Management of an Infant with Natal Canine: An Unusual Case Report and Review
Corresponding Author: Charan T Vemagiri, Department of Pedodontics & Preventive Dentistry, Dhanalakshmi Srinivasan Dental College, Perambalur, Tamil Nadu, India, Phone: +91 9553886588, e-mail: firstname.lastname@example.org
Received on: 21 May 2023; Accepted on: 15 June 2023; Published on: 23 August 2023
Aim and background: The eruption of teeth in a particular pattern corresponds to the child’s chronological age. However, factors like hereditary, endocrine disturbances, environmental conditions, and superficial positioning of tooth buds mark a significant alteration in the pattern of the eruption of teeth resulting in natal and neonatal teeth.
Case description: A 6-day-old female child reported a chief complaint of a hard tooth-like structure in the maxillary anterior region. Clinical and radiological investigations confirmed the diagnosis of type II natal canine. Upon parent approval, extraction was performed under local anesthesia after administering supplementary vitamin K. Follow-up revealed no postoperative complications.
Conclusion: Extraction is inevitable when the natal tooth is mobile, and administration of vitamin K is mandatory if performed before 10 days of age.
Clinical significance: Counseling parents to alleviate their anxiety and educating the parents and pediatricians about such teeth will help in reporting more cases.
How to cite this article: Reddy R, Vemagiri CT, Thote K, et al. Management of an Infant with Natal Canine: An Unusual Case Report and Review. J South Asian Assoc Pediatr Dent 2023;6(1):99-102.
Source of support: Nil
Conflict of interest: None
Keywords: Case report, Natal canine, Natal teeth, Supernumerary teeth.
Natal and neonatal teeth, termed by Massler and Savara, which erupts at birth and within 30 days after birth, respectively, are uncommon. However, the appearance of such rare teeth can be extremely disruptive to the child’s psychological and nutritional needs and the mental health of parents too.1 These teeth were also labelled as dentitia praecox, dens connatalis, congenital teeth, fetal teeth, early infancy teeth, predeciduous teeth, and precocious dentition in the literature.2
Most natal and neonatal teeth (90%) represent primary dentition’s early eruption, while <10% are of supernumerary origin.3 Documented literature showed the incidence range of natal and neonatal teeth from 1:2000 to 1:3500 depending on the population studied and data collected (Table 1).4 Moreover, natal teeth were found to be more frequent than neonatal (3:1), with a slight female predilection.5
|Study reported||Year||Incidence||Sample size|
|Massler and Savara||1950||1:2000||6,000|
|Bodenhoff and Gorlin||1963||1:3000||–|
|Kates et al.||1984||1:3667||18,155|
|Alaluusua et al.||2002||1:1000||34,457|
|El Khatib et al.||2005||1:3400||17,000|
Source: Mhaske et al., 20134
Evident literature detailed that the mandibular incisal areas are the most common site of eruption (85%), followed by the maxillary incisors (11%), the mandibular canine and molars (3%), and the very rare maxillary canine and molar region (1%).2 The present case report highlights clinical characteristics, therapeutic strategy, radiological diagnosis, and postoperative monitoring of one such uncommon natal tooth presence in the maxillary canine region of a 6-day-old infant.
A 6-day-old female infant with a complaint of an upper mobile front tooth visited the pediatric dentistry department with her mother. The infant was underweight and delivered via C-section by a primi mother (2.4 kg). Despite a history of oligohydramnios during the latter stage of gestation, the mother and infant seemed to be in quite good health. Her parents and family’s background did not contribute to any preventive genetic or syndromic propensity.
The mother gave a history of the presence of the tooth since birth. Upon clinical examination, the infant’s maxillary canine region revealed a grade II mobile natal tooth (Fig. 1). Its surface is smooth with a milky white appearance. No ulceration of the ventral surface of the tongue was observed. This clinical finding was confirmed by an intraoral peri apical radiograph with a diagnosis of type II natal tooth according to Hebling et al. (Table 2).6 Radiograph also elicited the confirmation that it belongs to a set of primary dentitions (Fig. 1). Given the baby’s significant risk of aspiration, the decision to extract the tooth outweighed the option of retaining it. A complete blood picture and platelet profile showed normal values.
|Type I||Shell-shaped crown poorly fixed to the alveolus by the gingival tissue and absence of a root.|
|Type II||Solid crown poorly fixed to the alveolus by the gingival and little or no root.|
|Type III||Eruption of the incisal margin of the crown through the gingiva|
|Type IV||Edema of the gingiva with an unerupted but palpable tooth|
Source: Hebling et al., 1997
The infant received prophylactic vitamin K (1 mg IM), and careful asepsis was followed for the extraction. The clinical chairside procedure was explained to the mother, and consent was obtained. The mother gently charmed and comforted the infant while also applying a Pro Gel B topical anesthetic gel (Septodont Healthcare India Pvt. Ltd, Maharashtra, India). A 2% lignocaine and adrenaline (Neon Laboratories Ltd, Mumbai, India) injection was given as local infiltration at the extraction site. The tooth was then extracted with forceps while a gauze piece acted as pharyngeal guard lingual to the extraction site, and the socket was cleaned out by curettage to eliminate any remaining odontogenic cells (Fig. 2). After achieving successful hemostasis, postoperative instructions were delivered. After 3 days and 1 week, recall and evaluation revealed a healed maxillary canine socket.
Natal and neonatal teeth are a rare anomaly that is not only associated with parental anxiety and a child’s nutritional demand but also linked to superstitions and social stigma among various ethnic groups. The natal maxillary canine reported in the current case report marks rarity in terms of site as well as incidence.4
Greater frequency of reporting of natal teeth than neonatal teeth can be attributed to the pediatrician’s knowledge and diagnosis of such teeth, as pediatricians are the first persons to examine the newborn child rather than pediatric dentists. While neonatal teeth were accidentally discovered by the mother during lactation.1
The incidence of these teeth was reported in pairs in the published scientific documentation, contrary to the isolated maxillary canine reported in the current case report.1,2 This might be due to the number of canines present in the deciduous dentition as well as the eruption time of incisors. Literature research suggested a slightly higher female predilection of these teeth which is true in the present documented female child.1-5
Despite various theories documented, the etiology of natal and neonatal teeth is still unclear. The deciduous tooth germ’s peripheral location with accelerated proliferation is the most agreed theory by many authors, which is, in turn, associated with the hereditary factor.2,3,5 Contrary to this, present child does not have any familial inheritance history.
Natal and neonatal teeth differ from supernumerary teeth in terms of both clinical and radiographic characteristics. Clinically, these teeth appear small, mobile in conical shape or resemblance normal teeth (depending on the degree of maturity) with whitish opaque or yellowish discoloration and hypoplastic.2-4 Similar clinical features were reported in the present case. Furthermore, radiographs not only provide information about the presence/absence of corresponding deciduous tooth buds but also the root development and its attachment to the gingiva.2 The mobility observed in the current case, in unison with other reports in published literature, may further compromise the root development by degeneration of Hertwig’s epithelial root sheath and changes in the cervical dentin, pulp cavity, and cementum.2,4 Hypoplasia of natal and neonatal teeth was also linked to premature exposure to the oral cavity resulting in metaplastic alterations of enamel epithelium.3
Furthermore, the decision of whether to retain or remove the natal and neonatal teeth should be carefully considered and discussed with the parents about risks and complications (degree of mobility, implantation, and type of dentition to which tooth belongs).3,5 Its significance must be stressed to the mother because it is linked to inadequate nourishment, infant lip and tongue lacerations, breast mutilation, and infant hypoxia (Riga-Fede disease).1 Treatment approaches were described in the flowchart (Flowchart 1). These teeth can be retained if they are of primary dentition with good implantation, no mobility, asymptomatic and nonproblematic to breastfeeding. However, if they are supernumerary or mobile with a risk of aspiration and displacement from the oral cavity, interfering with breastfeeding, extraction is the treatment of choice.7 Surprisingly, no report was published in the literature about the aspiration of natal or neonatal teeth except by Bigeard et al., who reported only the hypothetical possibility of aspiration by a 28-day infant.8
Furthermore, two treatment options were considered in the case of Riga-Fede disease, that is, rounding of sharp incisal edges followed by application of composite resin if there is mild irritation on the tongue with grade I mobility and no difficulty in breastfeeding.2,3 Extraction is preferred if the tooth is highly mobile (as in the present case), with compromised breastfeeding and creating discomfort to the child as well as injuring the mother’s breast.2,3,5-7
It is advisable to delay the extraction until the child reaches the 10th day which helps the commensal intestinal flora to establish and produce vitamin K, which prevents prothrombinemia. If extraction is inevitable, the administration of supplementary vitamin K (0.5–1 mg) intra muscular should be done to prevent any hemorrhage risk.2,5 Further curettage of the socket should be performed as in the present case report to prevent the development of the residual odontogenic remnants and dental papillary cells in the socket as described by Ooshima et al. and Tsubone et al.1,9,10
Follow-up of extracted natal and neonatal children is of utmost importance as the extraction of such teeth might result in loss of space and may result in permanent teeth crowding.
It is necessary to do a complete family history, radiography, and clinical presentation for diagnosis. In order to protect the baby’s health, development, and growth, the treatment approaches must be carefully communicated to the parents and should be carried out judiciously.
Creating awareness among pregnant women through various media sources will help in reducing the anxiety associated with natal and neonatal teeth. Moreover, educating the pediatricians will help in reporting more such cases as well as in formulating better treatment approaches.
Charan T Vemagiri https://orcid.org/0000-0001-9940-802X
6. Hebling J, Zuanon AC, Vianna DR. Dente natal–a case of natal teeth. Odontol Clin 1997;7:37–40.
8. Bigeard L, Hemmerle J, Sommermater JI. Clinical and ultrastructural study of the natal tooth: enamel and dentin assessments. ASDC J Dent Child 1996;63(1):23–31.
9. Ooshima T, Mihara J, Saito T, et al. Eruption of tooth-like structure following the exfoliation of natal tooth: report of case. ASDC J Dent Child 1986;53(4):275–278.
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