1. Dental assessment

a. Mobility: Tooth mobility >1 mm is usually an indication for the extraction of the natal/neonatal tooth.

b. Color and shape of tooth: Discoloration and abnormal morphology indicate an immature natal/neonatal tooth, which usually will require removal.

c. Root formation: This can be assessed with a dental

radiograph. However, a loose tooth is likely to be

lacking in root structure and is likely to exfoliate

spontaneously and early, with the risk of aspiration.

2. Soft tissue assessment

a. Ventral surface of the tongue: Riga-Fede disease is

the term given to an ulcerative granuloma formed

Table 55.1 Hebling Classification of Natal

Teeth

1. Shell-shaped crown poorly fixed to the alveolus by gingival tissue with

absence of a root

2. Solid crown poorly fixed to the alveolus by gingival tissue with little or

no root

3. Eruption of the incisal margin of the crown through the gingival tissue

4. Edema of gingival tissue with an unerupted but palpable tooth

Table 55.2

Conditions Associated with

Higher Incidence of Natal/

Neonatal Teeth

Ellis-Van Creveld syndrome

Hallermann-Streiff syndrome

Craniofacial synostosis

Multiple steatocystoma

Congenital pachyonychia

Sotos syndrome

Cleft palate

Pierre Robin anomalad

390 Section IX ■ Miscellaneous Procedures

on the ventral surface of the tongue. It results from

irritation of the tongue by the sharp margins of the

mandibular incisor.

b. Gingival tissue: Gingival tissue adjacent to the natal/

neonatal tooth should be examined for presence of

inflammation or granulomatous lesion, caused by

irritation by the sharp cervical margins of an immature tooth.

3. General assessment

Table 55.2 lists the systemic conditions associated

with higher incidence of natal/neonatal teeth. They

should each be ruled out to ensure that a pre-existing

medical condition is not overlooked.

D. Precautions

1. Keep in mind that the initial question in management

of natal teeth is whether extraction is indicated.

Indiscriminate extraction of natal/neonatal teeth is discouraged (14).

2. Natal and neonatal teeth should be differentiated from

cystic lesions such as Bohn nodules and Epstein pearls,

by palpation and location in the infant’s mouth. Bohn

nodules and Epstein pearls are firm and have a smooth,

rounded surface. There will usually be several nodules/

pearls, and they may be located on the posterior palate

or mandibular ridge.

3. Prior to extraction, it must be confirmed that the patient

has received the appropriate dose of vitamin K at birth

(12). There has been one report of difficulty in achieving hemostasis by local pressure after the extraction of

natal tooth. This patient received microfibrillar collagen hemostat over the extraction site (3). Current literature supports the extraction of the natal tooth at

10 days or later after birth, unless there is significant risk

of aspiration (11).

4. A detailed family history should be obtained, to rule

out inherited coagulopathy.