Clinical perspectives on premature tooth eruption and cyst formation in neonates

Premature eruption of teeth occurs in 1 of every 2,000 births. The reported association between natal teeth and serious, rare, inherited syndromes suggests that particular caution should be exercised in examination of newborns having prematurely erupted teeth. The ectomesenchyma, from which the orofacial structures develop, undergoes a complex, coordinated series of steps of proliferation and differentiation during the first two months in utero. At approximately seven weeks the presumptive mandibular and maxillary arches show a bandlike ectodermal thickening called the dental lamina. Odontogenesis (tooth development) begins with budding of the dental lamina and continues into the second week of life. Remnants of odontogenic epithelium or of epithelium covering the embryonic facial processes may develop into cystic structures, causing intraoral swellings on the alveolar ridges or palate (i.e., Bohn's nodules and Epstein's pearls). Prematurely erupted natal and neonatal teeth are generally normal deciduous incisors. Hypermobility of these teeth, resulting from poorly formed roots, may stabilize within a short period of time. Extraction of natal and neonatal teeth should not be done precipitously.