Habitual biting of oral mucosa: A conservative treatment approach
An 8-year-old boy was referred to the Pediatric unit of the Oral Health Sciences Center by a private practitioner with chief complaint of “soft tissue growth” on right cheek mucosa, which did not heal with local application of ointment and was gradually increasing in size over a period of 4 months. An intraoral examination of the patient showed hypertrophic, soft, roughened, non-pedunculated growth of about 2 mm × 2 mm on right mucosa of cheek. The growth was opaque white, non tender, without any ulceration []. The patient gave the history of traumatic injury to cheek while eating after which the tissue started growing in size and had resulted in a habit of cheek biting. The growth was evident along the masticatory surfaces of the primary molars. The patient was aware of the habit of cheek biting during the day and occasionally during his sleep. No lymphadenopathy or other constitutional signs/symptoms were detected. As the history and clinical findings were suggestive of cheek biting, surgical excision of the soft tissue growth was done using cautery [], after which the patient presented with uneventful healing. The excised tissue was sent for histopathological examination which showed evidence of hypertrophic tissue. After 2 months, however, patient again reported with a growing tissue of almost similar dimensions as the previous one and present at the same site due to persistence of habit, as revealed by the parents []. Fabrication of mouth guard was planned to prevent any further trauma to cheek mucosa and to promote healing. Maxillary and mandibular impressions were made using irreversible hydrocolloid. Mouth guard was fabricated from soft polyvinyl sheet of thick resilient material (Bioplast® Scheu Dental GmbH Iserlohn Germany) of 2 mm thickness after occluding the dental casts and placing sheet in a vacuum formed pressure molding device (Biostar® Scheu Scheu Dental GmbH Iserlohn Germany) with a thermally controlled infrared heater []. The sheet extended laterally from first molar region on the left side to first molar region on right side []. The patient was directed to wear the appliance during daytime after school hours and at night during his sleep. Patient was reviewed every 2 months till 6 months and he presented with uneventful healing, with no recurrence. After 6 months, the appliance was discontinued. The patient was again recalled and reviewed 6 months after the discontinuation of appliance; the tissue remained healed with no sign of recurrence of any traumatic lesions on the cheek mucosa [Figure and ].