Year : 2005 | Volume
: 23 | Issue : 1 | Page : 51--52
Sublingual traumatic ulceration due to neonatal teeth (Riga-Fede disease)
Department of Pediatric and Preventive Dentistry, Modern Dental College, Indore, India
The term Riga-Fede disease has been used historically to describe traumatic ulceration that occurs on the ventral surface of tongue in neonates and infants. It is most often associated with natal and neonatal teeth in newborns. A case of Riga-Fede disease is presented.
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Hegde R J. Sublingual traumatic ulceration due to neonatal teeth (Riga-Fede disease).J Indian Soc Pedod Prev Dent 2005;23:51-52
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Hegde R J. Sublingual traumatic ulceration due to neonatal teeth (Riga-Fede disease). J Indian Soc Pedod Prev Dent [serial online] 2005 [cited 2019 May 25 ];23:51-52
Available from: http://www.jisppd.com/text.asp?2005/23/1/51/16031
Traumatic ulceration on the ventral surface of the tongue is most commonly associated with natal or neonatal teeth in newborns., It may also occur in older infants after the eruption of primary lower incisors with repetitive tongue thrusting habits and in children with familial dysautonomia (in sensitivity to pain).
Typically the lesion begins as an ulcerated area on the ventral surface of the tongue with repeated trauma, it may progress to an enlarged, fibrous mass with appearance of an ulcerative granuloma. It may interfere with proper suckling and feeding and put the neonate at risk for nutritional deficiencies. In such instances, dental intervention may be required.
A twenty eight day old female was referred for evaluation of an ulcerated area on the ventral surface of the tongue [Figure 1]. The mother complained of child exhibiting pain during suckling and would not nurse.
Oral examination revealed two crowns in the mandibular anterior region, whitish in color and exhibiting grade II mobility in central incisor position. The ventral surface of tongue showed 5 mm x 10 mm ulceration that extended from anterior border of the tongue to lingual frenum [Figure 2]. On palpation, area elicited a pain response from the patient.
Examination of the rest of intraoral mucosa revealed no other lesions. Radiographic examination revealed a neonatal tooth, probably, a primary incisor, with well-formed crown but minimal root development. Based on clinical findings diagnosis of "Riga-Fede" disease was made.
Extraction of the teeth was chosen as treatment of choice over more conservative treatment which slows healing. Extraction was carried out under topical local anesthesia, which patient tolerated well. Patient was reviewed after ten days and the lesion was fully resolved. Mother informed that infant was feeding normally.
For the past two hundred years, many reports of infants born with teeth or teeth erupting immediately after birth have appeared in the medical and dental literature. These teeth have been referred as 'Natal teeth', 'congenital teeth' and precocious dentition (Mayhall and Badenhoff)., In modern dental literature, most satisfactory terminology has been defined by Massler and Savara. Natal teeth indicates teeth present in oral cavity at birth and 'neonatal teeth', those which erupt during the neonatal period i.e., from birth to thirtieth day of life. Neonatal teeth often present with hypoplastic enamel and underdeveloped roots, with resultant mobility.
Major complication from neonatal teeth is an ulceration on the ventral surface of the tongue caused by tooth's sharp incisal edge. Constant trauma may create ulceration sufficient to interfere with proper suckling and feeding and put the neonate at risk for nutritional deficiencies.
The lesion was first described by Antonio Riga, an Italian physician in 1881. Histologic studies and additional cases were subsequently published by F. Fede in 1890. It has been subsequently been known as "Riga-Fede disease".
Treatment of Riga-Fede disease has varied over the years. Early treatment consisted of excision of the lesion. Due to the erroneous diagnosis of the etiology, resolution of the lesion occurred only upon weaning of the child.
In case of mild to moderate irritation to the tongue, conservative treatment such as smoothing the incisal edge with an abrasive instrument is advocated. Alternatively, a small increment of composite may be bonded to the incisal edges of the teeth.
In this case, ulcerated area was large and denuded and even a reduced incisal edges may still contact and traumatize the tongue during suckling, enough to delay healing. The pediatrician's concern over the infants failure to gain weight due to ulceration's interference with suckling dictated the need for rapid resolution of the lesion. So extraction of the natal tooth was chosen over more conservative treatments.
At a follow up appointment, the lesion was fully resolved and infant was feeding normally.
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