Abstract

This case report is about a newborn that was delivered with two incisor teeth, which was met with mixed reactions from the local hospital staff. The mother, however, despite the talk that was all over the community heed to the medical advice and the child was thus well managed. The purpose of this case report is to review the myths and misconception surrounding natal teeth and the management of natal teeth.

Introduction:

The eruption of the first teeth of a child – known as the milk teeth – normally occurs at an average age of 6 months. There is a great variation of the time of teeth eruption, however, with some children getting eruption at 3½ months while in others eruption is delayed until they are one year old. Natal teeth, however, are very rare and when they are encountered there are several myths and misconceptions attached. Not so much, if any, is written about natal teeth in obstetric and midwifery text books yet nurses/midwives and doctor on maternity wards are usually the first health personnels to see these children with natal teeth sometimes even before the mothers are able to see inside the children’s mouths. Their reaction to natal teeth, you can imagine, is not different from that of lay-people due to their ignorance about the condition.

Case:

A male infant was delivered by caesarean section in Nkokonjeru Mission Hospital. The infant had good Apgar scores both at 1 and 5 minutes. Routine examination in theatre revealed two “incisor” teeth in the anterior mandibular jaw. The teeth were loose and rather mobile.

Figure 1 Newborn with two incisor teeth in the lower jaw

This was the first baby I delivered with natal teeth during my 15 years of medical practice and it was also the first in the history of this mission hospital as well, indicating the rarity of the condition. The teeth were left un-interfered; the baby was bottle-fed with formula milk for PMTCT purposes. The teeth became looser with time and at the age of 45 days they fell out. He later had normal eruption of “milk teeth” at the expected time and now, at 6 years, he is doing very well.

Figure 2 Same child as in figure 1 pictured at age 6 years

Literature review

When teeth are present at the time of birth they are called natal teeth while those that erupt within 30 days are referred to as neonatal teeth. Natal teeth are more frequent, approximately three times more common, than neonatal teeth.

Prevalence

The prevalence of natal teeth seems to vary from one geographical location to another. In one study Kate GA et al found the prevalence of natal teeth to be 1 in 3667 while Segaya NN et al found a prevalence of 1:600 to 1:800.

Incidence

The reported incidences vary greatly from those of Mayhall at 1:11 and Gordon at 1:100 through those of Massler and Savara, Gardiner, Spouge, all at 1:2000; down to those of Ballantyne at 1 in 6000 births, and Howkins at 1:10,000 ̒ . In their study Alexaner KC et al found an incidence of 1:3000 to 1:2000

Myths associated with natal teeth:

Myths can be defined as stories handed down from olden times containing the early beliefs of a race, it is a beliefs or an idea that is not based on correct information.

Misconception is based on in accurate information. This definitely needs to be addressed as action will be based on wrong information- with often dear consequences.

The misconceptions and myths surrounding natal and neonatal teeth vary; in some cultures a natal tooth is believed to herald good fortune, while in in others like some of the African community, its occurrence is considered to be bad omen. The affected child is considered to be a monster and bearer of misfortune in that specific family . Similar to African communities, in China, Poland and India, the affected children were considered to be monsters and bearers of misfortune. The child and its mother were condemned as evil because of teeth in the baby’s mouth. The mother could even be accused of having slept with a snake, just because of the teeth in the baby’s mouth .

Many hundred years ago, babies that were born with teeth would be tragically put to death because they were thought to be demons. Some literature shows that in many African tribes, children born with teeth were killed soon after birth because they were believed to bring misfortune to the community.

Some cultures believes that children born with two teeth is prediction that the child will be strong, fierce and harsh, but without fear . In Countries like England – it was believed that a child born with teeth would grow into a famous soldier . In Malaysian communities, a natal tooth is believed to herald good fortune.

Shakespeare contributed his thoughts on natal teeth in ‘King Henry the Sixth,’ when he referred to Richard the Third in his quotation “teeth hadst thou in thy head when thou wast born to signify thou camest to bite the world”. In England, the belief was that this condition would guarantee the conquest of the world13.

In France and Italy- it was thought that a child born with teeth would get on in the world; In German – The person will die early or will sink early into grave; In African tribes- natal teeth are foretell disaster to the child, and also to anyone with whom it comes into contact with the baby¹¹

Management of natal teeth:

In this case the baby was born in the African community and was accepted by the parents who farther adhered to medical advice and gave him the appropriate care. What was done for this infant is what many recommend i.e. leaving the natal teeth until a time when they cause discomfort to the child or the mother; or until they become so loose to drop out. Many children like this one in African communities, however, have lost their lives because of the myths associated with natal teeth. Some have had their lives intentionally cut short by infanticide while others have succumbed from infections resulting from crude methods of removing the teeth. Myths are difficult to address as they are stories that have been carried on over the years. We believe that, where the teeth do not harm, myths should be left alone. People often learn the truths about the myths later in life and choose to drop or perpetuate them for whatever benefits. In his article, Martinez CR gives the following recommendations in the management of natal teeth: 1. Obtain dental radiographs whenever possible before removing natal teeth in order to better advise the parents of complications. 2. Leave natal teeth in the mouth as long as possible in order to decrease the likelihood of removing permanent tooth buds with the natal tooth. 3. Obtain the parents' consent and rule out neonatal hypoprothrombinemia before removing natal teeth. 4. Recommend postoperative evaluation by a pedodontist in order to obtain diagnostic radiographs and necessary treatment.

According to Alexander K.C. Leung et al , if the tooth does not interfere with breastfeeding and is otherwise asymptomatic, no intervention is necessary. Tooth extraction is indicated if the tooth is supernumerary or if the tooth is poorly implanted and excessively mobile, which is associated with a risk of aspiration.

Conclusion:

Bad myths about natal teeth should dispelled whereas the good ones should be upheld. No interference should be made with natal teeth until they interfere with breastfeeding or they become a health hazard to the baby.