An initial exam should happen within 6 months of the eruption of the first tooth or no later than 12 months of age.2
The initial visit should consist of the following:
The initial exam is usually completed as a lap-to-lap exam. During this type of exam, the caregiver will sit facing the provider with both caregiver and providers knees touching. The infant will face the caregiver and the caregiver will gently lay the infant into the providers lap. The infant will most likely cry, so it is important to warn the caregiver of this. If the infant is crying, the provider should visualize the oral cavity while possible with the infants mouth open. The provider should demonstrate proper oral hygiene techniques.
Figure 2. Lap-to-lap or knee-to-knee technique.
Normal Clinical Findings in the Initial Exam:
Natal – present at birth
Neonatal – within the first 30 days
Treatment: Leave if not very mobile. If mobility is severe causing tooth to be aspiration risk, then removal is indicated. If there is a sharp edge causing irritation of tongue, then the tooth can be smoothed or removed. If removing, it is important to curette the socket so that any cellular remnants are not left behind as these can develop into other abnormal structures that require future removal.9 It is also important to consult with patients’ physician regarding vitamin K shot to prevent hemorrhage.
Associated finding – Riga-Fede disease. This is a traumatic ulcer on the tongue from the tooth.
Cysts of the Newborn:
These can incorrectly be diagnosed as natal teeth.
Figure 3. Bohn Nodules (palatal cyst).