Riga-Fede Disease

Linda - posted on 11/12/2010 ( 3 moms have responded )

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When my daughter turned 6 months she got her first tooth. Since then she's been rubbing her bottom tooth against the bottom of her tongue causing an ulcer. It's painful and sometimes she gets it to bleed. There isn't much on the internet about Riga-Fede Disease. I'm hoping there is another parent out there who can help me. My husband had it when he was little too. My daughter was born perfectly healthy and still is. We took Alesha to her pediatric dentist and they filed her tooth. It has helped, but she's still able to open the wound and it bleeds and she cries. I've cried with her too I feel helpless. I'm wondering if there is a cream or something on the market I can give her to help her. Any help is greatly appreciated.

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Cori - posted on 05/28/2011

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Linda, I am going through the exact same thing with my daughter. Our stories are identical! I feel helpless, we have been dealing with her ulcer for 7 weeks & its really starting to wear us all down. We had our daughters teeth filed by her dentist last week. She is scheduled for a biopsy and laser resurfacing of her tongue next week. I am so scared. Did your daughters ulcer heal? What treatment did she go through? I would REALLY appreciate any advice you could give me. All the best to you and your family.

Linda - posted on 11/12/2010

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I'm not going to extract her teeth she's not a candidate for that according to her dentist - thank goodness! Can you imagine having to do this to your baby! Extraction of the tooth/teeth should and must be the last resort. I'm interested in finding out what other options I have as a parent other than extraction.

Katherine - posted on 11/12/2010

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Abstract



The term Riga-Fede disease has been used historically to describe traumatic ulceration that occurs on the ventral surface of tongue in neonates and infants. It is most often associated with natal and neonatal teeth in newborns. A case of Riga-Fede disease is presented.







Keywords: Riga′s disease, Riga-Fede′s disease, traumatic sublingual ulceration





How to cite this article:

Hegde RJ. Sublingual traumatic ulceration due to neonatal teeth (Riga-Fede disease). J Indian Soc Pedod Prev Dent 2005;23:51-2



How to cite this URL:

Hegde RJ. Sublingual traumatic ulceration due to neonatal teeth (Riga-Fede disease). J Indian Soc Pedod Prev Dent [serial online] 2005 [cited 2010 Nov 12];23:51-2. Available from: http://www.jisppd.com/text.asp?2005/23/1...





Traumatic ulceration on the ventral surface of the tongue is most commonly associated with natal or neonatal teeth in newborns.[1],[2] It may also occur in older infants after the eruption of primary lower incisors with repetitive tongue thrusting habits[3] and in children with familial dysautonomia (in sensitivity to pain).[4]



Typically the lesion begins as an ulcerated area on the ventral surface of the tongue with repeated trauma, it may progress to an enlarged, fibrous mass with appearance of an ulcerative granuloma. It may interfere with proper suckling and feeding and put the neonate at risk for nutritional deficiencies. In such instances, dental intervention may be required.









Case Report





A twenty eight day old female was referred for evaluation of an ulcerated area on the ventral surface of the tongue [Figure - 1]. The mother complained of child exhibiting pain during suckling and would not nurse.



Oral examination revealed two crowns in the mandibular anterior region, whitish in color and exhibiting grade II mobility in central incisor position. The ventral surface of tongue showed 5 mm x 10 mm ulceration that extended from anterior border of the tongue to lingual frenum [Figure - 2]. On palpation, area elicited a pain response from the patient.



Examination of the rest of intraoral mucosa revealed no other lesions. Radiographic examination revealed a neonatal tooth, probably, a primary incisor, with well-formed crown but minimal root development. Based on clinical findings diagnosis of "Riga-Fede" disease was made.



Extraction of the teeth was chosen as treatment of choice over more conservative treatment which slows healing. Extraction was carried out under topical local anesthesia, which patient tolerated well. Patient was reviewed after ten days and the lesion was fully resolved. Mother informed that infant was feeding normally.









Discussion





For the past two hundred years, many reports of infants born with teeth or teeth erupting immediately after birth have appeared in the medical and dental literature.[5] These teeth have been referred as 'Natal teeth', 'congenital teeth' and precocious dentition (Mayhall and Badenhoff).[6],[7] In modern dental literature, most satisfactory terminology has been defined by Massler and Savara.[8] Natal teeth indicates teeth present in oral cavity at birth and 'neonatal teeth', those which erupt during the neonatal period i.e., from birth to thirtieth day of life. Neonatal teeth often present with hypoplastic enamel and underdeveloped roots, with resultant mobility.



Major complication from neonatal teeth is an ulceration on the ventral surface of the tongue caused by tooth's sharp incisal edge. Constant trauma may create ulceration sufficient to interfere with proper suckling and feeding and put the neonate at risk for nutritional deficiencies.



The lesion was first described by Antonio Riga, an Italian physician in 1881. Histologic studies and additional cases were subsequently published by F. Fede in 1890.[3] It has been subsequently been known as " Riga-Fede disease More Details".



Treatment of Riga-Fede disease has varied over the years. Early treatment consisted of excision of the lesion. Due to the erroneous diagnosis of the etiology, resolution of the lesion occurred only upon weaning of the child.



In case of mild to moderate irritation to the tongue, conservative treatment such as smoothing the incisal edge with an abrasive instrument is advocated.[9] Alternatively, a small increment of composite may be bonded to the incisal edges of the teeth.[10]



In this case, ulcerated area was large and denuded and even a reduced incisal edges may still contact and traumatize the tongue during suckling, enough to delay healing. The pediatrician's concern over the infants failure to gain weight due to ulceration's interference with suckling dictated the need for rapid resolution of the lesion. So extraction of the natal tooth was chosen over more conservative treatments.



At a follow up appointment, the lesion was fully resolved and infant was feeding normally.

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