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Dental Care for Children

Karlynn Sievers, MD and Paul Simmons, MD
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Many of the children we see in practice will have never seen a dentist, or may not have access to one. In order for us to feel more comfortable with children’s dental health, Paul interviews Dr. Karlyyn Sievers about how to perform a pediatric dental exam and what advice we should give.

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Heather W. -

This is a very interesting topic. I have a couple of other questions to add, that I think would make an interesting topic to review as well, natal teeth. As a provider myself I had never thought about them or seen them, nor was educated about them, and then low and behold, I have a child with natal teeth which raised a lot of questions.
-Why and how? When to test for genetic disorders?
-How to treat? Do you brush them? Do they need fluoride? Can fluoride be present in breast milk? When to remove or file? How to check them? Do they need a dental appt, how often?
-With feeding issues, biting and tongue ulceration, what is the best way to manage? How to combat bottle refusal, perceived pain?

Neda F., MD -

Hi Heather! Here is Dr. Sievers' reply:

"Natal teeth are rare (estimated 1:2000 to 1:3500 infants), and are most often due to premature eruption of the primary deciduous teeth, rather than supernumerary teeth. They are often smaller than primary deciduous teeth, with hypoplastic enamel and dentin and poorly formed roots, and as a result, many are mobile. There are two types - natal (teeth present at birth), and neonatal (present in the first 30 days of life). There are many theories as to why these may occur, including hormones, trauma, hypovitaminosis, etc. However, the current theory favors superficial positioning of a developing tooth germ, leading to premature eruption of the tooth.

Teeth that are very mobile or have poor root structure can spontaneously fall out, leading to aspiration of the tooth. They can also lead to discomfort while suckling, ulceration of the tongue, and laceration of mother's breasts in breastfeeding mothers. Therefore infants with natal/neonatal teeth should have a dental X-ray (ideally in the neonatal period) to distinguish supernumerary teeth from primary deciduous teeth, as well as a consultation with a pediatric dentist. Teeth that have poorly formed roots or that are symptomatic usually require extraction, and of course this should be done by a pediatric dentist comfortable in the technique. For infants that require extraction of natal teeth, parents should be strongly encouraged to accept vitamin K administration to prevent bleeding complications.

Teeth that are asymptomatic and not mobile do not require extraction. These teeth should be treated as all other primary teeth - they should be brushed twice daily, examined by a dentist every 6 months (or more frequently if recommended by a dentist), and fluoride varnish should be applied every 6 months (for children at lower risk for caries) or every 3 months (for children at higher risk for caries).

While there are some syndromes associated with natal teeth, most natal teeth are idiopathic. Therefore, unless the infant has other features leading to concern for a genetic syndrome, no additional testing for genetic disorders needs to be done.

Hope this is helpful!"

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Hippo Primary Care Written Summary September 2021 751 KB - PDF

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