Masochistic habits in a child patient: A case report and its management
A 6-year-old female patient with the chief complaint of pain along with burning sensation in relation to the gums between her upper-left back teeth for the past 10 days. At the time of the clinical examination, the patient had a healthy appearance and seemed relaxed and communicative, average in her studies at second standard with normal IQ level. Socio-economic status revealed that parents were from middle class socio-economic background leading a happy contented life.\nDuring the intraoral examination a bite-wing radiograph was taken to rule out for any foreign body impaction or proximal caries. There was evidence of gingival stripping on the buccal surface extending 4 mm apical to the cement–enamel junction and a narrow zone of attached gingival margin measuring approximately 1 mm []. There was also loss of papilla height on the distal aspect of the first deciduous molar tooth. The gingiva in this region was edematous, reddish, and had an ulcerated appearance (“the ulcer looked raw”); plaque deposits were minimal.\nThe parents were interviewed regarding any unusual practices or habits involving the child's mouth. Mother indicated that the child pricked at the area with her fingernails and also child patient had a habit of left forearm sucking, since birth for the past 6 years. A Hyperpigmented area of 12 × 7 mm was visible in the left forearm region [].\nA detailed family history was taken to rule out untoward family background. All were negative and not supportive for the cause. It was concluded that severe gingival stripping and hyper-pigmentation on the forearm observed in this case was primarily the result of self-injury. It was recommended that a full arm sleeve covering the arm and fingers during sleeping and play hours can be used for habit breaking []. Selective grinding of cusps was done on the lower-left first and second primary molars. Topical anesthetic gel was prescribed.\nAfter 1-month follow-up, the gingiva in relation to the upper-left deciduous molars healed []. After 1-year follow-up, the parents reported that the child discontinued the habit of NB and also the forearm sucking frequency was reduced. Dermatological management for hyper-pigmentation on the left forearm scar was done.