Factitial oral lesions in an autistic paediatric patient

Abstract

Self Injurious Behaviour (SIB) is a deliberate harm to the body that may lead to factitial injuries. Its origin may be functional or biological and it has a higher prevalence in females and in psychologically impaired individuals. Seventy per cent of autistic patients have SIB. Seventy-five per cent of factitial injuries are located in the head and neck region. A paediatric case report concerning a 4-year-old autistic female is presented. Detailed medical history, physical examination, clinical intraoral and radiographic examination, incisional biopsy, neuropaediatrical, psychological and speech evaluation were undertaken. Diagnosis included hypochromic macrocytic anaemia, caries, coronal fracture, factitial ulcer, factitial periodontitis, self-extraction of primary teeth and permanent teeth buds, non-specific oral ulcer with inflammatory reaction, mild mental retardation, speech impairment, autistic syndrome and self injurious behaviour consisting of putting fingers and foreign objects in the gingiva, fingernail biting and hair pulling. Differential diagnosis included hystiocitosis X, prepuberal periodontitis and leukocyte adhesion deficiency. Dental preventive and restorative treatment was performed. Non-contingent reinforcement therapy was successfully used to diminish SIB. Treatment of factitial oral injuries must be interdisciplinary and requires cooperation of the patient, the parents, health care providers, and medical team.

Clinical immunology Clinical manifestations in the oral cavity in patients with hyper-IgE syndrome.

“…Three patients assessed at our Centre were diagnosed with tooth wear and injuries to the buccal mucosa in the occlusion line, ulceration, and ulcer scars on the lateral tongue margin, which were consistent with bruxism. Self-injuries to the oral mucosa and teeth are frequently associated with emotional and neurological disorders [40][41][42]. Clinical neurological manifestations in patients with HIES were reported as resulting from vascular lesions in the CNS [43].…”

“…Association between bruxism, allergic diseases and psychological problems has been well established [42][43][44][45][46]. It is indicated to perform investigations to determine the incidence of self-injuries in patients with HIES, and also identify the causative factors, since frequent oral mucosal injuries, in view of a permanent Candida spp.…”

Autoextraction in a child with autistic spectrum disorder

“…Although there are a number of rare causes of deciduous tooth loss in children, 10 nearly all of these are associated with significant alveolar bone loss (Table 1). In this case, the normal alveolar bone limits the differential diagnosis to two or three causes.…”

Case report of self-injurious behaviour (SIB) presenting as gingivitis artefacta major

“…2 Prevalence in females aged 15-19 is greater than in males, however, this trend is reversed in the 21-24 age group. 2 The relationship between SIB and genetic conditions such as Lesch-Nyhan Syndrome and autism is well documented [3][4][5] with a prevalence of up to 40% cited where profound disabilities exist.…”

“…7,13 Oral presentations include ulceration of the tongue from biting and cigarette burns, 9 and scratching of the gingivae causing recession (gingivitis artefacta) with bone loss. 3 In severe cases, this leads to autoextraction. 10,11 Two presentations of gingivitis artefacta, minor and major have been described.…”