Newborn teeth

Baby Born With Teeth: Natal Teeth, Feeding and What to Do

Nobody expects to find a tooth during the first cuddle. The NHS says most babies start teething at around 6 months, but some are born with their first teeth. It is unusual rather than unheard of: one NHS hospital’s newborn examination guideline, for example, tells examiners to check the gums for teeth.

How surprising the tooth looks matters far less than three practical questions: how firm it is, how feeding is going and whether it is rubbing your baby’s tongue.

What to check first

Show the tooth to whoever does your baby’s newborn physical examination. It is offered within 72 hours of birth, usually by a specially trained midwife, nurse or doctor, who will also ask how feeding is going. If you spot a tooth once you are home, mention it to your midwife, health visitor or GP. The first six weeks guide sets out which of them you are likely to see, and when.

In the meantime, keep an eye on four things:

• Wobble. Notice whether the tooth moves when your baby feeds or when their tongue touches it, but leave testing it to a professional. Do not pull, twist or file it.
• Feeds. Signs a breastfed baby is getting enough include rounded cheeks, hearing them swallow and, after the first few days, at least 6 wet nappies a day. A nipple that is pinched, cracked or bleeding is a reason to ask for help.
• The underside of the tongue. In good light, look for an ulcer, a raw patch or bleeding where the tongue rubs over the tooth.
• Your baby overall. Teething can raise a baby’s temperature slightly, but the NHS puts that below 38C. A baby under 3 months with a temperature of 38C or higher needs urgent help, tooth or no tooth (see when to get help).

What are natal and neonatal teeth?

A natal tooth is already through the gum when a baby is born. A neonatal tooth comes through during the first 30 days. Doctors and dentists usually talk about them together, because the questions are the same.

They usually appear in the lower front gum, where the two bottom middle teeth (the lower central incisors) would normally come through, and they often come as a pair. More than two is rare.

Most are not extra teeth. Fewer than 1 in 10 natal teeth are supernumerary (extra); the rest are ordinary milk teeth that have turned up months early. That is one reason dentists prefer to keep a natal tooth when it is safe to.

What a natal tooth looks like

Some look just like a normal baby tooth. Many are smaller, cone-shaped or yellowish, with weaker enamel and little or no root. With so little root or bone holding it, the tooth is often attached mainly at the edge of the gum, which is why some are wobbly.

How common is it for a baby to be born with teeth?

Uncommon, and the figures vary a lot. A 2006 review put natal teeth at about 1 in 2,000 to 1 in 3,000 live births. A 2023 review that pooled 23 studies from around the world found higher rates: about 1 in 289 newborns had natal teeth and about 1 in 2,212 had neonatal teeth. Rates differed widely between continents, and none of the studies met every quality check the reviewers applied, so treat any single figure as a rough guide.

Either way, teeth that are there at birth are seen more often than teeth that come through in the first month.

Why are some babies born with teeth?

Usually there is no clear reason. Older theories pointed to things like fever, hormones or a lack of vitamins, but the current view is that the developing tooth simply sits closer to the surface of the gum than usual, so it comes through early.

It can run in families. In one hospital series of 33 babies with natal or neonatal teeth, 8 had a relative who had them too, including siblings, fathers, a grandmother and an aunt.

Most of the time a natal tooth is not linked to any medical condition. Occasionally it appears alongside a cleft palate, Pierre Robin sequence or a rare syndrome such as Ellis-van Creveld, Hallermann-Streiff or Sotos syndrome. Neonatal teeth are much more common in babies with a cleft palate: about 10%, compared with 0.02% of babies generally. The newborn examination looks at your whole baby, so a single tooth in a baby whose check is otherwise normal is not a reason to start reading up on rare syndromes.

You may also hear that a tooth at birth is a sign of great luck, or of bad luck. Different cultures have read it both ways. Medically, it is a tooth that arrived early.

Loose natal teeth and choking

The main safety worry is a very loose tooth coming out and being breathed into the airway (aspirated) or swallowed. That is why clinicians pay close attention to how loose a tooth is, and why a tooth at real risk of coming out is usually removed. A tooth that moves only slightly may simply be watched.

Never take a tooth out yourself, however loose it looks. Removing one from a newborn needs planning:

• Bleeding. A newborn’s blood clots less readily in the first days of life. The NHS offers a vitamin K injection after birth, or doses by mouth, to help prevent a rare bleeding disorder called haemorrhagic disease of the newborn. Before an early removal, the team will check whether your baby had vitamin K. Published dental advice suggests waiting until a baby is at least 10 days old where waiting is safe, and checking whether vitamin K is needed first if it was not given at birth.
• Which tooth it is. A dental X-ray is sometimes used to tell an early milk tooth from an extra one, which can change the decision.
• Follow-up. Rarely, tooth-forming tissue left in the gum carries on growing after a natal tooth is removed, so a dental check afterwards is worthwhile.

Breastfeeding with natal teeth

Many babies with natal teeth feed well. In one hospital series, only 1 of 32 mothers had problems from a damaged breast. When a baby is well attached, their tongue comes forward over the lower gum to draw the breast in, which cushions the nipple from the edge of the tooth, and the nipple sits far back against the soft palate.

So if feeding hurts, look at the attachment first and the tooth second.

1. Ask for a whole feed to be watched. Your midwife, health visitor or a breastfeeding supporter can check position and attachment. The National Breastfeeding Helpline is open 24 hours a day on 0300 100 0212.
2. Aim for a big mouthful. Hold your baby close with their nose level with your nipple, let their head tip back, and wait for a wide-open mouth, with the chin touching the breast first.
3. Get help early for damage. If a nipple hurts at every feed, or starts to crack or bleed, the NHS advises getting help as soon as you can. Cracked or bleeding nipples raise the risk of infection.
4. Express if you need to. If direct feeding is too painful, or your baby cannot latch well while the tooth or a tongue sore is sorted out, you can express milk by hand or with a pump so your baby still gets breast milk.
5. Show them the tooth. A better latch cannot fix a very loose tooth or a sharp edge rubbing the tongue. Those need a clinical or dental check.

Nipple shields can change how a baby attaches, so the NHS suggests avoiding them if you can. Talk to a feeding supporter before trying one.

The breastfeeding pain guide has a six-point latch check for the next feed and what helps sore or cracked nipples. If you need to express for a while, the breast pump guide compares hand expression with manual and electric pumps and explains hiring.

Bottle feeding

A sharp tooth can rub the tongue of a bottle-fed baby too. Hold your baby semi-upright, let them draw the teat in when their mouth opens wide, and keep the bottle almost horizontal. Never leave a baby to feed alone from a propped-up bottle. If feeds become a struggle or your baby is taking less than usual, ask your midwife or health visitor to look at the feed and the mouth together.

The baby bottle guide explains how to choose a teat flow by the way your baby feeds rather than by the age on the pack.

Riga-Fede disease: a sore under the tongue

Riga-Fede disease is the name for an ulcer caused by the tongue rubbing over the edge of a tooth again and again as a baby feeds and swallows. It is usually on the underside of the tongue, but it can also form on the floor of the mouth, the gum or the inside of the cheek.

It may be painless, or sore and bleeding enough to put a baby off feeding, and a baby who keeps refusing feeds can struggle to gain weight. If you see a sore, get it looked at rather than waiting to see whether it settles.

Treatment depends on the tooth. If it is firm and your baby is feeding well enough, a dentist can smooth the sharp edge, which is the gentler option and keeps the tooth. If the tooth is very loose, removing it is usually the better choice.

Do not put teething gel or other numbing products on the sore. The NHS says general oral pain relief gels are not suitable for children, it is not clear that teething gels work, and paracetamol is only for babies aged 2 months or older. Ask the team before putting any medicine in a newborn’s mouth.

Keep, smooth or remove?

Keeping a firm tooth that is causing no trouble avoids a procedure and keeps what is usually a normal milk tooth. Smoothing is less invasive than removal and the tooth stays. Removal is the usual answer for a tooth at real risk of coming out, and for an extra tooth.

The decision should be made with you, weighing up the risks for your baby and for feeding. In the UK, the first person to look is usually the doctor, midwife or nurse doing the newborn check, or your GP. General dentists can diagnose natal teeth and give initial care, and babies with more complex problems, or a tooth that is likely to need removing, are referred on to hospital dental services. Some hospitals refer straight from the newborn check.

Caring for a natal tooth that stays

1. Wipe it gently. Clean the tooth and gum with a clean, damp cloth.
2. Brush when you can. The NHS says to start brushing as soon as a milk tooth comes through, twice a day with one of those last thing at night, using a baby toothbrush and a smear of children’s fluoride toothpaste containing no less than 1,000ppm fluoride. Ask your dentist or health visitor how to do this gently if the tooth is still slightly loose.
3. Skip the rinse. Rinsing with water washes the fluoride away. Keep the tube out of reach.
4. Look every day. New wobbling, a chipped or sharp edge, bleeding, swelling or a sore under the tongue are reasons to get it checked.
5. Register with a dentist now. The NHS says to register your baby with a dentist when their teeth start coming through, and NHS dental care for children is free. The British Society of Paediatric Dentistry recommends a first dental visit when the first teeth come through, or by the first birthday at the latest. A dentist may look in a young baby’s mouth with a lap-to-lap check, your baby lying back from your lap into theirs.
6. Expect some wear. Natal teeth often have weaker enamel, so they can wear down or discolour more than other milk teeth. Regular check-ups help.

In England, you can also get free NHS dental treatment yourself until your baby is 12 months old. If you cannot find a dentist taking NHS patients, your local integrated care board (ICB) may be able to tell you where to get an appointment.

When the rest of the teeth start to arrive, usually from around 6 months, the teething guide covers the usual order they come through, what soothes sore gums and how to brush a first tooth. Later on, the usual tooth-decay rules apply: only breast milk, formula or cooled boiled water in a bottle, and no juice or sugary drinks. For the ordinary brushing routine, see brushing baby and toddler teeth; follow your dentist’s individual advice for a natal tooth.

When to get help

Contact your midwife, health visitor or GP promptly, or ask a dentist, if:

• the tooth is very loose, or seems looser than before
• there is an ulcer, raw patch or bleeding under the tongue, on the gum or inside the cheek
• feeds hurt, your baby keeps losing the latch or the teat, or seems to be taking less milk
• your nipple is cracked or bleeding
• a socket keeps bleeding after a tooth is removed, or a lump or swelling appears where a tooth was taken out

Quick questions

Is it a tooth or a gum cyst?

Small bumps on a newborn’s gums or the roof of the mouth are common. These are cysts (gingival cysts, Epstein pearls or Bohn’s nodules), not teeth, and they usually disappear shortly after birth without treatment. If you are not sure which you are looking at, ask the midwife or doctor.

Can a natal tooth fall out on its own?

A very loose one can, which is exactly why it should be checked rather than left. A firm natal tooth is usually an ordinary milk tooth and can stay until it is lost like the others, years later.

Will another tooth grow if a natal tooth is removed?

Not if it was a normal milk tooth: the gap stays until the adult tooth comes through, which can be several years. If it was an extra tooth, the usual milk tooth should still come through in its own time.

Sources

1. NHS: Baby teething symptoms
2. NHS: Tips for helping your teething baby
3. NHS: Looking after your baby’s teeth
4. NHS: Children’s teeth
5. NHS: Newborn physical examination
6. NHS: What happens straight after the birth? (vitamin K)
7. NHS: Breastfeeding positioning and attachment
8. NHS: Sore or cracked nipples when breastfeeding
9. NHS: Expressing and storing breast milk
10. NHS: Bottle feeding advice
11. NHS: When to get urgent medical help for babies and children under 5
12. NHS: How to stop a child from choking
13. NHS: When to use NHS 111
14. nidirect: GP out of hours service
15. NHS: Who can get free NHS dental treatment
16. NHS: How to find an NHS dentist
17. British Society of Paediatric Dentistry: Patients
18. British Society of Paediatric Dentistry: Dental Check by One FAQ
19. British Dental Journal: Natal and neonatal teeth, a review and case series (2022)
20. Journal of the American Dental Association: Worldwide prevalence of natal and neonatal teeth (2023)
21. American Academy of Pediatric Dentistry: Perinatal and infant oral health care (2025)
22. Journal of the National Medical Association: Natal teeth, a review (2006)
23. Contemporary Clinical Dentistry: Natal and neonatal teeth, a tertiary care experience (2018)
24. European Journal of Paediatric Dentistry: Riga-Fede disease, a systematic review (2021)
25. BMJ Case Reports: Management of an infant having natal teeth (2013)
26. Pediatric Dentistry: Complication after extraction of natal teeth (2016)
27. British Dental Journal: Natal teeth, a sign of fortuity or grave misfortune (2011)
28. MedlinePlus: Natal teeth
29. La Leche League International: Teething
30. Norfolk and Norwich University Hospitals: Newborn and infant physical examination guideline