International Journal of Oral & Maxillofacial Pathology. 2012;3(2):43-44 ISSN 2231 – 2250

Available online at http://www.journalgateway.com or www.ijomp.org

Case Report

Riga-Fede Disease Due to Neonatal Tooth: A Case Report

Nitin Sharma, Subhash Chander, Shweta Soni, Shamsher Singh, Madan Gopal Chodhary

Abstract

The natal and neonatal tooth has been reported to cause ulceration on the ventral surface of the tongue in neonates and infants, which may affect the child’s feeding habits. This appearance was described by Riga and Fede and hence been termed as Riga-Fede disease. Treatment option is either conservative or extraction of natal and neonatal tooth. This paper presents a case of Riga- Fede disease caused by a neonatal tooth. Extraction of neonatal tooth was planned. On follow-up the lesion was resolved and infant was feeding normally.

Key words: Mouth Disease;Oral Ulcer;Natal Teeth;Predeciduous Tooth;Newborn;Riga-Fede.

Nitin Sharma, Subhash Chander, Shweta Soni, Shamsher Singh, Madan Gopal Chodhary. Riga-Fede

Disease Due to Neonatal Tooth: A Case Report. International Journal of Oral and Maxillofacial Pathology;

2012:3(2):00-00. ©International Journal of Oral and Maxillofacial Pathology. Published by Publishing

Division, Celesta Software Private Limited. All Rights Reserved.

Introduction

Received on: 22/11/2011 Accepted on: 21/04/2012


of child exhibiting pain during suckling and
The lesion was first described by Antonio Riga in 1881 and Francesco Fede done subsequent histological studies in 18901, subsequently this lesion was termed as
Riga-Fede disease. Riga-Fede is a rare condition of benign ulceration caused by repetitive trauma to the lingual tissues by the tooth in children younger than two years of age. The differential diagnosis includes infective and neoplastic conditions. Traumatic ulceration on the ventral surface of tongue is commonly associated with the
natal and neonatal teeth in newborn.2,3 It may also occur in older infants after the
eruption of primary lower incisors with
repetitive tongue thrusting habit. It may interfere with proper suckling and feeding and put the neonate at risk for nutritional deficiencies.4 The presence of natal and neonatal tooth is definitely a disturbance of
biological chronology whose aetiology is still
unknown. Neonatal tooth has been related to several factors, such as superficial position of the germ, infection or malnutrition, febrile states, eruption accelerated by febrile incidents or hormonal stimulation, hereditary transmission of a dominant autosomal gene, osteoblastic activity inside the tooth germ and
hypovitaminosis.5 Here, an interesting case of Riga Fede disease due to neonatal teeth
is discussed

Case report

The parents of twenty days old child reported to department of Pedodontics and Preventive dentistry with chief complaint of ulcerated area on the ventral surface of tongue of their child. The mother complained
could not be able to nurse the child. Clinical examination revealed a whitish tooth like structure in the anterior region of mandibular arch, exhibiting grade II mobility. The ventral surface of tongue showed 5 x 8 mm ulceration that extended from anterior border of tongue to lingual frenum (Figure 1a). On palpation of involved area pain was felt. Examination of the rest of intraoral mucosa revealed no other lesion. The cause of this ulceration was due to neonatal tooth. Hence, extraction of teeth was chosen as treatment of choice over more conservative treatment which shows slower healing. Extraction of the offending neonatal tooth was carried out under topical Anastasia, which patient tolerated well (Figure 1b). Extracted tooth showed well developed crown and a very short root (Figure 1c). On follow-up it was observed that child was feeding normally.

Discussion

Riga-Fede disease is a reactive, traumatic mucosal disease characterized by persistent ulceration of the oral mucosa.1 Most frequently it involves the ventral surface of
the tongue or the lingual fraenum because the tongue is raked over the teeth.3
Presentation appears to be bimodal, coinciding with natal teeth (present at birth) or neonatal teeth (erupting during the first 30 days of life), and eruption of the primary teeth. Classification into two discrete groups aids etiological identification. ‘Early’ cases (before six months of age) are related to natal or neonatal teeth, which often present with hypoplastic enamel and underdeveloped roots, with resultant early mobility. ‘Late’ cases (six months of age and

©2012 International Journal of Oral and Maxillofacial Pathology. Published by Publishing Division, Celesta Software Private Limited . All Rights Reserved

44 Nitin Sharma et al., ISSN 2231 - 2250

older) occur with primary dentition, are frequently habitual, and may be related to neurological or developmental disorders.6,7
In case of mild to moderate irritation to the tongue, conservative treatment such as smoothing the incisal edge with an abrasive instrument is advocated.8 Alternatively a small increment of composite may be bonded to the incisal edges.9 Extraction may
be needed to alleviate feeding difficulties or
complications like Riga-Fede disease. Extraction may also be indicated if child’s age is ten days or above and child has appropriate amounts of Vitamin K in the blood. Otherwise prophylactic administration of vitamin K (0.5 - 1.0 mg, I,m) is advocated before and after extraction, since vitamin K is essential for the production of prothrombin in the liver as there could be risk of
haemorrhage.10

a b c


Figure 1: The Photograph of Infant with a neonatal tooth causing sublingual ulceration (a), post- extraction of neonatal tooth (b) and the extracted neonatal tooth (c).
This present case reported with a large ulceration of tongue and the conservative approaches might have delayed healing with negative impact on feeding. Hence, extraction was planned as the treatment of choice.

Author Affiliations

1. Dr.Nitin Sharma, Senior Lecturer, Department of Pedodontics and Preventive Dentistry, 2. Dr.Subhash Chander, Senior Lecturer, Department of Conservative and Endodontics, 3. Dr.Shweta Soni, Senior Lecturer, Department of Periodontics Dentistry, 4. Dr.Shamsher Singh, Senior Lecturer, Department of Pedodontics and Preventive Dentistry, Vyas Dental College and Hospital, Jodhpur, Rajasthan, 5. Dr.Madan Gopal Chodhary, Assistant Professor, Department of Pediatrics, Government Medical College, Bikaner, India

References

1. Choi SCP, Choi YC, Kim GT. Sublingual traumatic ulceration (a Riga-Fede disease): Report of two cases. Dental Traumatology 2009;25:e48-e50.
2. Goho C. Neonatal sublingual traumatic ulceration (Riga-Fede disease): reports of cases. J Dent Child 1996;63:362-4.
3. Buchanan S, Jenkins CR. Riga-Fede syndrome: Natal or neonatal teeth associated with tongue ulceration, case report. Aust Dent J 1997;42:225-7.
4. Slaryton R. Treatment alternatives for sublingual traumatic ulceration (Riga- Fede Disease). Fed Dent 2000;22:413-
4.
5. Robson Frederi cocunha, Farli Aparecida Carriiho Boer. Natal and neonatal teeth: review of the literature. Pediatric Dent 2001;23(2):158-62.
6. Hegde RJ. Sublingual traumatic ulceration due to neonatal teeth (Riga- Fede disease). J Indian Soc Pedo Prev Dent 2005;23:51-2.
7. Cunha RF. Natal and Neonatal Teeth: Review of literature. Paed Dent
2001:23:(2)158-62.
8. Allwright W, Natal and neonatal teeth. A study among Chinese in Hong Kong. Br Dent J 1958;105:163-72.
9. Baghdadi ZD. Riga-Fede disease: Report of a case and review. J Clin Fed Dent 2001;25:209-13.
10. Samadi F, Babaji P. Case Report of Natal Teeth: Report of Two Cases and Review of Literature. Int J Oral Maxillofac Pathol 2011;2(1):33-6.

Author Correspondence

Dr. Nitin Sharma,

Senior Lecturer, Department of Pedodontics and Prevantive Dentistry, Vyas Dental College, Jodhpur, Rajasthan, India.

Ph: +91 9413552698

E Mail: dr.nitinsharma4u@gmail.com

Source of Support: Nil, Conflict of Interest: None Declared.


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