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Case Reports
. 2017:2017:1986834.
doi: 10.1155/2017/1986834. Epub 2017 Feb 15.

The Diagnosis and Treatment of Multiple Factitious Oral Ulcers in a 6-Year-Old Boy

Priscilla Santana Pinto Gonçalves  1 , Daniela Alejandra Cusicanqui Mendez  1 , Paulo Sérgio da Silva Santos  2 , José Humberto Damante  2 , Daniela Rios  1 , Thiago Cruvinel  1
Affiliations
Case Reports

The Diagnosis and Treatment of Multiple Factitious Oral Ulcers in a 6-Year-Old Boy

Priscilla Santana Pinto Gonçalves et al. Case Rep Dent. 2017.

Abstract

Factitious ulcers are characterized by self-inflicted lesions with multifactorial origin. These lesions are frequently found in head, neck, and hands. This report shows a 6-year-old boy diagnosed with factitious oral ulcers that occurred after the self-biting of buccal vestibule and nail-scratching of gingival tissue. Clinically, a significant swelling was observed, hard on palpation, located at the right lower third of the face, next to the posterior area of the mandible. In the intraoral examination, ulcers at different healing stages were noted on the swelling area. During the anamnesis, the father reported a change in his familial structure that triggers psychological stress, providing the clues to the presumptive diagnosis of factitious oral ulcers. We prescribed the topical use of Gingilone® three times a day to control the local pain and inflammation. At 7-day follow-up, we noticed the reduction of extraoral swelling and the initial healing of the ulcers. The presumptive diagnosis was confirmed at 30-day follow-up, with the lasting remission of oral lesions. The treatments of factitious oral ulcers should be individually tailored for each patient, focused on a multidisciplinary approach, including psychotherapy and periodic clinical control. To the best of our knowledge, gaps of evidence lead to the lack of standardized clinical protocols on this issue.

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Conflict of interest statement

The authors declare that there is no conflict of interests regarding the publication of this paper.

Figures

Figure 1
Figure 1
The initial clinical aspect of the child. Note the presence of swelling on the right lower third of the face.
Figure 2
Figure 2
Frontal clinical view of the maxillary and mandibular arches.
Figure 3
Figure 3
Maxillary and mandibular occlusal views. Note the presence of a dental caries lesion developed on the hypomineralized distal-occlusal surface of tooth #75. There is no evidence of clinical alterations in the right mandibular teeth and mucosa.
Figure 4
Figure 4
The initial clinical aspect of the ulcerated mucosa. Note the presence of factitious oral ulcers and localized swelling. The lesions were produced by self-biting of buccal vestibule and nail-scratching of gingival tissue.
Figure 5
Figure 5
The clinical aspect of the boy at 30-day follow-up appointment.
Figure 6
Figure 6
The clinical aspect of health mucosa at 30-day follow-up appointment.
See this image and copyright information in PMC

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