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CASE REPORT
Year : 2020  |  Volume : 38  |  Issue : 3  |  Page : 311-314
 

Accidental displacement of primary anterior teeth following extraction of neonatal teeth


1 Department of Pedodontics and Preventive Dentistry, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
2 Department of Oral and Maxillofacial Pathology, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India

Date of Submission30-Jan-2020
Date of Decision25-Jul-2020
Date of Acceptance31-Jul-2020
Date of Web Publication29-Sep-2020

Correspondence Address:
Dr. A J Sai Sankar
Department of Pedodontics and Preventive Dentistry, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISPPD.JISPPD_48_20

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   Abstract 


Eruption of the first tooth at 6 months of age is a significant stage in a child's life. However, the presence of a tooth in the oral cavity of a newborn can lead to a lot of delusions. Natal and neonatal teeth are of utmost importance not only to a dentist but also for a pediatrician due to parental anxiety, folklore superstitions, and numerous complications associated with it. The present case report describes a 1.5 cm × 1.5 cm, slow-growing, soft-tissue gingival mass which developed following the extraction of a tooth-like structure in a 4-month-old male patient. Histological examination revealed that it contained a tooth-like hard tissue intermingled with bone and fibrous tissue. Based on clinical and histological findings, the present case was diagnosed as gingival hyperplasia with displaced tooth buds of 71 and 81, which might be due to chronic irritation or traumatic extraction of the neonatal teeth. No abnormal recurrence of the lesion was detected during the follow-up period. However, postoperative clinical and radiographic photographs further reconfirmed the absence of tooth in relation to 71 and 81.


Keywords: Gingival hyperplasia, neonatal teeth, odontoblasts


How to cite this article:
Sridhar M, Sai Sankar A J, Sankar K S, Kumar K K. Accidental displacement of primary anterior teeth following extraction of neonatal teeth. J Indian Soc Pedod Prev Dent 2020;38:311-4

How to cite this URL:
Sridhar M, Sai Sankar A J, Sankar K S, Kumar K K. Accidental displacement of primary anterior teeth following extraction of neonatal teeth. J Indian Soc Pedod Prev Dent [serial online] 2020 [cited 2020 Oct 30];38:311-4. Available from: https://www.jisppd.com/text.asp?2020/38/3/311/296641





   Introduction Top


Development of a child from conception through the first few years of life is characterized by many changes, which make the parents more anxious; one among these is the appearance of tooth/tooth-like structures at birth.[1] The eruption of the first primary tooth takes place around 6 months of age, which is the first milestone both in terms of functional and psychological changes in a child's life. Occasionally, children are born with tooth-like structures that erupt even before the eruption of the first deciduous teeth. These precociously and prematurely erupted teeth are called natal and neonatal teeth, respectively, which must be differentiated from the true deciduous teeth.[2] Even though the etiology is not clear, a number of factors are attributed to its incidence, which include the superficial position of the tooth germ, infection or malnutrition, febrile state, hormonal stimulation, hereditary transmission of a dominant autosomal gene, osteoblastic activity, and hypovitaminosis. Some investigators suggested that the presence of natal/neonatal teeth is associated with various syndromes or systemic conditions.[3]


   Case Report Top


A 4-month-old male infant was brought to the outpatient department by his parents, with the chief complaint of a bulbous soft-tissue mass in the lower front tooth region, which is causing difficulty while feeding. History revealed that the child was born healthy, at full term, and through normal delivery. The parents noticed tooth-like structures in the lower front teeth region at birth, for which they have consulted a general dental practitioner, which were extracted uneventfully when the child was 10 days old. Eventually, after a few months, a small, slow-growing mass appeared at the previous site of extraction. On intraoral examination, an exophytic growth measuring approximately 0.5 cm × 1.5 cm was noticed extending from the corner of the mouth on either side with a pink, smooth, shiny surface [Figure 1]. On palpation, the growth was nontender and firm inconsistency. To ascertain the presence of any hard-tissue inclusions, an intraoral periapical radiograph was taken in the same region, which revealed the presence of radiopaque tooth-like structures within the mass, and sockets in relation to 71 and 81 were empty. However, the adjacent developing tooth buds in relation to 72 and 82 regions were normal [Figure 2]. Based on the clinical and radiographic findings, it was provisionally diagnosed as gingival hyperplasia with displaced developing tooth buds. The suspicion of eruption cyst, Epstein pearls, Bohn's nodules, and natal teeth were ruled out as they are of developmental origin. Pulp polyp is omitted as it is associated with a carious tooth.[4],[5] However, the possibility of trauma or local irritation was considered. As the present case needs to be differentiated from other similar conditions through histological examination, the whole soft-tissue mass was excised using a low-grade, soft-tissue diode laser with gallium arsenide medium 810 nm at 2–3 W after obtaining the informed consent from the parents. Postsurgical healing was uneventful, and the patient was recalled after 3 months for reevaluation [Figure 3].
Figure 1: Preoperative photograph showing the soft-tissue mass

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Figure 2: Radiograph showing the displacement of tooth buds of 71 and 81 out of sockets

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Figure 3: Postoperative healing after 2 weeks

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Histopathological picture revealed a hyperparakeratinized stratified surface epithelium with fibrous connective tissue stroma that contained numerous immature collagen fibers that were loosely arranged with well-formed blood vessels. The elongated cells with an oval-shaped nucleus were suggestive of odontoblasts and the uniform eosinophilic structure above these cells was the predentin [Figure 4]. Absence of marked proliferation of endothelial cells, multinucleated giant cells, and osteoid material, ruled out the diagnosis of pyogenic granuloma, peripheral giant cell granuloma, and peripheral ossifying fibroma. Thus, a final diagnosis of reactive fibrous hyperplasia with displaced deciduous tooth buds in relation to 71 and 81, was reconfirmed in the immediate postoperative radiograph and clinical photograph after 10-month follow-up [Figure 5] and [Figure 6].
Figure 4: Photomicrograph (×10) showing the hyperplastic stratified squamous epithelium with fibrous connective tissue stroma and eosinophilic dentin-like structure

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Figure 5: Postoperative radiograph

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Figure 6: Ten-month follow-up postoperatively revealing the absence of 71 and 81 and eruption of 72 and 82

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   Discussion Top


The presence of natal or neonatal teeth may be a source of suspicion while deciding on the treatment plan, whether to maintain these teeth in the oral cavity or not. Factors such as degree of mobility, difficulty during suckling, interference with breastfeeding, the possibility of traumatic injury to the tongue and oral tissues, and whether the tooth is part of the normal dentition or is a supernumerary need to be evaluated.[6],[7] If the tooth is diagnosed as one from the normal series, maintenance of the same is important unless it causes injury to the individual. However, if these teeth are to be extracted, precaution should be taken to prevent hemorrhage, assessing the need for administration of Vitamin K before extraction, avoiding unnecessary injury to the gingiva, and creating alertness regarding the risk of aspiration during removal.[8] In most of the cases, the extraction site heals uneventfully, but in rare cases, a proliferative growth may occur at the site of extraction, due to inflammation or procedural errors.[9]

In the present case, the gingival overgrowth following the extraction of neonatal teeth could be due to excessive pressure to control postoperative bleeding, local curettage to remove the remnants of dental lamina, or chronic low-grade irritation/microtrauma. One rare finding that was noticed in this case was the dislodgement of the primary tooth buds from the socket into the gingival overgrowth. This could be due to the pressure exerted by proliferating collagen fibers of dental follicle that displace the developing tooth buds out of its sockets.

Conventionally, these sort of lesions are excised surgically. However, in this case, soft-tissue laser was used to excise the lesion to have an accurate, bloodless field with minimal trauma and faster healing. Even a study by Mustafa and Kawas[10] noticed that there is no effect on the developing enamel, cementum, periodontal ligament, and eruption process following the usage of soft-tissue lasers. Moreover, the usage of lasers reduces the operator's chairside time and postoperative discomfort has less or no requirement of local anesthesia.

In the present case, replacement of the missing lower anterior primary teeth with a functional space maintainer is planned after the eruption of the adjacent teeth during the follow-up visit.


   Conclusion Top


Complications following the extraction of natal/neonatal teeth are a rare finding. However, in this case, the presence of low-grade irritation and improper execution of the surgical procedure led to this condition. Restoring the form and function of the missing primary teeth followed by long-term follow-up till the succedaneous permanent teeth erupt into the oral cavity is mandatory. Thus, early diagnosis, prompt treatment, and gentle handling of the tissues should be the primary concern in management to prevent the occurrence of these types of anomalies.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Cunha RF, Boer FA, Torriani DD, Frossard WT. Natal and neonatal teeth: Review of the literature. Pediatr Dent 2001;23:158-62.  Back to cited text no. 1
    
2.
Maheswari NU, Kumar BP, Karunakaran, Kumaran ST. “Early baby teeth“: Folklore and facts. J Pharm Bioallied Sci 2012;4:S329-33.  Back to cited text no. 2
    
3.
Boyd JD, Miles AE. Erupted teeth in cyclops fetus. Br Dent J 1951;91:173.  Back to cited text no. 3
    
4.
Vergotine RJ, Hodgson B, Lambert L. Pulp polyp associated with a natal tooth: Case report. J Clin Pediatr Dent 2009;34:161-3.  Back to cited text no. 4
    
5.
Hayes PA. Hamartomas, eruption cyst, natal tooth and Epstein pearls in a newborn. ASDC J Dent Child 2000;67:365-8.  Back to cited text no. 5
    
6.
Chow MH. Natal and neonatal teeth. J Am Dent Assoc 1980;100:215-6.  Back to cited text no. 6
    
7.
Hegde RJ. Sublingual traumatic ulceration due to neonatal teeth (Riga-Fede disease). J Indian Soc Pedod Prev Dent 2005;23:51-2.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Sethi HS, Munjal D, Dhingra R, Malik NS, Sindhu GK Natal tooth associated with fibrous hyperplasia-A rare case report. J Clin Diag Res 2015:9:ZD18-9.  Back to cited text no. 8
    
9.
Kim SH, Cho YA, Nam OH, Kim MS, Choi SC, Lee HS. Complication after extraction of natal teeth with continued growth of a dental papilla. Pediatr Dent 2016;38:137-42.  Back to cited text no. 9
    
10.
Mustafa EA, Kawas SA The effect of Gallium-Arsenide laser irradiation on odontogenesis. J Int Dent Med Res 2010;3:52-6.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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    Abstract
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