Most babies get their first tooth around six months of age, so it surprises many parents to learn that a small number arrive with a tooth already showing, or grow one within the first few weeks. A tooth present at birth is called a natal tooth, and one that erupts in the first 30 days is a neonatal tooth. They are uncommon, occurring in roughly one in 2,000 to one in 3,500 births, and while they can look alarming, most are managed simply once a dentist has checked them.
Key takeaways
- A natal tooth is present at birth, while a neonatal tooth appears in the first month.
- Most are normal baby teeth that have come through very early, not extra teeth.
- They usually appear in the lower front of the mouth.
- The main issues are feeding problems and a tongue ulcer called Riga-Fede disease.
- Conservative care comes first, and removal is reserved for specific situations.
The one question to settle first: is it a normal tooth or an extra one?
The first thing a dentist works out is whether the early tooth is one of the baby's normal front teeth that simply came through ahead of schedule, or a genuinely extra tooth. This matters because the great majority are normal teeth, so removing one means the child will have a gap in the baby teeth until the adult tooth arrives years later. That single fact, that you are usually looking at a real tooth rather than a spare, is why dentists lean toward keeping these teeth wherever it is safe to do so. An X-ray helps confirm which it is.
What natal and neonatal teeth are
These teeth form in the normal way but erupt much earlier than expected, often because they sat very close to the surface of the gum. They are most commonly the lower central incisors, the two teeth in the middle of the lower front. They may look small, slightly yellow or a little loose, because the root is often not fully formed at such an early stage. Most are part of the normal set of 20 baby teeth rather than additional teeth.
The two main concerns
Feeding difficulties
An early tooth can make breastfeeding uncomfortable for the mother and sometimes awkward for the baby. Many families work through this with feeding support and small adjustments rather than removing the tooth.
Riga-Fede disease
This is an ulcer that forms on the underside of the baby's tongue, caused by the tongue rubbing repeatedly over the sharp edge of the new tooth during feeding. It can make feeding painful and, if it persists, affect how well the baby feeds. It is the most common complication that prompts treatment, and it is very treatable.
How they are managed
Conservative care first
For most natal and neonatal teeth, the approach is to keep the tooth and manage any problems. If there is a sharp edge causing a tongue ulcer, the dentist can gently smooth the edge, and the ulcer usually heals. Feeding support and keeping the area clean handle most other issues. The tooth is then monitored as it firms up over the following months.
When removal is considered
Removal is reserved for specific situations: a tooth that is very loose with a risk of coming free and being inhaled, a tooth that severely interferes with feeding despite other measures, or a genuinely extra tooth with no role to play. When a very young baby needs a tooth removed in the first days of life, the medical team may check that vitamin K levels are adequate first, because blood clotting takes a short time to establish after birth. This is a decision made carefully with the paediatric and dental teams.
| Situation | Usual approach |
|---|---|
| Healthy, stable tooth | Keep and monitor |
| Sharp edge causing tongue ulcer | Smooth the edge, treat the ulcer |
| Feeding difficulty | Feeding support first, review |
| Very loose tooth or severe feeding interference | Consider removal with the medical team |
General cost considerations in Australia
Assessment of a natal or neonatal tooth usually involves an examination and sometimes an X-ray, and smoothing a sharp edge is a minor procedure. Removal, when needed, is planned with the medical team and costed separately. As a general guide, an examination sits around $60 to $120 and an X-ray around $40 to $90. These are market ranges only, not a quote. Lumi Dental does not publish its own prices here. See the offers page or ask for a written estimate.
Frequently asked questions
Why is my baby born with a tooth?
It is usually a normal baby tooth that developed close to the gum surface and erupted very early. The exact reason is often not clear, and most cases are isolated.
Should the tooth be removed?
Usually not. Because it is most often a normal tooth, it is kept where possible. Removal is reserved for a very loose tooth or significant feeding problems.
What is Riga-Fede disease?
It is an ulcer under the tongue caused by the tongue rubbing on the sharp new tooth during feeding. Smoothing the edge usually allows it to heal.
Can my baby still breastfeed?
Often yes, sometimes with feeding support and small adjustments. Many mothers continue breastfeeding successfully once any sharp edge is managed.
Could the tooth be inhaled?
This risk applies only to a very loose tooth. If a tooth is markedly mobile, the dentist and medical team will discuss whether removal is safer.
Keep the tooth if it is safe to
A baby born with a tooth is uncommon and usually nothing to fear, and the modern approach favours keeping a healthy tooth and managing feeding and any ulcer rather than rushing to remove it. For related reading, see our guides to eruption cysts in babies and a child's first dental visit. To have your newborn's tooth assessed, contact the team at Lumi Dental.
This article is general information and not a substitute for an assessment by your child's dentist or paediatric team.
