Neonatal tooth: Will it cause future problems?

Our daughter had a tooth when she was born. The doctor called it a milk tooth, and eventually the tooth fell out. Now her baby teeth have come in with a gap where her milk tooth used to be. Will this gap remain when her adult teeth come in, or will a tooth replace it?

Question:

Occasionally a child is born with teeth. Teeth can also erupt early -- within the first 30 days of life. These are called natal teeth and neonatal teeth, respectively.

Most commonly, there are only one or two natal/neonatal teeth in the lower anterior area, although more can be present in other areas of the mouth. The presence of natal or neonatal teeth in the posterior region is not common and may be associated with systemic conditions or syndromes.

These teeth are usually the normal primary incisor teeth erupting early. Due to this early eruption, the tooth will not be fully developed. While the majority of the crown will be formed, the root structure is not normally present; therefore, a natal or neonatal tooth will be mobile.

If the mobility is not too severe, the tooth may become firm on its own and can be left alone. Excessive mobility may lead to exfoliation of the tooth, as in your daughter's case. If the tooth is excessively mobile and has not exfoliated, parents should consider having the tooth extracted to avoid aspiration or ingestion of the tooth. If the tooth is extracted, care needs to be exercised to extract the entire tooth.

If only the crown is extracted with pulpal tissue (nerve and blood vessels present in the tooth) left behind, dentin (the layer of tooth structure underneath the enamel) and root structure may subsequently form. If this occurs, root removal may be required in the future.

Because natal and neonatal teeth are usually normal primary teeth, a new primary tooth will not replace them once they are lost. In the anterior region of the mouth, this premature loss of the primary tooth does not typically result in problems with the permanent teeth. In the posterior region, maintenance of space for the permanent teeth to erupt normally should be considered.

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