Natal teeth: feeding, tongue sores and treatment choices

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

Do not pull, twist, file or repeatedly test the tooth at home. If it is highly mobile, bleeding, causing a tongue ulcer or making feeding ineffective, contact your midwife/newborn team, health visitor or GP promptly and ask how your local paediatric dental service accepts referrals. Call NHS 111 if you cannot reach the usual team. A newborn with a temperature of 38°C or higher needs urgent GP/NHS 111 advice; fever is not a normal consequence of a natal tooth.

The first 24 hours: what parents should check

1. Show the tooth to the newborn examiner before discharge if possible. Every baby should be offered a physical examination within 72 hours; mouth findings and feeding concerns can be recorded and referred.
2. Look, but do not keep wobbling. Note whether the tooth visibly moves during feeding or when the tongue touches it. Leave stability testing to a clinician.
3. Watch a complete feed. Is attachment possible? Can you hear swallowing? Does the baby stay attached and appear satisfied? Is the feeding parent’s nipple pinched, cut or bleeding?
4. Look under the tongue in good light. A sharp tooth can repeatedly rub the underside of the tongue and create an ulcer known as Riga–Fede disease.
5. Ask what happens next. A stable, symptom-free tooth may simply be monitored; marked looseness, injury or feeding disruption changes the referral urgency.

What exactly are natal and neonatal teeth?

Natal teeth are already through the gum at birth. Neonatal teeth erupt during the first month. A 2023 systematic review estimated natal teeth in about 1 in 289 newborns worldwide and neonatal teeth in about 1 in 2,212, but the authors found substantial differences between studies and none met every quality criterion. They are unusual—not an unheard-of medical mystery.

They most often appear where the two lower central incisors would normally emerge. Older clinical studies and current paediatric oral-health guidance find that most belong to the normal set of 20 primary teeth; a minority are supernumerary, meaning extra. That distinction matters: removing a normal primary tooth can leave a gap until the permanent successor erupts years later.

Why can they be so wobbly?

The tooth may have erupted before much root formation or bony support developed. It can look small, yellowish or irregular and attach mainly at the gum margin. Appearance alone does not tell you whether it is safe to keep, which is why stability and function need checking.

Did anything in pregnancy cause it?

Usually no specific cause is found, and parents did not make a tooth erupt by eating the wrong food or taking an ordinary action. Some families report more than one affected relative. Natal teeth can occur alongside certain medical or craniofacial conditions, but most babies with one do not have a syndrome. The newborn clinician decides whether anything else in the examination or family history warrants investigation; an isolated tooth is not a reason to internet-diagnose a rare condition.

Can a baby breastfeed or bottle-feed with natal teeth?

Often, yes. In an effective breastfeed, the nipple is drawn deep into the mouth and the tongue covers the lower gum, so the tooth does not automatically bite the nipple. Pain may come from a shallow latch, a sharp tooth edge, tongue injury or more than one issue at once.

If breastfeeding hurts

1. Ask someone skilled to watch a full feed. A midwife, health visitor or breastfeeding supporter can adjust positioning and attachment and check milk transfer.
2. Show them the tooth and the baby’s tongue. A perfect latch cannot fix a highly mobile tooth or an ulcer that needs dental care.
3. Get help early for cracked or bleeding nipples. NHS advice is not to simply tolerate damage. Expressing may protect milk supply if direct feeding temporarily becomes too painful.
4. Do not improvise a cap or file the tooth. Anything placed over a newborn tooth can detach, and home filing can injure the mouth.

The National Breastfeeding Helpline is available 24 hours a day on 0300 100 0212. It can help with feeding technique, but a loose tooth or tongue wound still needs a clinical route.

If bottle feeding is difficult

Check that the teat flow, position and pacing are appropriate and that the baby can seal around the teat. Do not enlarge a teat hole or prop the bottle. Frequent dribbling, coughing/choking during feeds, very long feeds, reduced intake or poor weight gain needs newborn/feeding assessment rather than repeated teat shopping.

How is a natal tooth assessed?

A newborn clinician or dentist will look at:

• location, number, shape and colour;
• how mobile it is and how it attaches;
• whether it is likely part of the normal primary set or extra;
• the tongue, lips, palate and surrounding gum;
• breast or bottle feeding and weight/hydration;
• the feeding parent’s nipple injury where relevant; and
• the rest of the newborn examination and family history.

An X-ray is sometimes used to see tooth structure and relation to the developing primary tooth, but it is not automatic in every newborn. The assessment should answer a practical question: is this tooth stable and useful to preserve, or is it creating a risk or stopping effective feeding?

Keep, smooth or remove? The options compared

Why might the team ask about vitamin K?

Newborns have low vitamin K stores, and the routine vitamin K offered after birth protects against serious bleeding. If extraction is considered very early, the clinical team checks whether vitamin K was given and plans bleeding control. That is one reason extraction belongs in a proper medical/dental pathway, never at home. Do not give a supplement or delay an urgent assessment while trying to solve this yourself.

Does every loose tooth have to come out?

“Loose” covers a range. A clinician may monitor modest mobility, while a tooth at real risk of detaching may warrant removal. The decision also considers feeding, tongue injury and whether preserving the tooth is realistic. Current paediatric guidance supports keeping natal and neonatal teeth when they do not disrupt feeding, threaten aspiration or interfere with oral function.

What happens after extraction?

The team will explain bleeding control, feeding and pain relief. Follow the exact aftercare instructions. Seek urgent advice if bleeding does not stop, the baby will not feed, wet nappies reduce, pain seems severe, swelling worsens, or the baby develops fever or seems unwell. Do not put numbing gel, clove oil, alcohol, teething powder or another product on the socket unless specifically prescribed.

How to care for a natal tooth that stays

1. Clean gently from the start. Before a toothbrush is practical, a clean damp cloth can remove milk residue from the tooth and gum without vigorous rubbing.
2. Move to a tiny soft baby toothbrush when advised and manageable. NHS guidance is to brush as soon as a milk tooth is present, twice daily, using a tiny smear of fluoride toothpaste containing at least 1,000 ppm fluoride.
3. Do not rinse away the fluoride. Use only a smear and keep the tube out of reach.
4. Check the tongue and tooth daily. Look for mobility, a sharp/chipped edge, bleeding, swelling, plaque or a sore underneath.
5. Arrange a dental home. NHS dental care for children is free. If no local practice accepts new NHS patients, contact your integrated care board for help finding a service.

At this age, milk is the diet; ordinary breastfeeding does not need to stop because a tooth appeared early. When complementary foods begin later, follow the same tooth-decay prevention as any child: minimise frequent sugar exposure and avoid putting sweet drinks in a bottle.

Questions parents ask about babies born with teeth

Is a natal tooth a real tooth?

Yes. It has erupted through the gum. Most natal and neonatal teeth are prematurely erupted primary teeth, usually lower central incisors; a smaller number are extra teeth.

How common is a baby being born with teeth?

A 2023 systematic review estimated about 34.6 natal-tooth cases per 10,000 newborns—roughly 1 in 289—but estimates varied and the underlying studies had limitations. Neonatal teeth were less common, around 1 in 2,212.

Will a natal tooth fall out?

It may remain like an ordinary baby tooth, become more stable, or loosen and be lost/removed. Do not wait for a highly mobile tooth to fall out without assessment because detachment can create an inhalation concern.

Will another baby tooth replace it if removed?

Usually not if the removed tooth was the normal primary tooth. The space may remain until the permanent tooth erupts years later. If it was an extra tooth, the normal primary tooth may still erupt. Examination and sometimes imaging help clarify this.

Can a newborn choke on a loose natal tooth?

A very mobile tooth can detach; clinicians are particularly concerned about possible inhalation into the airway. Prompt assessment is appropriate. Do not attempt home extraction or keep testing the mobility.

Can I breastfeed a baby with natal teeth?

Yes, many babies feed successfully. Get an observed feeding assessment for persistent nipple pain, damage, poor attachment or ineffective milk transfer, and have the tooth/tongue assessed at the same time.

What is a sore under the tongue from a natal tooth?

Repeated rubbing can produce an ulcer called Riga–Fede disease. It needs assessment if painful, bleeding, persistent or affecting feeding; treatment can include smoothing/protecting a stable tooth or extraction when the tooth is very mobile or conservative care fails.

Is a baby born with several teeth more likely to have a syndrome?

Most natal teeth are not linked to a medical condition. Multiple or unusual teeth should still be examined as part of the whole newborn assessment. The clinician considers other physical findings and family history rather than diagnosing from tooth count alone.

Should I use teething gel on a natal tooth?

Not routinely. A newborn is below the age of many teething products, and gel will not stabilise a loose tooth or fix a tongue ulcer. Ask the newborn or dental team before putting any medicine in the mouth.

When should I start brushing?

NHS advice is to begin as soon as a milk tooth is through. For a newborn, ask the dental/newborn team how to do this without traumatising a mobile tooth; gentle damp-cloth cleaning may be the first practical step.

Who treats natal teeth in the UK?

The first contact is often the midwife, neonatal/newborn clinician, health visitor or GP, who can assess urgency and refer to paediatric/community/hospital dentistry according to the local pathway. A general NHS dentist can also advise; very young or complex cases may need a specialist service.

Clinical, dental and parent-care sources

1. NHS: newborn physical examination within 72 hours.
2. Norfolk and Norwich University Hospitals: NIPE guideline and neonatal-tooth referral.
3. American Academy of Pediatric Dentistry: perinatal and infant oral healthcare best practice.
4. Journal of the American Dental Association: 2023 systematic review and prevalence meta-analysis.
5. Riga–Fede disease systematic review: conservative care and extraction indications.
6. Tertiary-care series: retention unless symptomatic, with feeding/mobility indications.
7. MedlinePlus: natal tooth features, home care and loose-tooth concern.
8. NHS: brushing and dental care from the first tooth.
9. NHS Best Start in Life: fluoride toothpaste amount and routine.
10. NHS: breastfeeding positioning, attachment and help.
11. NHS: sore or cracked nipples and early support.
12. NHS: fever thresholds in babies.
13. NHS: finding an NHS dentist and ICB help.