ORAL ULCERS DUE TO SELF-INJURY IN PEDIATRIC PATIENTS: Case Presentation and Literature Review.
Traumatic oral ulcers are common pathologies in pediatric patients and are sometimes self-inflicted due to frequently unconscious self-aggressive behavior. In these cases, it is important to refer the patient to a psychologist to identify causes and provide treatment for pain and inflammation. We present the case of a 9-year-old girl who came to the oral medicine clinic at the UNPHU School of Dentistry, accompanied by her father, for lingual ulcers that had previously been evaluated by different specialists without resolution. The father mentioned a biopsy, diagnosing an ulcerated telangiectatic granuloma without the need for treatment. The patient was initially uncooperative but eventually allowed for evaluation in confidence, revealing two irregular ulcerative lesions with raised borders, one measuring 1.5 cm with a necrotic base and hemorrhagic areas at the tip of the tongue, and the other measuring 4 mm on the left lateral border. It was observed that the patient exhibited oral movements suggestive of chronic sucking or biting, which the father confirmed she did constantly. The diagnosis of self-inflicted traumatic oral ulcers was established. Emphasis was placed on controlling the habit, psychological assessment, and the need for topical anti-inflammatory treatment (mixture: 15 ml of milk of magnesia and 4 mg of dexamethasone) applied three times a day for two weeks, along with oral antihistamines. At the first follow-up, there was a significant reduction in the larger lesion, and complete remission of the other lesion was observed. The treatment was extended, and complete healing was observed after one month, leading to the patient's discharge. As of the present date, there have been no new lesions.
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It is decided to prescribe topical treatment with a mixture of 15ml of Milk of Magnesia, 15ml of diphenhydramine syrup, and the content of a 4mg dexamethasone ampoule, which should be applied 4 to 5 times a day after meals. Additionally, the father is explained the importance of monitoring the habit of tongue sucking/biting and the possible need to design an appliance to control the habit in case the child does not achieve awareness of it, along with a psychological assessment.