Interdisciplinary Management of Gingivitis Artefacta Major: A Case Series

Abstract

Cases described here discuss interdisciplinary (periodontal and behavioral) approach in the management of rare and difficult to diagnose self-inflicted injuries of gingiva such as gingivitis artefacta major. Self-inflicted injuries to the gingiva are rare and their management by periodontal therapy alone is inadequate. Proper management of this condition requires early detection and effective psychological treatment through behavioral therapy in addition to the treatment of dental lesion. Three male patients in their twenties presented with traumatic injuries of gingiva with history of self-injury and underlying emotional disturbances. Following basic periodontal intervention, their self-inflicting behavior was confirmed on psychiatric consultation. All of them underwent cognitive behavior therapy and were able to successfully curb their self-inflicting behavior prior to any definitive dental procedures. These cases illustrate the essentiality of behavioral intervention in addition to periodontal procedures in the management of such lesions.

Case of Frontal Glioma With a Factitious Disorder of Self-Inflicting Dental Injuries Managed by Coronally Advanced Flap With Orthodontic Buttons

“…Damage to the gingiva can be done by impinging any foreign object or by scratching of gingiva with fingernails. This leads to ulceration, bleeding, baring of soft tissue, and exposure of underlying bone [ 7 - 8 ].…”

“…In the present case described, the lesions were consciously self-inflicted by the patients with the help of matchsticks. Gingivitis artefacta major is the physical manifestation of an underlying emotional disorder [ 7 ]. It is very difficult to diagnose and can be easily missed during routine examinations.…”

“…Until the psychological treatment is corrected, the recurrence of the lesion or failure of treatment will occur. Differential diagnosis of gingivitis artefacta may include physical or chemical injury of the gingiva, aphthous ulcer, and gingival recession [ 7 ]. Pattnaik et al described a case series of gingivitis artefacta major managed successfully with an interdisciplinary (periodontal and behavioral) approach [ 7 ].…”

“…The various signs and symptoms of the factitious disorder such as neurological, gynecological, urological, dental, and others were well documented [ 4 ]. Oral manifestations of self-inflicting dental injuries include ulcerations, lacerations of the tongue, and buccal mucosa due to biting and scratching of the gingiva (gingivitis artefacta) resulting in gingival recession associated with the bone loss [ 5 - 7 ]. There are various traumatic gingival injuries such as thermal injuries, and chemical or physical injuries have been well documented [ 6 , 7 ].…”

“…Oral manifestations of self-inflicting dental injuries include ulcerations, lacerations of the tongue, and buccal mucosa due to biting and scratching of the gingiva (gingivitis artefacta) resulting in gingival recession associated with the bone loss [ 5 - 7 ]. There are various traumatic gingival injuries such as thermal injuries, and chemical or physical injuries have been well documented [ 6 , 7 ]. Further, the physical injuries to the gingiva either due to accidental or iatrogenic causes depict an intentional self-abrasion of the gingival tissues caused by the patient’s own fingernail or use of any toothpick or pin.…”