What is the Riga-Fede ulcer?

A few weeks ago, we dealt with a very interesting case at the clinic that aroused the curiosity of our followers. It was about a baby just 2 months old who had stopped eating because she had a natal tooth that was causing a wound.

You can see the post here:

But why does all this happen?

Let's talk about Riga-Fede's Ulcer

Riga-Fede ulcer is a traumatic lesion, usually whitish in colour and with irregular edges, that appears on the tongue, mainly affecting children under 2 years of age.

This lesion appears due to the continuous rubbing between the tongue and the lower teeth because most newborns have a smaller and posterior mandible (or lower jaw) (known as mandibular retrognathia) with respect to the upper jaw, so that sucking and swallowing are brought forward. This causes the tongue to make several movements, including extension, which it does in order to cover the lower gum and thus press on the breast or teat until the milk is obtained.

This is a completely normal movement in neonates, as we say, and nothing out of place in principle occurs. However:

What happens if a tooth is present or emerging?

It is when the baby has a tooth that the problem arises. There are two types of teeth that a baby can have before the age of 6 months: natal teeth and neonatal teeth. The former are those that are in the baby's mouth from birth and the latter are those that erupt in the first 30 days after birth.

In addition, the incisors are teeth whose shape is perfect for cutting food, and which also have very marked mamelons on the edge to facilitate eruption, thus eliminating the gum more effectively to go into the mouth.

Therefore, when this sharp shape is combined with the way of swallowing, the continuous rubbing of the tooth against the mucosa will create the ulcer. It is not a malignant lesion, but it is painful, which will cause babies to stop feeding because of the pain of trying to feed.

And how can we deal with it?

Treatment will depend on a number of factors, but is common:

Tooth extraction

When it is a natal tooth, i.e. a tooth that has been in the mouth since birth, and is mobile or even a supernumerary tooth, i.e. an 'extra' conoid-shaped tooth that is usually not 'necessary' in the mouth, the solution is a simple extraction.

If it is mobile, this is done preventively, to prevent the baby from choking or even suffocating if the tooth comes out by itself. And if it is a supernumerary tooth, to prevent it from hindering the eruption of the primary teeth, which will begin at around 6 months of age.

An ameloplasty

Or to put it a little more prosaically, 'filing the edges'. This is the ideal option when the lesion is caused by temporary teeth that we do not want to remove, because the baby will need them later on, when he or she starts to chew. By rounding them off we relieve the cutting area and achieve complete healing of the ulcer.

If this is not sufficient, we can cover these teeth with composite or ionomer, thus producing a more rounded shape that does not rub against the mucosa.

In the event that none of these alternatives is able to make the lesion disappear, extraction would be carried out, but it is not the ideal option in any case.