The Journal of Korea Assosiation for Disability and Oral Health (대한장애인치과학회지)

Korean Association for Disability and Oral Health (대한장애인치과학회)
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SELF-INJURIOUS BEHAVIOR IN A PATIENT WITH AUTISM : A CASE REPORT

자폐 환자의 자해로 인한 구강 내 손상 : 증례 보고

  • Ji, Eun-Hye (Department of Pediatric Dentistry, College of Dentistry, Yonsei University) ;
  • Lee, Hyo-seol (Department of Pediatric Dentistry, College of Dentistry, Yonsei University) ;
  • Choi, Hyung-Jun (Department of Pediatric Dentistry, College of Dentistry, Yonsei University) ;
  • Kim, Seong-Oh (Department of Pediatric Dentistry, College of Dentistry, Yonsei University) ;
  • Choi, Byung-Jai (Department of Pediatric Dentistry, College of Dentistry, Yonsei University) ;
  • Son, Heung-Kyu (Department of Pediatric Dentistry, College of Dentistry, Yonsei University) ;
  • Lee, Jae-Ho (Department of Pediatric Dentistry, College of Dentistry, Yonsei University)
  • 지은혜 (연세대학교 치과대학 소아치과학교실) ;
  • 이효설 (연세대학교 치과대학 소아치과학교실) ;
  • 최형준 (연세대학교 치과대학 소아치과학교실) ;
  • 김성오 (연세대학교 치과대학 소아치과학교실) ;
  • 최병재 (연세대학교 치과대학 소아치과학교실) ;
  • 손흥규 (연세대학교 치과대학 소아치과학교실) ;
  • 이제호 (연세대학교 치과대학 소아치과학교실)
  • Received : 2012.05.01
  • Accepted : 2012.06.05
  • Published : 2012.06.29
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Abstract

Self-injurious behavior (SIB) has been defined as the deliberate destruction or alteration of body tissue without conscious suicidal intent. It occurs in conjunction with a variety of psychiatric disorders as well as various developmental disabilities and some syndromes. The behavior is destructive and causes concern and distress to all involved in the care and treatment of the affected individual. A 13-year-old girl with autism, mental retardation and delayed development was reffered from her pediatrician because of severe and painful lower lip biting. An intraoral examination revealed a diffuse swelling of lower lip. It was covered with necrotic slough and the ulcer and scarring of the lower lip was observed. We chose to use an oral removable prosthesis for Conservative treatment. It was decided to use a soft silicone mouthguard in the maxillary arch. Initially, she could not tolerate the appliance inside her mouth but soon adapted with the appliance. After one month, she lost the mouth guard and started lip biting. So we made mouth guard again. There are no standard methods for preventing self-injurious behavior in a patient who is developmentally disabled. Appropriate preventive methods must be developed for each individual patient based on close observation and clinical findings. Behavior modification techniques, pharmacological treatment, extraction of teeth, orthognathic surgery and intra/extra oral appliances can be performed for adjust self-injurious behavior. A suitable oral guard could be tried initially before employing more invasive approaches.

자폐증 및 정신 지체가 있는 환자의 입술 깨물기 증상을 mouthguard를 사용하여 성공적으로 조절하였다. 치과적으로 접근 가능한 구강 내 자해 증상의 치료는 가철성 혹은 고정성 장치를 이용하거나 관련 치아의 발치, 악교정 수술 등을 시도할 수 있으며 각 환자에 맞는 적절한 치료법을 선택하는 것이 중요하다. 자해 행동이 일시적으로 개선되었다 해도 재발의 가능성이 높으므로 장기적인 관리와 소아정신과와의 협진 하에 정신심리학적 환경 개선 및 약물 치료가 병행되어야 할 것이다.

Keywords

References

  1. Lucavechi T, Barberia E, Maroto M, et al.: Selfinjurious behavior in a patient with mental retardation: review of the literature and a case report. Quintessence Int, 38:e393-398, 2007.
  2. Medina AC, Sogbe R, Gomez-Rey AM, et al.: Factitial oral lesions in an autistic paediatric patient. Int J Paediatr Dent, 13:130-137, 2003. https://doi.org/10.1046/j.1365-263X.2003.00440.x
  3. Saemundsson SR, Roberts MW: Oral self-injurious behavior in the developmentally disabled: review and a case. ASDC J Dent Child, 64:205-209, 228, 1997.
  4. Fardi K, Topouzelis N, Kotsanos N: Lesch-Nyhan syndrome: a preventive approach to selfmutilation. Int J Paediatr Dent, 13:51-56, 2003. https://doi.org/10.1046/j.1365-263X.2003.00412.x
  5. Cauwels RG, Martens LC: Self-mutilation behaviour in Lesch-Nyhan syndrome. J Oral Pathol Med, 34:573-575, 2005. https://doi.org/10.1111/j.1600-0714.2005.00330.x
  6. Shimoyama T, Horie N, Kato T, et al.: Tourette’s syndrome with rapid deterioration by self-mutilation of the upper lip. J Clin Pediatr Dent, 27:177-180, 2003.
  7. Chen LR, Liu JF: Successful treatment of selfinflicted oral mutilation using an acrylic splint retained by a head gear. Pediatr Dent, 18:408-410, 1996.
  8. Johnson CD, Matt MK, Dennison D, et al.: Preventing factitious gingival injury in an autistic patient. J Am Dent Assoc, 127:244-247, 1996. https://doi.org/10.14219/jada.archive.1996.0176
  9. Mobily PR, Herr KA, Kelley LS: Cognitive-behavioral techniques to reduce pain: a validation study. Int J Nurs Stud, 30:537-548, 1993. https://doi.org/10.1016/0020-7489(93)90025-P
  10. Wing L: The definition and prevalence of autism: A review. Eur Child Adolesc Psychiatry, 2:61-74, 1993. https://doi.org/10.1007/BF02098832
  11. Howlin P: Behavioural techniques to reduce selfinjurious behaviour in children with autism. Acta Paedopsychiatr, 56:75-84, 1993.
  12. 김지희, 최병재, 김성오, 최형준, 손흥규, 이제호: Lesch-Nyhan 증후군 환아의 자해에 의한 혀의 외상. 대한소아치과학회지, 35:532-537, 2008.
  13. Eguchi S, Tokioka T, Motoyoshi A, et al.: A selfcontrollable mask with helmet to prevent self finger-mutilation in the Lesch-Nyhan syndrome. Arch Phys Med Rehabil, 75:709-710, 1994. https://doi.org/10.1016/0003-9993(94)90200-3
  14. Jeong TS, Lee JH, Kim S, et al.: A preventive approach to oral self-mutilation in Lesch-Nyhan syndrome: a case report. Pediatr Dent, 28:341-344, 2006.
  15. Finger ST, Duperon DF: The management of self-inflicted oral trauma secondary to encephalitis: a clinical report. ASDC J Dent Child, 58:60-63, 1991.
  16. Kumar P, Bhojraj N: Successful prevention of oral self-mutilation using a lip guard: a case report. Spec Care Dentist, 31:114-118, 2011. https://doi.org/10.1111/j.1754-4505.2011.00188.x
  17. Rashid N, Yusuf H: Oral self-mutilation by a 17-month-old child with Lesch-Nyhan syndrome. Int J Paediatr Dent, 7:115-117, 1997.
  18. Macpherson DW, Wolford LM, Kortebein MJ: Orthognathic surgery for the treatment of chronic self-mutilation of the lips. Int J Oral Maxillofac Surg, 21:133-136, 1992. https://doi.org/10.1016/S0901-5027(05)80778-7