Hand to Hold's Official Blog: Written by Parents for Parents

Dental Issues of Prematurity

We all picture the day our baby’s gummy smile is suddenly changed by their first teeth erupting. I mean, what’s cuter than a little baby looking up at you with their tiny new pearly whites grinning back at you? But what if there were issues that your preemie could be facing once they began teething? Wouldn’t you want to know so you could be prepared? I’ll tell you who wasn’t prepared…. ME.

15 Months - tooth eruption

15 Months – tooth eruption

One of the first common issues we faced was DELAYED TOOTH ERUPTION. If your preemie was particularly small or sick, an approximate 2-6 months delay of tooth eruption is common. We took our 29weeker to the dentist at 12 months to make sure everything looked ok. We were told the delay was just a “preemie thing” and were told to bring him back when his first tooth erupted. At 15 months, I was grinning ear to ear when it finally happened. It was finally going to happen!!

And then came the shocker. His teeth were noticeably dark YELLOW.

No one had warned us that preemies are more prone to having TOOTH DISCOLORATION. Generally, this yellow


or brown discoloration is only seen in preemies that have high bilirubin levels while in the NICU. In our case, TPN (total parenteral nutrition) was used for a prolonged period of time resulting in cholestatic jaundice, which significantly raised our son’s bilirubin level causing his primary teeth to become discolored. The downside is brushing or having them cleaned by the dentist cannot remove the discoloration, but the good news is the discoloration is only seen on the primary teeth.

Enamel Hypoplasia

Enamel Hypoplasia

It seemed like just as we were coming to terms that our son’s teeth would be discolored for the first 6 or so years of his life, we were hit with the next wave of dental issues – ENAMEL HYPOPLASIA. Enamel hypoplasia means there is a lack of enamel on the outside of the teeth. This can lead to the thin enamel chipping away, developing discolored spots on the tooth crowns, pitting or irregularity of the tooth crowns, and the teeth are more prone to wear and fracture (which is why he’s missing half of his front tooth).

We were faced with the question of what to do to treat these issues. Our son visited the dentist every 3 months for treatment and at just under 4 years old, we made the decision to have his teeth restored. Most people ask why we waited so long and what the process was like. We knew because of his thin enamel that a cavity was inevitable at some point and his dentist recommended we should wait and have everything done at once because sedation would be necessary. There were no negative impacts caused by the enamel hypoplasia. There were constant stares, pointing and whispers, but our son was in no pain whatsoever. Besides, we had more serious health issues to tend to in regards to his special needs before scheduling a cosmetic procedure that would most likely have him running to the hills every time he saw the dentist afterwards.

Recovery Room

Recovery Room

On the day of surgery, we checked-in to the Children’s hospital where their special needs care team took great care to make our son comfortable. After 2 hours in the operating room, we were in the recovery room with our little man. They had filled his cavities, filed and restored all of the pitting caused by the hypoplasia and had sealed his teeth so they would remain strong until his permanent teeth come in.

I wish I had been educated when it came to my preemie’s teeth so I could have been prepared for the road we had ahead. I now know that all of this is completely normal and want you to know if you are going through it, that you are not alone.

preemie tooth resoration

After Restoration

Beauty is not flawless. It shines even through your flaws.

Cristal Grogan About Cristal Grogan

Cristal Grogan (MD) is the mother of Seth, who was born at 29 weeks weighing 2lbs 4oz due to severe preeclampsia, HELLP, and IUGR. As a military wife, Cristal and her husband were living in southern Spain at the time. Seth’s NICU stay was complicated as he battled NEC, ROP, IVH, PDA, Sepsis and PVL, but Seth defied all odds. He is now a happy and healthy 3 year old avid reader living with Autism and SPD. After navigating through the NICU life in a foreign country, amidst a language barrier and lacking proper resources or support system, Cristal swore to become involved in the preemie community to make sure no other parent was left in the same desperate situation. Currently, she is the Administrative Assistant for Preemie Parent Alliance and social media volunteer for It’s a Preemie Thing. In her personal blog, she describes the daily life of a military family with a special needs child.


  1. Cristal, thank you for this post! My son was 14 months old before he got his first tooth, but our pediatrician wasn’t sure if the cause was his prematurity or just his own timing. With my daughter, I’ve noticed that one of her front teeth is stained a bit and was chipped soon after it erupted, just from her grinding her teeth while she was teething. Most of her other teeth seem fine, so we’re lucky. But, she had to stay on TPN an extra few days, and she was extremely jaundiced. So, your post has led me to wonder if what I’m noticing are some of the side effects. Our pediatrician recently suggested we go ahead and take our daughter to a pediatric dentist (she just turned 2), and your post is reinforcing that a check up would be a good idea. Thanks again!

  2. This happened to my daughter and I never knew what it was. I thought it was from too much antibiotics but now I’m starting to think it was from being in NICU. Her 2 front teeth discolored and deteriorated really bad, but she never had cavities.

  3. Interesting post. I don’t know whether I had any of these issues (I am a former preemie). I did need braces because my jaw was too narrow and hence my front teeth stuck forward. I heard this could be a side effect of ventilation.

  4. Very informative article. Thank you for sharing what you learned. My preemie got his first tooth at 16 months. I remember wondering if they were in there at all!

  5. Thank you so much for this information. I’ve had worries about the long term effects of TPN related cholestasis. (He was on actigal for almost 2 months to lower the bili) Unfortunately, my pediatrician didn’t have an answer for me. He is 7 months (5 months adjusted) and no teeth yet. His older sister didn’t have any til almost a year and she was full term. So, we could be waiting awhile. I’ll definitely let his dentist know about this in his health history. Thank you again!

  6. Thanks for the post. We too have dealt with this in our 29 weaker, severe pre-e, reverse diastolic flow, IUGR, SGA, NEC and long term TPN use. Thankfully it’s only his top 4 center teeth which are very yellow, nubby/malformed, lack enamel and I swear have a ridge in one where a tube sat in his mouth. I found very little information online. He’s been seen by the dentist since age one when they wanted to cap them right away. I however did not want sedation if we didn’t need to as he had bad reactions with it in the Nicu and had only been home a few months. We opted to try vigilant brushing (very hard with a kid with mild oral aversion) and a paste called MI Paste which acts as a protective layer we apply 2x a day. It’s been a pain but so far at age 3 we are still cavity free and the yellowing has actually Improved slightly with the paste. Fingers crossed we can make it until he’s ready for his adult teeth!

  7. My daughter (29 weeker) was actually born with her two bottom front teeth. Not nice for breast feeding! They fell out when she was 18 months old. I was worried it would lead to her other teeth closing the gap, causing problems when her adult teeth come through; but trips to the dentists have assured me that shouldn’t be a problem. We’ll see. She’s five now, and the biggest problem I have is my daughter doesn’t remember losing her teeth, and stresses out about them. I just have to keep telling her that everyone is different, and give her big hugs!

  8. I have a 29-weeker, and a couple of her teeth are much farther behind than the others in their location. Is that normal also? Didn’t know if it happened to preemies, or if it’s just hers. I also didn’t know the things that are mentioned in this article.

  9. My 24 Weeker now 10 years old, has had and has always had the most beautiful white teeth she was also on tpn for prolonged time the only thing she has is she gets congested when teething and on 3 occasion (2 of which are happening now) the milk teeth will not just drop out without the 2nd teeth being nearly all the way through first so she has a runny nose and a cough until the milk teeth drop out, our dentist is more than happy with her teeth, says she might need a brace when she is older but so do full gestation kids so nothing not normal there, kids are kids and they are all different, I have family members with discoloured enamel, and I too have tetrocyclin staining due to medication when I was younger but my daughter having been on the NICU for 150 days has none of this, thank the Lord xx

  10. This article was very helpful. My 30 weeker who is now 7 recently had two major procedures on his permanent teeth that had grown in brown. The dentist said they were almost like mush because the enamel did not grow in with the tooth. I asked him if it was because he was a preemie and he said that could be the case but he wasn’t sure. Thank you very much for writing this article and shedding some light on our questions.

  11. Do you all think it may be them being premature or just from them being in the nicu? My daughter wasnt preemie she was full-term but diagnosed with a genetic disorder and had the cleft lip and palate when born. My daughter had her first teeth come in close to a year old and seemed like not too long after she got them they started losing the enamel and chipping away. This is worth having her doctors look into and see if they can treat hers too. Ty for this post. I have never heard of anything like that before.

  12. Many thanks for the article! it was very helpful , are the permanent theeth coming out ok or should we be concerned also with special care for them too?

  13. Christina says:

    Yes please if anyone could help me my preemie just turned 5 and he has seen the dentist every 6 months. I changed dental clinics because of the drive and my boy has been there 4 years. The last visit they informed me that he needed oral surgery asap! And have him scheduled for Wed in 2 days. I’m having second because I’m
    not happy with him being out on anesthesia. They immediately told me it was delayed tooth decay but the last two visits they couldn’t take expats because he fought them and they said oh we will get some next time. He is on Medicaid so I’m confused and concerned the want to cao for 4 front teeth and they said they wouldn’t know how many in the back there would be because of the fact he won’t take X rays. I ask them to give him laughing gas to get X-ray’s but they just blew it off like all if a sudden they needed to do oral surgery right away! Should I get a second opinion?
    Thank you for any replies

    • Leigh Ann TorresLeigh Ann Torres says:

      Yes, I highly recommend getting a second opinion, especially if they are rushing into surgery. It doesn’t mean he doesn’t have issues that may need to be addressed, but for that magnitude of work, I would definitely get a second opinion.

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