Teething is a normal part of a baby’s development during the first year of life. Most babies get their first tooth between 4 and 7 months of age. The first teeth that poke through the gums are the central incisors, which are located on the bottom front.

While most infants get their first teeth months after birth, some babies are born with one or more teeth. These are called natal teeth. Natal teeth are relatively rare, occurring in about 1 out of every 2,000 births.

It can be a shock if your baby is born with teeth. But you don’t need to worry or take action unless the teeth interfere with feeding, or are a choking hazard. Your pediatrician can help advise you about what to do.

Natal teeth can seem mysterious, but there are certain conditions that can increase the chances of babies being born with teeth. These teeth may be seen in babies with a cleft palate or lip. Babies who are born with irregularities in dentin (the calcified tissues that help form teeth) may also have natal teeth.

There are underlying medical issues that may cause natal teeth. These include the following syndromes:

  • Sotos
  • Hallerman-Streiff
  • Pierre Robin
  • Ellis-van Creveld

In addition to certain medical conditions, there are a few risk factors that may increase a baby’s chances of being born with teeth. About 15 percent of babies born with teeth have close family members that had natal teeth when they were born, too. These include siblings and parents.

While there are conflicting studies on the role of gender and natal teeth, females seem to be more likely to be born with teeth than males.

Malnutrition during pregnancy is another possible risk factor.

While some babies are born with teeth, the situation isn’t always so clear cut. There are four types of natal teeth. Your doctor can determine which case your baby has:

  • fully developed, though loose, crowns affixed to a few root structures
  • loose teeth that don’t have any roots at all
  • small teeth just emerging from the gums
  • evidence of teeth about to cut through the gums

Most cases of natal teeth involve just one tooth. Being born with multiple teeth is even more rare. Lower front teeth are the most common, followed by upper front teeth. Less than 1 percent of babies with natal teeth are born with molars.

The exact type of teeth your newborn has will determine the risk for complications. This will also help your doctor determine if treatment is necessary.

Some babies aren’t born with teeth, but get them shortly after birth. Generally seen within the first month of life, teeth that emerge soon after birth are called neonatal teeth.

According to the journal Pediatrics, neonatal teeth are even more rare than natal teeth. In other words, your baby has a higher chance (though rare) of being born with teeth than getting teeth a few weeks after birth.

Symptoms of teething can start as early as 3 months of age. But in these cases, your baby won’t get any actual teeth for a month or more after that. Neonatal teeth appear so quickly after birth that your baby may not exhibit the normal telltale signs of teething like drooling, fussiness, and biting their fingers.

Natal teeth that aren’t loose are usually left alone. But if your baby is born with loose teeth that have no roots, your doctor might recommend surgical removal. These types of natal teeth can put your baby at risk for:

  • choking from accidental swallowing of the loose tooth
  • feeding problems
  • tongue injuries
  • injuries to the mother during breast-feeding

A loose tooth will be looked at via X-ray to determine whether a solid root structure is present. If no such structure exists, removal may be necessary.

Being born with teeth is rare, but it’s possible. If your baby has teeth at birth, be sure to talk to your pediatrician. Any loose teeth may need surgical removal to prevent hazards and health complications.

A pediatric dentist can help guide you through the process. Even if your newborn’s teeth aren’t considered an immediate concern, it’s important to monitor them to prevent any complications.