooth with incomplete or substandard structure.Poor prognosis.

The terms natal and neonatal teeth proposed by massler and savara Were limited only to the time of eruption and not to the anatomical, morphological, and structural characteristics.Spouge and Feasby recognized the need to classify these teeth.12Classification by Hebling (1997)Hebling (1997) recently classified natal teeth into 4 clinical categories:1. Shell-shaped crown poorly fixed to the alveolus by gingival tissue and absence of a root.2. Solid crown poorly fixed to the alveolus by gingival tissue and little or no root.3. Eruption of the incisal margin of the crown through gingival tissue.4. Edema of gingival tissue with an unerupted but palpable tooth.

If the degree of mobility is more than 2 mm, the natal teeth of category (1) and (2) usually need extraction.

13Clinical Features Gender -Conflicting reports.No difference in prevalence between males and females.Females > males (kate et al) 66% F : 31% M.

Natal teeth > Neonatal teeth ( 3X)

With respect to gender, there Was no difference in prevalence between males and females.

However some authors have cited predilection for females.Kates et al (1934) reported a 66% proportion for females against a 31% proportion for males.14 Site According to Bodenhoff & Gorlin (1963),Mand CI (85%) > Maxillary incisors (11%) > Mandibular cuspids or molars (3%) > Max cuspids or molars (1%).An unusual case of a newborn with two immature natal maxillary molars Was presented by Marlei Seccani Galassi et al in 2008. More frequently Bilateral.

Clinical Appearance May be conical or normal in shape and size. Immature appearance Enamel hypoplasia Small root formation Opaque yellow brownish in color.

Natal teeth With severe mobility indicated for extractionNatal teeth With mild mobilityNatal tooth in a premature infant. The extrinsic stain was caused by ferrous sulfate ingestion (case 21).Natal tooth with an irregular incisal edge that caused Riga-Fede diseaseAnd F. Neonatal teeth. (18th day of life)16Histological CharacteristicsENAMEL Covered with hypoplastic enamel with varying degrees of severity.

Friend et al (1991) alteration in Amelogenesis was detected d/t premature exposure of tooth to the oral cavity, which resulted in the metaplastic alteration of the epithelium of the normally columnar enamel to a stratified squamous configuration.

First report on microscopic observation of natal and neonatal teeth Was done by HoWkins (1992)

Most of the croWns of natal and neonatal teeth are covered by hypoplastic enamel With varying degress of severity.17

Ground section of natal toothMicroradiograph of natal toothGround section of natal toothDemineralized H and E ground sectionA break in the continuity of normal enamel formation is seen. In the cervical area irregularly formed osteodentin appearing as a spur is observed.The spur is covered by an outer layer of about same radiodensity as the enamel,Enamel lacks prism structure apical dentin exhibits an irregularly formed hard tissue of osteodentinal character in which enclosed cells can be observed18DENTIN Hawkins(1992) observed normal dentin, except for certain irregular Irregular interglobular areas with structures resembling osteodentinAtypical arrangement of dentinal tubules-nce of root development

PULP Large pulp chamberWider radicular canalsWeils zone and cell rich zone are missing.

In different areas of dentin, tubules 20-30 nm in diameter can be observed,Micro r/g - Arrows indicate an area of irregularly formed osteodentindentinal zone (black arrow) with an increased mineral content situated pulpal to carious lesions20Radiographic featureshollow calcified cap of enamel and dentin Without pulp tissue.Like a celluloid crown.

DiagnosisDsis is based on Complete history Radiographic findings Presence of tooth germ of primary dentitionComplications Risk of dislocation and aspiration Traumatic injury to babys tongue Interference With breast feeding and traumatic injury to maternal breast.

ManagementIf the erupted tooth is diagnosed as a tooth of the normal dentition Maintenance - 1st treatment option When Well implanted should be left in the arch. smoothening of the incisal margin Martins et al (1998) Goho (1996) covering incisal portion of the tooth With composite resin.

Teeth extraction is indicated if, supernumerary poorly implanted excessively mobile traumatic injury babys tongue &/or maternal breast.In the decision of maintaining or not these teeth, some factors should be considered Implantation and degree of mobilityInconveniences during sucklingPossibility of traumatic injuryWhether the tooth is part of the normal dentition or is supernumerary.24Hals, Zhu and King, Water et al no relationship btw Wounding of the mothers nipple and +nce of natal teeth.Only babys tongue is injured.

This condition 1st described by, Caldarelli in 1857 in association with general organ failure in a child followed by death.

Riga and Fede histologically described the lesion.RIGA FEDE Disease.

If treatment option is extraction Can be removed with forceps or even with fingers. Topical anesthetic Adequate soft tissue anesthesia gentle curettage is recommended. (Risk of residual tooth formation 9.1%)

Curettage is recommended to ensure that the underlying dental papilla and HERS are removed, as root development can continue if these structures are left in situ.26Precautions during extraction Avoid upto 10th day of life. Assess the need to administer vit K Consider general health condition of the baby. Avoid unnecessary injury to the gingiva Risk of aspiration during removal Be alert.

Rusmah (1991) tooth extraction is contraindicated in newborns.Administration of vit K before the procedure permits safe removal.

If not possible to wait Vit K ( 0.5 1.0 mg ) is administered intramuscularly.This Waiting period before performing tooth extraction is due to the need to Wait for the commensal flora of the intestine to become established to produce vit K, Which is essential for the production of prothrombin in the liver.Thus it is safer to Wait until a child is 10 days old before extraction.27Natal/Neonatal tooth Treatment1. Is the tooth supernumeraryTake a radiograph When possibleNoYes2. Does the tooth present severe mobilityExtractionNoYesExtraction3. Does the patient present With Rega Fede disease or does the mother present With an ulcer on the breast?YesNoMaintenance With edge recontouringMaintenanceConcerns Premature loss of a primary tooth loss of space for the permanent tooth (Leung 1986)

need for prevention of dental caries by controlling bacterial plaque

periodic fluoride application CONCLUSIONNatal and neonatal teeth are rare events in the oral cavity.

The decision to keep or to extract a natal and/or neonatal tooth should be evaluated in each case. Radiographic examination is an essential auxiliary tool for the differential diagnosis between supernumerary primary teeth and teeth of the normal dentition.

Periodic follow-up by pediatric dentists is of fundamental importance.References1. Robson Frederico Cunha, Dr. Farli Aparecida Carrilho Boer Dr. Dione Dias Torriani, Dr. Wanda Terezinha Garbeline Frossard. Natal and neonatal teeth: review of the literature. Pediatric Dentistry 23:2, 20012. GORAN ANNEROTH, GORAN ISAGSSON, ANN-MARIE LINDWALL AND GORAN LINGE. Clinical, histologic and microradiographic study of natal, neonatal and pre-erupted teeth. Scand.J. Dent. Res. 1978: 86: 58-66.3. Lcia Ftima Almeida Deus Moura et al. Natal and Neonatal Teeth: A Review of 23 Cases. Journal of Dentistry for Children-81:2, 2014.4. Roopa S Rao, Sudha V Mathad. Natal teeth: Case report and review of literature. Journal of Oral and Maxillo Facial Pathology Vol. 13 Issue 1 Jan - Jun 2009.5. Dentistry for the child and adolescent- Dean, McDonald, Avery

THANK YOU