Masochistic or self-injurious oral habitsare behaviors in which a child deliberately causes injury to their own oral tissues without suicidal intent. These habits can result in damage to the lips, cheeks, tongue, gingiva, or teeth and are sometimes referred to as gingivitis artefacta or self-inflicted oral injuries. Managing these cases often requires a multidisciplinary approach involving pediatric dentists, psychologists, and caregivers.
Common Clinical Manifestations
Self-injurious oral habits may present in several ways, including:
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Factitial Injuries: Repeated biting, scratching, or chewing of the lips, cheeks, or tongue using teeth, fingernails, or objects such as pencils and toothpicks.
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Gingival Stripping: Deliberate picking or scratching of the gums, leading to gingival recession, ulceration, or tissue loss.
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**Tooth Mutilation or Self-Extraction:**Intentional manipulation, filing, loosening, or extraction of primary teeth.
Causes
Several factors may contribute to the development of self-injurious oral habits:
Psychological and Emotional Factors
Children may use self-injury as a coping mechanism to manage stress, anxiety, frustration, or emotional distress.
Neurological and Developmental Conditions
These habits are more frequently observed in children with:
- Autism spectrum disorder (ASD)
- Developmental delays
- Intellectual disabilities
- Certain psychiatric or behavioral disorders
Compulsive Behaviors
Severe habits such as nail-biting, finger sucking, or repetitive oral manipulation may progress to self-inflicted tissue injury.
Diagnosis
Diagnosis can be challenging because these behaviors often occur unnoticed by parents or caregivers. A thorough clinical examination and detailed history are essential.
The pediatric dentist should:
- Assess the pattern and location of oral injuries.
- Look for similar injuries elsewhere on the body.
- Differentiate self-inflicted lesions from accidental trauma, abuse, or systemic diseases.
- Evaluate possible psychological or developmental factors contributing to the habit.
Management
Successful treatment requires addressing both the oral injury and its underlying cause.
Behavioral Counseling
Referral to a child psychologist may be necessary for:
- Habit-reversal therapy
- Behavioral modification techniques
- Stress and anxiety management
Dental Interventions
- Habit-breaking appliances and protective splints can help prevent further injury.
- Selective grinding of sharp tooth cusps may reduce trauma to soft tissues.
- Topical anesthetics and protective pastes can provide relief and promote healing.
MBH/PS