Sir, we would like to report an unusual case of sublingual and ventral tongue ulceration, which was present for two weeks, in a six-week-old female Caucasian baby. The mother was concerned about her baby's intraoral discomfort and difficulty with feeding. Examination revealed a distressed baby with a lower right mandibular tooth of whitish colour and shape resembling a primary incisor, with grade II mobility. The tongue was slightly raised at rest with an 8 × 10 mm indurated and tender ulcer on the ventral surface/floor of the mouth extending from the tip to the lingual fraenum (Fig. 1). The medical history was clear. As the tooth was the suspected cause of the ulceration and pain it was extracted and this was completed using topical anaesthetic. On review ten days later, examination revealed complete healing of the ulcer and the extraction socket. The baby appeared to be much more content and the mother reported that her baby was feeding normally.

Figure 1
figure 1

Ulcer on the ventral surface/floor of the mouth

Full size image

Ulceration of the ventral surface of the tongue in newborn babies or infants is most commonly related to natal or neonatal teeth, as illustrated in this case.1,2 We believe this particular type of ulceration to be a case of Riga-Fede disease;3 this was initially described by Riga in 1881 and Fede in 18904 and has been reported since, but not widely in the British literature. Typically, the benign lesion begins as an ulcerated area on the ventral surface of the tongue exposed to repeated trauma from a natal tooth.2 It may progress to an enlarged fibrous mass and has appearances that have been described as those of a traumatic ulcerative granuloma (with stromal eosinophilia)5 (Fig. 1). Such ulceration can also be seen in infants with primary teeth and a tongue thrusting habit and in children with familial dysautonomia (insensitivity to pain).6 Recognition of these clinical signs may also be an indicator of neurological disorders.

Treatment of Riga-Fede disease has varied from excision of the lesion, to smoothening of the sharp incisal edges or rounding of the sharp edges of the tooth with composite increments, the latter being where mild to moderate ulceration occurs.4 Where the ulceration is large and interfering with feeding, removal of the tooth can be beneficial, as in this case.