Neuropathological chewing: a dental management protocol and treatment appliances for pediatric patients

Overcoming the oral aspects of -self-mutilation: description of a method

BACKGROUND/AIM

Self-injurious behavior (SIB) is a serious and chronic condition frequently seen in special needs populations, affecting 10% to 17% of individuals diagnosed with intellectual and/or developmental disabilities. A 2.5-year-old infant with SIB, whose presenting symptoms were severe tongue and lip lacerations accompanied by much hemorrhage, is presented here to illustrate the problem and to show how this may be prevented.

MATERIALS AND METHODS

An appliance is described which effectively limits the damage caused by SIB and permits rapid healing of existing injuries.

RESULTS

The method provides for a stable, retentive, and comfortable device on the infant's undererupted and largely nonretentive crowns of the deciduous teeth as well as for all permanent teeth in children, adolescents, and adults.

CONCLUSIONS

The appliance has been successfully employed for the past 10 years in patients with SIB who have attended for treatment in the Special Needs Clinic in our Department.

Role of a dentist in comprehensive management of a comatose patient with post traumatic head injury and neuropathological chewing

Injury of the head and neck region can result in substantial morbidity. Comprehensive management of such patients requires team work of several specialties, including dentists. A young female patient with extensive loss of cranium and associated pathological chewing was referred to the dental department. The lost cranium was replaced by a custom-made, hand-fabricated cranioplast. Trauma due to pathological mastication was reduced by usage of a custom-made mouthguard. Favorable results were seen in the appearance of the patient and after insertion of the mouthguard as evidenced in good healing response. The intricate role of a dental specialist in the team to manage a patient with post traumatic head injury has been highlighted. The take away message is to make the surgical fraternity aware of the scope of dentistry in the comprehensive management of patients requiring special care.

Oral self-injury: an update

BACKGROUND

Self-inflicted oral injuries of organic origin are particularly common in certain diseases, syndromes, and systemic disorders. In this article, we discuss the characteristics of these oral lesions and their treatment.

LITERATURE SEARCH

The authors have reviewed the most relevant literature relating to oral self-injury through a search in textbooks and published articles included in the Medline database for the years 1970-2010, and selected published cases from the last two decades.

RESULTS

The majority of the literature on oral self-injury is in the form of case reports. Self-injury is particularly prevalent in patients with Lesch-Nyhan syndrome, a heterogeneous group of neurological disorders, congenital insensitivity to pain with anhidrosis, and mental retardation. It is most common in males in the early years of life, and the sites most frequently involved are the lower lip and the tongue. Therapeutic approaches in these patients have included psychological and pharmacological treatment, intraoral devices, and surgical procedures.

CLINICAL IMPLICATIONS

Intraoral devices are the best therapeutic option for self-injury of organic origin, although this approach is not free of complications. The current lack of standardized treatment protocols for oral self-injury means that therapy must be individualized.

Utilization of a modified bite guard for preventing traumatic macroglossia

This clinical report describes the treatment of a patient having traumatic macroglossia due to schwannoma in the craniocervical region. Enlarged tongue or macroglossia may compromise vital functions of the patient. To avoid a chronic tongue bite trauma, a bite guard that was inspired from a habit breaker was fabricated. Tongue injury has significantly healed with the use of this appliance, and the patient was able to masticate without biting on his tongue.

The use of stock fluoride trays in the management of soft tissue trauma in children who are comatose

Pediatric patients who are comatose may develop a neuropathological chewing or clenching reflex that results in self-inflicted injury to the soft tissues of the oral cavity. An early and quick response to these problems may minimize the extent of soft tissue trauma. The use of a stock fluoride tray in the hospital management of a pediatric patient who was neurologically impaired and unconsciously traumatizing his oral soft tissues is described. This treatment modality may serve as an initial or interim device in managing pediatric patients with uncoordinated mandibular movements or clenching. In some instances, given the sometimes self-limiting nature of this problem, fluoride trays may serve as the sole mode of treatment

Prevention of Habitual Cheek Biting: A Case Report

Oral and peri-oral structures can be traumatized by self-injurious behavior (SIB). 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; however, reports of oral SIB in individuals unaffected by the above conditions are scarce. This case report describes the use of a removable prosthesis to prevent a stress-induced cheek biting habit in 15-year-old girl who did not have any of the commonly related conditions. The report discusses the importance of designing a prosthesis that protects tissues, while considering injury severity and the patient's healthas well as her ability to cooperate with treatment.