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Am Fam Physician. 2022;106(4):online

Author disclosure: No relevant financial relationships.

To the Editor: A mother (gravida 3, para 3) and her four-day-old female infant, born via normal spontaneous vaginal delivery, presented to our Federally Qualified Health Center for the infant's first examination after discharge. Based on the mother's preference, the infant was exclusively formula feeding without difficulties. At discharge, the infant had Epstein pearls on the lower gums, congenital dermal melanosis on the sacrum, and a hymenal tag.

A physical examination in the clinic found swelling of the mandibular gum with two protruding, white, mobile teeth on the anterior mandible with inflamed gingiva (Figure 1). The infant's vital signs were normal, and she was gaining weight. Radiography indicated supernumerary natal teeth, and pediatric dentistry recommended extraction; however, removal was delayed because of insurance issues and the COVID-19 pandemic. The teeth were extracted without complications when the infant was about six months old. The swelling and gingival inflammation had caused the teeth to appear similar to Epstein pearls at the hospital discharge examination.

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