Co esponding au ho : P awa i Nu aini.
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Managing a mobile na al oo h in an in an : P e en ing aspi a ion and alle ia ing
b eas eeding discom o
Ha man Tanzil, Meidiana Adiningsih, Aloci a Anindyana i, P awa i Nu aini and Be adion Rizki Sina edi *
Depa men o Pedia ic Den is y, Facul y o Den al Medicine, Uni e si as Ai langga, Su abaya, Indonesia.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 1785-1789
Publica ion his o y: Recei ed on 22 Ma ch 2025; e ised on 05 May 2025; accep ed on 08 May 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.26.2.1599
Abs ac
In oduc ion: Na al ee h a e a a e condi ion in which a newbo n p esen s wi h ee h a bi h. The lowe p ima y
cen al inciso s a e he mos commonly a ec ed ee h. Na al ee h ypically come in pai s and i is a e o see mo e han
wo e up .
Case His o y: A 2-mon h-old baby boy come wi h his mo he o den al check-up. Acco ding o he he e oanamnesis,
he lowe oo h had e up ed since bi h and caused di icul y, discom o , and so eness du ing b eas eeding. Two ee h
had p e iously e up ed, bu one o hem was ex ac ed soon a e bi h. On in ao al examina ion, a na al oo h was
obse ed in he lowe an e io egion, wi h se e e mobili y based on Mille ’s classi ica ion (G ade 2).
Discussion: Diagnosis is made based on his o ical and physical examina ion. Se e al ac o s o conside be o e made
he ea men plan whe he o main ain he ee h in o al ca i y o ex ac hem a e deg ee o oo h mobili y, con enience
du ing suckling, in e e ence wi h b eas eeding, auma ic inju y o he ongue, he oo h pa o no mal den i ion o
supe nume a y, o he sys emic ac o s. I he e up ed ee h a e no mobile, do no in e e e wi h b eas eeding,
asymp oma ic, and diagnosed as a oo h o he no mal den i ion, hese ee h should emain in he a ch. I he e up ed
ee h a e mobile, in e e ence wi h b eas eeding, and pa o supe nume a y ee h, hese ee h should be ex ac ed.
Conclusion: Mobile na al ee h should be ex ac ed o p e en he isk o aspi a ion and o make b eas eeding mo e
com o able.
Keywo ds: Na al Tee h; In an ; B eas eeding; Ex ac ion
1. In oduc ion
P ima y ee h begin e up ion a ound 6 mon hs old. Na al ee h a e p esen a bi h in o al ca i y while neona al ee h
e up ed du ing he i s 30 days o a mon h o li e.[1,2] The e iology o na al ee h s ill emain unknown and may be
ela ed o se e al ac o s such as supe icial posi ion o oo h ge m, in ec ion, eb ile s a es, malnu i ion, ho monal
s imula ion and ma e nal exposu e o en i onmen al oxins, gene ic, and hypo i aminosis. [3–5]
The wo ldwide p e alence o na al ee h is es ima ed o be 34.55 pe 10,000 and he incidence is be ween 1:2,000 and
1:3,000 li e bi hs.[6] Na al ee h occu mo e o en han neona al ee h in he a io o 3:1. Bodenho ’s s udy ound ha
85% o na al ee h a e mandibula inciso s, 11% maxilla y inciso s, 3% mandibula canines, and 1% a e maxilla y
canines o mola .[5,7–14] They o en appea in pai s. P edilec ion o emales was ci ed by some au ho s wi h Ka es e
al., epo ing a 66% p opo ion o emale agains a 31% p opo ion o male.[9]
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Ulce a ion o en al su ace o he ongue ha caused by he sha p incisal edge is majo complica ion o na al ee h. I
is also known as Riga-Fede disease. O he complica ions a e inju y o he mo he ’s b eas and di icul y while
b eas eeding. In he o he hand, deg ee o mobili y and he p esence o ulce a ions ha ound in child’s mou h a e
impo an clinical cha ac e is ics o conside when making he ea men plan.[3]
2. Case His o y
A 2-mon h-old baby boy came o pedia ic den al clinic a den al hospi al Uni e si as Ai langga wi h his mo he . Based
on he e oanamnesis, chie complain he lowe oo h had e up ed since bi h and caused di icul y, discom o , and
so eness while b eas eeding. Two ee h had p e iously e up ed, bu one o hem had been ex ac ed soon a e bi h.
Medical his o y was noncon ibu o y.
Ex ao al examina ion showed symme ical ace wi h no lymphadenopa hy. On in ao al examina ion, was ound c own
o a oo h in he mandibula inciso egion wi h whi e colo , small size, and se e e mobili y based on Mille ’s
classi ica ion (G ade 2) (Figu e 1). So issue was no mal and no ulce a ion on he en al su ace o he ongue.
Figu e 1 Na al Too h
Managemen o na al ee h is in luenced by se e al ac o s including oo h p ognosis, isk o aspi a ion, di icul y in
b eas eeding, isk o haemo hage. In his case, he p ognosis o he oo h was poo and he isk o aspi a ion was high.
The oo h also in e e ed wi h b eas eeding and isk o haemo hage was low. A e discussing he ea men plan wi h
his mo he . Ex ac ion was he bes op ion because she was conce ned abou he so eness and pain while b eas eeding.
Fi s , he oo h was anes he ized wi h opical anaes hesia (benzocaine 20%) hen ex ac ion was pe o med using
an e io o ceps and o a ional mo emen (Figu e 2). Hemos asis was achie ed pos ex ac ion (Figu e 3). Pos -
ope a i e ins uc ions we e gi en and ecall isi a e 1 week was scheduled. One mon h a e he ea men , he gingi a
had healed (Figu e 4). His mo he also eels mo e com o able while b eas eeding.
Figu e 2 Ex ac ed Na al Too h
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 1785-1789
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Figu e 3 pos -ope a i e
Figu e 4 One mon h ollow up
3. Discussion
Fo many yea s, cases o in an s bo n wi h na al and neona al ee h ha e been epo ed in he den al li e a u e. Na al o
neona al ee h a e small and conical. They ha e a yellowish-b own o whi ish opaque colo and ha e a hypoplas ic
enamel o den in wi h poo o absen de elopmen o he oo . Mos o hese ee h a e mobile.[9,10] The e iology o
na al ee h s ill emain unknown and may be ela ed o se e al ac o s such as supe icial posi ion o oo h ge m,
in ec ion, eb ile s a es, malnu i ion, ho monal s imula ion and ma e nal exposu e o en i onmen al oxins, gene ic,
and hypo i aminosis.[3–5]
The appea ance o each na al oo h in he o al ca i y can be classi ied in o ou ca ego ies gi en as ollows by Hebling
e al., based on he ee h eme ge in he o al ca i y: (1) shell-shaped c own poo ly ixed o he al eolus by he gingi al
issue and absence o a oo ; (2) solid c own poo ly ixed o he al eolus by he gingi al issue and li le o no oo ; (3)
e up ion o he incisal ma gin o he c own h ough he gingi al issues; (4) edema o he gingi al issue wi h an
une up ed bu palpable oo h.[8,10,11,15,16] Spoug and Feasby ha e sugges ed ha , clinically, na al and neona al ee h
a e u he classi ied acco ding o hei deg ee o ma u i y: (1) A ma u e na al o neona al oo h is he one which is
nea ly o ully de eloped and has ela i ely good p ognosis o main enance; (2) The e m imma u e na al o neona al
ee h, on he o he hand, implies a oo h wi h incomple e o subs anda d s uc u e; i also implies a poo
p ognosis.[15,16]
Diagnosis is made based on his o ical and physical examina ion. To a oid indisc imina e ex ac ions and i i is possible,
adiog aphic examina ion is ca ied ou o ule ou no mal den i ion o supe nume a y ee h.[16] Abou 1 – 10% o
na al and neona al ee h a e supe nume a y and abou 90 – 99% o hem a e ea ly e up ion o he no mal p ima y
deciduous ee h.[8,9,12,16] Se e al ac o s o conside be o e made he ea men plan whe he o main ain he ee h
in o al ca i y o ex ac hem a e deg ee o oo h mobili y, con enience du ing suckling, in e e ence wi h b eas eeding,
auma ic inju y o he ongue, he oo h pa o no mal den i ion o supe nume a y, o he sys emic ac o s.[8,13,15–
17] I he e up ed ee h a e no mobile, do no in e e e wi h b eas eeding, asymp oma ic, and diagnosed as a oo h o
he no mal den i ion, hese ee h should emain in he a ch. The e o e, main aining hese ee h a e he p ima y
ea men op ion. I he oo h causing auma, ea men such as smoo hing he sha p edges is necessa y.[10,11]
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 1785-1789
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In some cases, he oo h may be mobile o he ex en , which may equi e ex ac ion o a oid displacemen o
aspi a ion.[11] I is sa e o wai un il a child is 10 day old be o e ex ac ing he oo h. This wai ing pe iod be o e
pe o ming oo h ex ac ion is due o he need o wai o he commensal lo a o he in es ine o become es ablished
and o p oduce i amin K. I is equi ed o he p oduc ion o p o h ombin in he li e and coagula ion o blood. I i is
no possible o delay he ex ac ion, a consul a ion wi h paedia ician should be assessed, so hey can assess i he e is
a need o adminis e i amin K o no . Ame ican Academy o Pedia ics ecommends single dose o 0.5 – 1 mg which is
gi en in amuscula ly o all newbo n babies be o e ex ac ion because i is essen ial o he o ma ion o clo s a he
ex ac ion si e.[10,12,13,16,18]
4. Conclusion
Na al ee h a e a a e condi ion in which a newbo n p esen s wi h ee h a bi h. Diagnosis is made based on his o ical
and physical examina ion. The decision whe he o main ain o ex ac he na al ee h should be e alua ed in each case.
I he na al ee h ha e complica ions o mobile i should be ex ac ed o p e en he isk o aspi a ion and o make
b eas eeding mo e com o able.
Compliance wi h e hical s anda ds
Acknowledgmen s
The au ho s hank he e iewe s o hei insigh ul sugges ions.
Disclosu e o con lic o in e es
The au ho s decla e ha he e is no con lic o in e es ega ding he publica ion o his documen .
S a emen o e hical app o al
E hical app o al was ob ained.
S a emen o in o med consen
In o med consen was ob ained om pa ien included in he s udy.
Re e ences
[1] Ma wah N. Tex book o Pedia ic Den is y. 4 h Edi ion. Jaypee B o he s Medical Publishe l d.; 2019.
[2] Dean JA. McDonald and A e y’s Den is y o he Child and Adolescen . Vol. 10, McDonald and A e y’s Den is y
o he Child and Adolescen : Ten h Edi ion. 2016. 177–184 p.
[3] Va iano BM, Ades L, Vaughan SR. Case Repo : A a e case o bila e al mola na al ee h in a e m newbo n. F on
Den Med. 2024;5.
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