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Case Report
Int J Clin Prev Dent 2015;11(1):51-54ㆍhttp://dx.doi.org/10.15236/ijcpd.2015.11.1.51
ISSN (Print) 1738-8546ㆍISSN (Online) 2287-6197
Oral Manifestation and the Treatment of Self-Injurious
Behaviors Associated with a Preterm Infant:
A Case Report
Su-Hyun Shim1, Byeng-Ken Cho2, Ja-Won Cho2
1
Department of Dental Hygiene, Kyungbok University, Namyangju, 2Department of Preventive Dentistry, College of Dentistry,
Dankook University, Cheonan, Korea
Behavioral problems could be easily observed in patients with various mental disorders. Self-injurious behavior (SIB) can be
defined as deliberated harm to one’s own body without conscious suicidal intent. It usually occurs as head banging or hitting, body hitting, skin cutting, or finger biting. Also it frequently involves oral tissue’s damage in pediatric patients, such as
lip, cheek and tongue biting. Various articles have described prostheses used to prevent SIB-related injuries to the oral tissues
of patients who have developmental or medical problems, such as psychological problems, congenital syndromes or mental
retardation. But reports of oral SIB in individuals unaffected by the above conditions are scarce. The case presented in this report discusses oral SIB in a premature baby. We found an optimal way that would prevent SIB-related injuries and also protect the causative teeth. These days, dentists should be able to manage those patients with several treatment modalities, furthermore, to prevent SIB according to the causative disorders.
Keywords: preterm birth, self injurious behavior, self mutilation
Introduction
such as bipolar disorder and depression, those with conditions
that result in indifference to pain, such as familial dysautonomia, and others with a variety of developmental disabilities [2].
The prevalence of SIB in the general population has not been
established, but it is estimated that such problems could affect
about 750 out of every one million individuals [3]. Prevalence
is higher among females [4].
The origin of SIB is complex, and theories exist of both biological and functional origins. Medina et al. [4] list biological
causes such as Lesch-Nyhan syndrome, Cornelia de Lange syndrome, Tourette syndrome and XYY syndrome, as well as other
conditions including mental retardation, encephalitis, congenital
malformations, coma and epilepsy. The typical cause of such
behaviors in children is Lesch-Nyhan syndrome, followed by
mental deficiency and infectious diseases such as encephalitis.
However, reports of oral SIB in individuals unaffected by the
Self-injurious behavior (SIB) is defined as deliberated damage of one’s own body without suicidal intent [1]. It could vary
from a trifling injury to damages that could lead to further
disabilities. And diverse populations have been known to exhibit SIB. These include individuals with psychiatric diagnoses
Corresponding author Ja-Won Cho
Department of Preventive Dentistry, Dankook University
College of Dentistry, 119 Dandae-ro, Dongnam-gu,
Cheonan 330-714, Korea. Tel: +82-41-550-1953, Fax: +82-41553-6582, E-mail: [email protected]
Received March 6, 2015, Revised March 17, 2015,
Accepted March 18, 2015
Copyright ⓒ 2015. Korean Academy of Preventive Dentistry. All rights reserved.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/
by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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International Journal of Clinical Preventive Dentistry
above conditions are rare. So this report presents oral SIB case
associated only with preterm infant.
Case Report
A 10-month old infant who was hospitalized for a pre-term
birth was consulted from his pediatrician because of traumatic
ulcer of tongue (Figure 1). His pediatrician told that his tongue
thrusting habit began with the eruption of mandibular primary
incisor.
The doctor added that the frequency and severity of the
tongue biting was proportional to the eruption.
An oral examination showed trauma was induced by his
tongue thrusting and biting habit. But there were no anchorage
in his mouth as he was just 10-month infant. A typical removable
prosthesis could not be applicable. So we tried to apply stainless
steel crown to his unerupted #81 tooth first (Figure 2). Ten days
after delivery of stainless steel crown, he was referred from his
medical doctor again. Althoug the size of ulcer was decreased,
it still remained (Figure 3). After dressing and oral examination,
we soon noticed that the patient still had tongue biting habit with
#71 tooth. But #71 tooth was erupted less than the half of its
crown height. His parents and pediatrician allow us to extract
the tooth. In order to avoid the extraction, we applied stainless
steel crown to the #71 tooth lastly. One month later, we recalled
the patient. Traumatic ulcer of tongue was successfully treated
(Figure 4).
Four month after delivery, the patient was referred from his
pediatrician due to a traumatic ulcer of tongue again. After oral
examination, we found that this ulcer was owing to the eruption
Figure 3. Ten days after delivery.
Figure 1. Traumatic ulcer of tongue.
Figure 2. Delivery of stainless steel crown in #81 tooth.
52 Vol. 11, No. 1, March 2015
Figure 4. One month after delivery of stainless steel crown.
Su-Hyun Shim, et al：Oral Manifestation and the Treatment in Self-Injurious Behaviors
of #82. However, the tooth had just erupted. We just smoothened
the surface of #82 tooth and covered the tooth with glass ionomer slightly. We instructed his parents and pediatrician to wait
until the tooth was erupted enough for stainless steel crown
delivery.
However, against our expectations, his tongue biting habit
was disappeared after the fully eruption of #82 tooth. For about
2 years, we followed the patient and there was no significant sign
and symptom though the primary dentition was completed.
Discussion
According to Medina et al. [4], among the many proposed
treatment modalities for SIB, the most common include medications, behavior modification or physical restraints. Prescribed
medications and behavior modification techniques may be
helpful for some patients with SIB, but these approaches are labor-intensive [5]. And when we used physical restraints, we
must provide the most effective protection with minimal
restraint. Therefore usually, no single treatment method guarantees the eradication of SIB [4].
Few document [6] reports injuries caused by biting in patients
who do not have psychological, mental or congenital disorders.
When prescribing a prosthesis such as the one described in
this case report for SIB treatment, it is necessary to choose a design that is appropriate for the patient’s age, general health, ability to cooperate and the severity of the oral injuries [7].
According to Hanson et al. [8], a prosthesis to prevent oral
self-injury should be designed to: deflect tissues to be damaged
by involuntary, mandibular movements away from the occlusal
table; avoid posing further injury to the patient; permit a full
range of mandibular motion; allow for daily oral care; withstand
breakage and displacement over time; allow healing of traumatized oral tissue and be easily fabricated and installed without
discomfort or risk to the patient.
SIB usually occurs as tongue and lip biting in oral tissue. In
case of tongue biting, we have to separate tongue and teeth considering the mandibular movement pattern [9]. Like this case,
there is no standard method for preventing SIB. A suitable oral
guard could be tried initially before employing more invasive
approaches. Furthermore, after delivery of the appliance, the
long term education to the patient, family and nurses is needed.
These days clinicians should be well aware of the treatment
modalities, and research to discover how to prevent oral SIB in
dental clinic.
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