presence of teeth in a new born is a rare condition with an incidence ranging from 1:1000 to 1:30000 . teeth present at birth and emerging in the oral cavity within the first 30 days of life are defined as natal and neonatal teeth , respectively . almost all of these teeth are normal primary complement and are often loose due to incomplete root development . however , persistent natal / neonatal teeth can be uncomfortable for the infant as well as the mother . complications such as aspiration into the infant 's lung and ulceration of the tongue can occur . in addition , the sharp incisal edges of these teeth may cause difficulties during breast - feeding for the mother . therefore , disking of the sharp edges or extraction in cases of hyper - mobility can be choose as treatment . the treatment of patients with clp starts as soon as possible after birth and does not end until the adulthood . after clinical evaluation and taking the history , the orthodontist takes intraoral impression routinely for preparing the feeding / presurgical orthopedic therapy plate . consequently , presence of natal / neonatal teeth has a paramount importance for the orthodontist . first , natal teeth have to be noted and essential treatments should be performed before the impression stage to prevent any aspirations . if teeth emerge after birth ( neonatal teeth ) ; the intraoral plate may not fit and modifications of the plate may be required . in some cases , the therapy has to stop and postpone until the teeth has extracted . moreover , researches stated that natal / neonatal teeth are more frequently observed in patients with clp compared to general population . therefore , the aim of this retrospective study was to determine the prevalence and the distribution of natal / neonatal teeth in infants with clp according to gender , involving jaw and side and to show the management of some cases with natal / neonatal teeth . the present study was performed retrospectively using the data of 88 infants with clp who were treated in the clp clinic of yeditepe university during 20142015 . nineteen of 88 patients were excluded from the study because of the following reasons : 
 no records were taken at weekly follow - up appointments ( n = 9)referred to the clinic later then 1 week after birth ( n = 10 ) . no records were taken at weekly follow - up appointments ( n = 9 ) referred to the clinic later then 1 week after birth ( n = 10 ) . finally , 69 ( 31 females , 38 males ) infants with clp were enrolled into the study . afterward , a categorization of the natal teeth was performed according to gender , cleft type , location , and position . the results were evaluated , and statistical analysis was performed using statistical software program ibm spss statistics 22 ( ibm spss , turkey ) . to analyze the data , descriptive statistical methods ( mean value , prevalence ratio , and standard deviation ) the results were evaluated , and statistical analysis was performed using statistical software program ibm spss statistics 22 ( ibm spss , turkey ) . to analyze the data , descriptive statistical methods ( mean value , prevalence ratio , and standard deviation ) neonatal teeth were recorded in five infants ( 5/65 ; 7% ) . no statistical significant difference according to gender was found ( p > 0.05 ) . however , more than half ( 60% ) of the neonatal teeth were determined in female infants [ table 1 ] . comparison of neonatal teeth presence between gender and cleft types and distribution of neonatal teeth according to gender , cleft type , region , jaw and side the presence of neonatal teeth was not statistically different between cleft types ( p > 0.05 ) . natal teeth were identified in vestibular alveolar region in more than  ( 80% ) of the cases . all of the neonatal teeth were located in the maxilla ( 100% ) and positioned on the cleft - side ( 100% ) [ table 1 ] . a 5-day - old female infant with complete bilateral clp was referred to the cleft clinic . a dark soft tissue extension was evaluated on the right - labial cleft - side of the premaxillary segment by examination [ figure 1a  d ] . at the 1 week follow - up appointment a progressive eruption of the neonatal tooth after blood test ( prothrombin level ) was performed , the neonatal tooth was extracted and 1 week later the intraoral impression were taken [ figure 1i  l ] . the nasoalveolar molding therapy was started at the age of 20 days by direct addition of nasal stents and vertical and horizontal bands . ( 1 ) initial records , 5-day - old . ( a ) columellar view . ( d ) lateral view ; neonatal teeth on cleft - side vestibular region , 13-day - old . ( e ) ( l ) lateral view a 12 day male infant with complete bilateral clp presented with a neonatal tooth on the right - palatal cleft - side of the premaxillary segment [ figure 2a ] . the tooth was extracted and an appointment for 1 week later was set [ figure 2b ] . nevertheless , at this appointment , a large dark brown soft tissue extension of the palatal healing side was recorded . therefore , to avoid any misdiagnose ( either re - emerge of another neonatal tooth or the eventually eruption of primary tooth ) a periapical radiograph was taken [ figure 2c ] . hence , no presence of any tooth in the soft tissue was observed , the presurgical orthopedic treatment was started . a male case with bilateral complete cleft lip and palate . ( a ) intraoral view of neonatal teeth on cleft - side palatal region , 12-day - old . ( c ) intraoral radiograph to determinate soft tissue extension a neonatal tooth on the cleft - side of the greater alveolar segment in 18-day - old female infant with complete left unilateral clp was observed during the intraoral evaluation in the cleft clinic [ figure 3a ] . 1 week after the extraction of the neonatal teeth , the soft tissue was not healed yet [ figure 3b ] . to avoid any irritation of the healing side , the nasoalveolar therapy was postponed for 2 weeks and only horizontal lip bands were used [ figure 3c ] . a female case with unilateral complete cleft lip and palate . ( a ) intraoral view of neonatal teeth on cleft - side vestibular region , 18-day - old . ( c ) follow - up of the healing period by using horizontal lip bands , 25-day - old a 5-day - old female infant with complete bilateral clp was referred to the cleft clinic . a dark soft tissue extension was evaluated on the right - labial cleft - side of the premaxillary segment by examination [ figure 1a  d ] . at the 1 week follow - up appointment a progressive eruption of the neonatal tooth after blood test ( prothrombin level ) was performed , the neonatal tooth was extracted and 1 week later the intraoral impression were taken [ figure 1i  l ] . the nasoalveolar molding therapy was started at the age of 20 days by direct addition of nasal stents and vertical and horizontal bands . ( 1 ) initial records , 5-day - old . ( a ) columellar view . ( d ) lateral view ; neonatal teeth on cleft - side vestibular region , 13-day - old . ( e ) a 12 day male infant with complete bilateral clp presented with a neonatal tooth on the right - palatal cleft - side of the premaxillary segment [ figure 2a ] . the tooth was extracted and an appointment for 1 week later was set [ figure 2b ] . nevertheless , at this appointment , a large dark brown soft tissue extension of the palatal healing side was recorded . therefore , to avoid any misdiagnose ( either re - emerge of another neonatal tooth or the eventually eruption of primary tooth ) a periapical radiograph was taken [ figure 2c ] . hence , no presence of any tooth in the soft tissue was observed , the presurgical orthopedic treatment was started . a male case with bilateral complete cleft lip and palate . ( a ) intraoral view of neonatal teeth on cleft - side palatal region , 12-day - old . a neonatal tooth on the cleft - side of the greater alveolar segment in 18-day - old female infant with complete left unilateral clp was observed during the intraoral evaluation in the cleft clinic [ figure 3a ] . 1 week after the extraction of the neonatal teeth , the soft tissue was not healed yet [ figure 3b ] . to avoid any irritation of the healing side , the nasoalveolar therapy was postponed for 2 weeks and only horizontal lip bands were used [ figure 3c ] . a female case with unilateral complete cleft lip and palate . ( a ) intraoral view of neonatal teeth on cleft - side vestibular region , 18-day - old . ( c ) follow - up of the healing period by using horizontal lip bands , 25-day - old the normal eruption is at approximately at 6 months of age and is celebrated in the family in many cultures . however , if this eruption is considered rather early , at birth for instance ; it leads to anxiety and worry in parents . not only the chaotic feelings of the parents are of matter for specialists but also the difficulties during daily functions such as feeding concerns them . in summary , presence of these teeth has to be recognized as a disturbance of biological chronology and should be approached with ample attention . the incidence of natal / neonatal teeth is relatively low in infants without cleft . on the other , the prevalence of natal or neonatal teeth was found significantly higher in patients with clp . similarly , kates et al . found that the ratio of natal teeth presence is double in females compared to males . on the other , some researches argued that this situation occurred more frequently in males or that no gender differences are evident . 60% neonatal teeth were from unilateral cleft patients though the frequency was lower than the bilateral patients . in bilateral clp cases , de almeida and gomide stated a lesser whereas iwamoto et al . none of the infants with only cp showed the presence of natal / neonatal teeth . other studies argued also that they not recorded natal / neonatal teeth in cases with only cp . all natal / neonatal teeth were found in the maxilla and on the cleft - side . de almeida and gomide also reported that the most prevalent location of these teeth were in the maxillary incisor region . on the other , kadam et al . reviewed 151 infants with clp and recorded three cases with neonatal teeth . indeed , in the general population , the most frequent location of natal / neonatal teeth was described as the mandibular incisor region . tsai et al . argued that natal teeth among cases with clp were more often observed in the premaxillary and maxillary segments , unlike the cases without cleft . they suggested that variations in tooth number such as supernumerary teeth occur most often in the cleft areas in both primary and permanent dentition , whereas tooth anomalies outside the cleft region are more seen in the permanent dentition . neonatal teeth may also be indicated as primary supernumerary teeth and consequently always located on cleft - side . in the management of neonatal teeth , sometimes a dental radiograph may be helpful in the differentiation of premature eruption of deciduous tooth or large soft tissue enlargement with different color from a supernumerary ( neonatal teeth ) . hebling et al . suggested to preserve and to maintain the tooth in healthy condition using all possible clinical resources . in an overview of 60 research mentioned that when infants with clp have neonatal teeth , they interfere with fabrication and application of intraoral appliance . therefore , they recommended extraction of neonatal teeth to facilitate orthopedic therapy . according to the results of this study , all the neonatal teeth were located at the cleft - side and consequently inside the borders of the intraoral molding plate . therefore , in the routine protocol of our cleft clinic , neonatal tooth extraction is performed in all cases with clp who will undergo presurgical orthopedic treatment . the extraction is performed not earlier than 10 days after birth . during the first 10 days after delivery , the bacterial flora may be ineffective in vitamin k production , which plays a major role in prothrombin synthesis . the risk of hemorrhage due to hypo - prothrombinemia is present . to avoid any complications , advised vitamin k administration if extraction due to mobility has to performed before the age of 10 days . after an approximately 1-week healing period , the presurgical orthopedic treatment is always started . however , sometimes the healing period is longer and during the follow - up period only horizontal lip bands may be used . in some cases , neonatal teeth emerge during the 1 month of life after the start of presurgical orthopedic treatment or the systemic well - being do not enable the extraction . in such cases , modification of the border of the intraoral plate until the extraction and during the soft tissue - healing period to enable fit of the plate may be recommended . following the results of the present study , the presence of natal / neonatal teeth in infants with unilateral and bilateral clp was not rare . in all of these cases , the teeth were located adjacent to the cleft region . in isolated palatal cleft , where the alveolar region including the teeth buds are away from the cleft , no neonatal teeth were observed . it may be concluded that neonatal teeth in infants with clp are frequently located inside the borders of the presurgical orthopedic plates . if possible immediate extraction of the neonatal teeth is advised . in cases of systemic health pathologies , modifications of the plate hence , the physiology is different in infancy , the specialist has to be careful in management of them . overall , more studies are needed to make up guidelines for management of neonatal teeth in infants with clp .
objective : the aim of this study was to determine the prevalence and distribution of natal / neonatal teeth in infants with cleft lip and palate ( clp ) according to gender , involving jaw and side and to show the management of some cases.materials and methods : a retrospective study was carried out on medical history and photographic records of 69 infants with clp , who were treated at the clp clinic of yeditepe university between years 20142015 . 
 the presence of neonatal teeth was determined , and if present the gender , type of cleft , and position were recorded . 
 statistical analysis was performed.results:neonatal teeth were observed in 7% of the study group . 
 no significant differences were found between cleft types and gender ( p > 0.05 ) . 
 the prevalence of neonatal teeth in bilateral , unilateral and isolated cleft type was 16.5% , 6.5% , and none , respectively . 
 all neonatal teeth were located in the maxilla and on the cleft - side ( 100%).conclusion : the presence of natal / neonatal teeth in infants with clp was not rare . in all of these cases the teeth were located adjacent to the cleft region . in isolated palatal cleft , where the alveolar region including the teeth buds are away from the cleft , no neonatal teeth were observed . 
 it may be concluded that neonatal teeth in infants with clp are frequently present and located inside the borders of the presurgical orthopedic treatment ( pot ) plate . 
 therefore , if possible , immediate extraction of the neonatal teeth is advised or if not possible because of systemic health reasons , modifications of the plate are required .