neonatal and natal
DESCRIPTION
natal and neonatal teethTRANSCRIPT
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Under guidance of
Dr. Sandeep Tandon Prof & HOD
PRESENTATION
PresenterNikhil Prasad
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Title: Neonatal Tooth—How Dangerous Can it Be?
Journal: Journal of Clinical Pediatric DentistryYear: 2009 Volume: 34
Pages: 59-60
Authors: Mala Kamboj/ Rahul B Chougule
JOURNAL REVIEW
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Massler and Savara suggested that natal teeth are present in the oral cavity from birth; on the other, neonatal teeth erupt during neonatal period, i.e., within 30 days after birth.(1,2)
Incidence of neonatal teeth is very low. In previous studies, it has been estimated to be between 1: 1,000 and 1: 30,000.(3,4)
Natal and neonatal teeth erupt in the same position as that of deciduous teeth in the arch,
- more common in mandibular than maxillary arch, and - more in the incisor region than the canine and molar
regions.
INTRODUCTION
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• Various investigators noted that - 85% erupt in mandibular incisor region, - 11 % in maxillary incisor region, - 3% in mandibular canine region - 1% in maxillary canine and molar regions
INTRODUCTION
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Highlight that these predeciduous teeth can sometimes lead to dangerous consequences about which the general dentist must be aware of and must take prompt action.
AIM & OBJECTIVE
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A 15 day old infant visited the clinics with a large swelling below the chin and high grade fever
Case history : - The mother gave history of single tooth
eruption in the anterior part of lower jaw when he was 7 days old.
- child birth at home - no difficulty in breast feeding - sudden appearance of swelling & increased
within 2-3 days
CASE REPORT
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Clinical examination: 1)A small rudimentary tooth resembling an
incisor was seen attached to the anterior mandibular alveolar ridge loosely by the mucosa.
2)A swelling was present associated with the chin, red in color, filled with pus.
3)The infant had high grade fever and breathing difficulties
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Treatment :Emergency drainage of the abscess to provide
respiratory clearance and Removal of the neonatal tooth was done under
general anesthesiaThe fluid was sent for biochemical evaluation. The extracted tooth was only a crown resembling
incisor with no root formed . A ground section of the tooth showed layers of
normal enamel and dentin The biochemical report stated it to be a sterile
abscess.
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Several terms have been used in the literature to designate teeth that erupt at a much earlier age or those present at birth are called congenital teeth, fetal teeth, predecidual teeth and dentitia praecox (1,2,3)
If the primary teeth erupt during the third to the fifth month of life, they are termed precocious dentition.
Natal teeth are more frequent than neonatal teeth, ratio being approx. 3: 1.
DISCUSSION
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Spouge and Feasby, classified natal and neonatal teeth as mature or immature;
Mature when they are fully developed in shape and comparable in morphology to the primary teeth and
Immature when their structure and development are incomplete
Hebling (1997) recently classified natal teeth into 4 clinical categories:
• Shell-shaped crown poorly fixed to the alveolus by gingival tissue and absence of a root.
• Solid crown poorly fixed to the alveolus by gingival tissue and little or no root.
• Eruption of the incisal margin of the crown through gingival tissue.
• Edema of gingival tissue with an unerupted but palpable tooth.
DISCUSSION
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Etiology : unknownVarious views of investigators- During initiation and proliferation stage excessive
development causes formation of natal teeth- Hyperactivity of osteoblastic cells within the tooth
germ- Superficial positioning of tooth germs during
developmental period- Endocrinal disturbances- Association with various syndromes- Increased rate of eruption during or after febrile states, - Inheritance, congenital syphilis and dietary deficiencies
DISCUSSION
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Morphology : natal and neonatal teeth are conical or normal in size and shape
Color : opaque, yellowish brown
Crowns of these teeth are normal without any radicular portion due to lack of root formation
Ground section: hypomineralized enamel, irregular arrangement of enamel rods, irregular dentino-enamel junction, irregular dentinal tubules, pulp :more cellular and numerous vascular channels
with large pulp chamber (Massler et al,1950; Bodenoff
J,1963)
DISCUSSION
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Complication : 1) When the teeth are not fully erupted, pressure
on them maybe painful (the infant to refuse the nipple)
2) The teeth may lacerate the breasts during feeding.
3) The teeth are loose and movable in the early stages(danger of
aspiration or swallowing)4) Natal teeth may cause sublingual ulcerations
(Riga-Fede)5) Periapical abscess is also possible if enamel
breakdown leads to caries
Treatment may include grinding to smooth the teeth, or in some cases, extraction.
DISCUSSION
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After seeing the serious complications, special care must be taken regarding neonatal teeth
CONCLUSION
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Natal and Neonatal Teeth
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Natal teeth
DefinitionNatal teeth are that group of teeth present at the birth due to abnormal premature development in the dental lamina of primary teeth. They are different from neonatal teeth, which erupt in during the first 30 days after birth.
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Born Heroes
England- children born with teeth will grow into famous soldiers
France and Italy- they will “get on in the world”
Sweeden- they can cure an injured finger if placed in the mouth
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Ill Omen
China- If a baby is born with teeth, it is an ill omen for the family. When the precocious teeth begin to bite, one of the parents will die. If it is a boy, the father, if a girl, the mother.
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Premature death
Denmark- “Old age dentition is a rare thing, just as are children born with teeth” Hallager
Italian and German proverb: “The one whose teeth grow early, will sink early into the grave”
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Even Death
In some native African tribes, the child was put to death shortly after birth, as it was believed that natal teeth not only foretell disaster to the child, but to anyone with whom it comes into contact.
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Epidemiology1:2,000-3,000
More common in American Indian
Natal teeth > Neonatal teeth
>60% family history
♂ : ♀ = 3 to 1
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Frequencies in the mouth (Approximately)
10% Supernumerary Teeth
90% Primary Teeth
85% Lower Central Primary Incisors
11% Maxillary Incisors
3% Mandibular Canines And Molars
1% Maxillary Canines And Molars
To sum up “MORE COMMON AS PREMATURELY ERUPTED PRIMARY TEETH COMMONLY IN LOWER AND ANTERIOR AREA”.
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1. Completely erupted with little or no root.
2. Partially erupted.
3. Swelling of the gum tissue with an unerupted but palpable tooth.
Clinical Presentation
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A- Intra-uterine enviromental factors:
1. Exposure to high levels of chemicals like polychlorinated biphenyls.
2. Infection. 3. Fever.4. Malnutrition including
hypo-vitaminosis.5. Trauma.
Aetiology
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1. Commonly Genetically determined congenital (sometime environmentally determined-CAUSED BY FAULTY PRESSURE AGAINST THE MANDIBLE INTRAUTERINE)
2. Mandibular micrognathia
3. Posterior displacement of the tongue (glossoptosis)
4. Upper airway obstruction
5. cleft palate
6. Mandibular hypodontia in children with PRS can be considered an indicator of an unfavorable long-term mandibular growth pattern.
B- Genetically factors & association with certain syndrome Pierre Robin syndrome
Aetiology , continue
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Chondroectrodermal dysplasia (Ellis-van Creveld syndrome ) Cleft palate
Peg-shaped Spaced Delayed eruption Missing teeth Extra fingers Missing or
deformed nails.
Common among Old Amish population of Lancaster County, USA
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Other rare syndromes are:
Cerebral gigantism (Soto syndrome )
Rare genetic with familial background
Mild mental retardation Hypotonia & macrodontia Macrocephaly
Oculomandibulofacial syndrome (Hallermann-Streiff syndrome )
VERY rare. 200 people with the syndrome worldwide
Commonly supernumerary, natal or hypodontia.
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To the mother: painful bitten or
bleeding nipples.
Complications
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To the infant :
Pain resulting in Malnutrition
Riga-Fede disease (trauma to the tip or undersurface of the tongue)
Inhalation or swallowing Possible development of
dental caries, as the enamel is often absent or poorly developed.
Complications
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1. Paedodontic Consultation .
2. Radiographical evaluation to determine:
The teeth are normal primary or supernumerary teeth
The extent of root development, enamel and dentin
The relationship to other teeth.
Management "leaving them alone, unless they are causing difficulty to the infant and
mother". Massler and Savara
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3. EXTRACTION
Extraction may be considered if the tooth is: supernumeraryvery looseassociated with cleft lip/palate because of
interference with the nasoalveolar molding appliance
Management
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Topical anesthetic creamVitamin K supplement before extraction in a
neonate under the age of 10 days.
NB: Extraction (or spontaneous loss) can be complicated by the development of ‘residual neonatal teeth’
Consideration during extraction1) Use of gauze at back side of mouth or use of
Spencer wells forceps for firm grasp to prevent aspiration
2) Check medical history for sinificant jaundice to prevent post operative bleeding
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4. CONSERVATIVE MANAGEMENT :Grinding/smoothing sharp edges of the
tooth
Composite resin to form a dome shape over the edge
Stomahesive Wafers‡ were used to cover the teeth and provide a smooth surface for the tongue to pass over during suckling. Stomahesive Wafers have the advantage that they are a home treatment which can be applied by the child’s parents.
Changes in feeding technique(use of breast pump or storing of milk)
Management
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Dental hygiene including topical fluoride application, gently wiping the gums and teeth with a clean, damp cloth.
Examine the infant's gums and tongue frequently to make sure the teeth are not causing injury.
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1. Buchanan S, Jenkins CR, Riga-Fedes syndrome: Natal or neonatal teeth associated with tongue ulceration. Case report. Australian Dental Journal 1997; 42: 225-227.
2. de Almeida CM, Gomide MR. Prevalence of natal/neonatal teeth in cleft lip and palate infants. Cleft Palate Craniofac J 1996; 33: 297-299.
3. Dyment H, Anderson R, Humphrey J, Chase I. Residual neonatal teeth: A case report. J Can Dent Assoc 2005; 71: 394–397
4. Ash, Major M.; Nelson, Stanley J. (2003). Wheeler's dental anatomy, physiology, and occlusion. Philadelphia: W.B. Saunders. p. 53.
References