Gingivitis artefacta--a case report of a patient undergoing orthodontic treatment

A Multidisciplinary Approach to the Management of Unusual Bilateral Gingival Recession Due to a Factitious Nail-Scratching Habit: A Case Report

Self-inflicted gingival injuries have been reported in children and adolescents as a result of multiple factors such as accidental trauma, fingernail biting, sucking on objects such as pencils, or a nail-scratching habit. Management of these lesions requires a multidisciplinary approach that includes psychotherapy, behavioral counseling, and definitive treatment of oral soft tissue lesions. This paper illustrates the diagnosis and treatment of a 16-year-old male patient with a bilateral gingival recession in mandibular canines due to habitual nail scratching. A multidisciplinary approach for treatment included behavior and psychological counseling, topical application of anesthetic & antimicrobial gels, and surgical management of gingival recession defects using a modified lateral pedicle flap with and without an indigenously prepared amnion-chorion membrane. Excellent soft tissue health was found at a two-year follow-up.

Acute periodontal lesions

This review provides updates on acute conditions affecting the periodontal tissues, including abscesses in the periodontium, necrotizing periodontal diseases and other acute conditions that cause gingival lesions with acute presentation, such as infectious processes not associated with oral bacterial biofilms, mucocutaneous disorders and traumatic and allergic lesions. A periodontal abscess is clinically important because it is a relatively frequent dental emergency, it can compromise the periodontal prognosis of the affected tooth and bacteria within the abscess can spread and cause infections in other body sites. Different types of abscesses have been identified, mainly classified by their etiology, and there are clear differences between those affecting a pre-existing periodontal pocket and those affecting healthy sites. Therapy for this acute condition consists of drainage and tissue debridement, while an evaluation of the need for systemic antimicrobial therapy will be made for each case, based on local and systemic factors. The definitive treatment of the pre-existing condition should be accomplished after the acute phase is controlled. Necrotizing periodontal diseases present three typical clinical features: papilla necrosis, gingival bleeding and pain. Although the prevalence of these diseases is not high, their importance is clear because they represent the most severe conditions associated with the dental biofilm, with very rapid tissue destruction. In addition to bacteria, the etiology of necrotizing periodontal disease includes numerous factors that alter the host response and predispose to these diseases, namely HIV infection, malnutrition, stress or tobacco smoking. The treatment consists of superficial debridement, careful mechanical oral hygiene, rinsing with chlorhexidine and daily re-evaluation. Systemic antimicrobials may be used adjunctively in severe cases or in nonresponding conditions, being the first option metronidazole. Once the acute disease is under control, definitive treatment should be provided, including appropriate therapy for the pre-existing gingivitis or periodontitis. Among other acute conditions affecting the periodontal tissues, but not caused by the microorganisms present in oral biofilms, infectious diseases, mucocutaneous diseases and traumatic or allergic lesions can be listed. In most cases, the gingival involvement is not severe; however, these conditions are common and may prompt an emergency dental visit. These conditions may have the appearance of an erythematous lesion, which is sometimes erosive. Erosive lesions may be the direct result of trauma or a consequence of the breaking of vesicles and bullae. A proper differential diagnosis is important for adequate management of the case.

Masochistic habits in a child patient: A case report and its management

This is a case report of diagnosis and management of masochistic habits, a special type of mechanical trauma to the gingival tissue known as self-inflicted lesions, also termed as gingivitis artefacta. Self-inflicted injuries can be premeditated, accidental, or can also result from an uncommon habit. The purpose of this article is to review clinical findings in a 6-year-old female patient who had a habit of left forearm sucking since birth and also presented with a nail-biting habit which caused a gingival stripping on the left buccal surface of maxillary first and second deciduous molars. A full-arm sleeve was advised to be used for habit breaking, selective grinding of cusps was done of lower left first and second deciduous molars, and also topical anesthetic gel was prescribed.

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

The case report described here discusses gingivitis artefacta major, an oral presentation of self-injurious behaviour, in an adolescent. On presentation, the patient knew well the ramifications of her gum scratching behaviour, however, was unable to stop. At further presentations new lesions had appeared with further bone loss. The cause of her behaviour seemed to be of psychological origin and therefore no interventive dental treatment was possible until this issue was resolved. A more preventive approach was adopted in the meantime. Referral to appropriate services from the dental profession also proved to be challenging. In conclusion, gingivitis artefacta, although rarely seen to this extent, is extremely challenging to diagnose and treat fully in a dental setting.

Autoextraction in a child with autistic spectrum disorder

Many children with mild/moderate autistic spectrum disorder (ASD) receive care in general dental practice. We report a seven year old boy with ASD presenting with dental pain who auto-extracted one of his deciduous canines. Children with ASD may have hyposensitivity to pain and can exhibit unusual forms of self-injurious behaviour.