SADOMASOCHISTIC HABITS

Shashank Trivedi

Contents:-

Introduction

Definition

Incidence

Classification

Clinical Features

Treatment

Conclusion

References

Introduction

Oral Habits:

A Habit can be defined as a fixed or constant practice established by frequent repetition.

Nail Biting Habit

(Obsessive-Intentional)

Tongue Thrusting habit(Non Obsessive-Functional)

MASOCHIS

TIC

OR

SELF IN

JURIO

US

HABITS

Self-injurious behaviour (SIB) may be defined as that which results in the infliction of physical damage and, perhaps, pain upon oneself.

The manifestations may be seen as finger biting, skin cutting, head banging, and trauma to the oral tissues and genital.

Self-inflicted oral mutilation (masochistic habits) is defined as deliberate harm to one's own body without suicidal intentions.

Documented cases exist of tooth self-extraction, nail biting (NB), tongue mutilation, sucking digits, or sucking a variety of foreign objects. Pencils, pens, eyeglass, earpieces, toothpicks, knives, dental floss, thread, and pacifiers are some of the items that have been reported as instruments of self-inflicted gingival injury.

Definition

Repetitive acts that result in physical damage to the person.

Example: Gingival stripping, Cheek biting, Tongue biting, Lip biting.

Incidence Extremely rare in normal child. It is between 10-20% in mentally retarded population. Prevalence: Higher in females. In the general population, prevalence is estimated at 750 in

1,00,000. Increasing in developmentally disabled individuals from 7.7%

to 22.8% and reaching 40% in profoundly retarded individuals.

Lip Biting Habit

Cheek Biting Habit

Tongue Biting Habit

Classification Ayer and Levin(1974)

(based on the aetiology) 

1)Organic:-This consists of syndromes and syndrome-like maladies such as Lesch-Nyhan and de Lange’s which have been associated with self-mutilation such as repetitive lip, tongue, finger, knee and shoulder biting.

2)Functional:-This is subdivided by Stewart and Kernohan into: 

Type A behaviour are injuries superimposed on a pre-existing lesion.E.g.: A skin lesion perpetuated by a skin biting habit.  

• Type B are injuries secondary to another established habit.E.g.: Rotating the thumb during sucking process causes ulcerations on the palatal gingiva. If the established habit is discontinued then the lesion disappears.

• Type C: Injuries of unknown or complex aetiology.This has greater psychogenic component.There may be multiple symptoms of great intensity.These habits may serve as form on stress release.Mallson and Robertson have concluded that castration fears, failures to resolve oedipal conflicts, represented homosexual impulses, severe guilt and self-punishment are ubiquitous

phenomenon in type C behaviours.

Clinical Features

These may produce factitial injuries, 75% of which are located in the head and neck region.

Oral structures such as gingiva, oral mucosa, tooth supporting structures or teeth maybe affected.

They usually consists of putting fingernails or foreign objects in the gingival sulcus, digital pressure on the oral structures or biting of tissue.

Factitial oral lesions (FOL) include factitial gingivitis, factitial periodontitis, factitial ulcer, and self-extraction.

The symptoms of both the functional and organic categories of self-injurious behaviour appear to be exacerbated during stressful situation.

It has been observed that some children experience a feeling of neglect, abandonment, and loneliness, and through the use of self-injurious behaviour they attempt to solicit attention and love.

Thus, some form of emotional stress, such as personal unhappiness, loss of security, or an unresolved pain producing dental condition is an important etiological factor.

It has been suggested that self-mutilation is a learned behaviour.

This maybe because attention is always gained, reinforcing the behaviour.

But any child who willingly inflicts pain to himself should be considered psychologically abnormal.

Lip Ulceration due to biting(Factitial oral Lesion)

Treatment:

•Requires multidisciplinary approach.

•The role of paediatric dentist in treatment is to elicit a thorough social and medical history and correctly diagnose the condition so as to distinguish it from one of physiological aetiology solely.

•After the diagnosis has been determined, referral to primary care physician usually paediatrician is done.

Palliative Treatment

Adjunctive therapy maybe initiated by the dentist to aid in the healing of oral ulcerations.

A squib oral bandage is beneficial to healing of oral tissues, as well as serving as a Habit Reminder.

Oral Bandage

Mechano-therapy: In addition, an ORAL SHIELD maybe fabricated and

inserted into the mouth at night. This appliance will deter the child from unconscious

continuation of the habit. This therapy should not be instilled alone, but used as part

of the multidisciplinary approach to the treatment of self-injurious behaviour.

Oral Shield

Behaviour Modification: The technique used for behaviour modification includes:

1. Continuous positive reinforcement while self-mutilative responses are absent.

2. Withdrawal of positive reinforcement upon self-mutilation.

At each consultation, the patient should receive instructions regarding the importance of habit interruption for the maintenance of gingival health until total removal of the appliance.

Restraints may be the reliable means of preventing injury to the self-injurious behaviour-affected individual, physical restraints include mittens, arm-boards, facial masks, helmets and restrictive clothing, but requires constant wear if they are to be successful.

Physical Restraints(Arm Board)

Mittens

Conclusion: Although the diagnosis of self-inflicted

oral mutilation may be a challenge for the paediatric dentists, this should not prevent the consideration of this possibility when idiopathic lesions are present in a child.

Appropriate preventive methods need to be developed for each patient based on reasonable consideration.

References:

Masochistic habits in a child patient: A case report and its management John Baby John, Vilvanathan Praburajan, Ariudainambi Stalin, and Murali Krishnan (International Journal of Critical Illness and Injury Science 2013 Jul-Sep; 3(3): 211–213) (PMCID: PMC3883201)

Textbook of Pedodontics, Dr.Shobha Tandon, 2nd edition, Page:492 Textbook of Pediatric Dentistry,Nikhil Marwah,3rd edition,Page374 Clinical Pedodontics,Finn,4th edition,Page 370