What are self-inflicted mouth ulcers?

This is the 5271th article of Da Yi Xiao Hu

One day I received a 19-year-old girl. When I saw her, I saw large areas of bruises on her cheeks. My first feeling was trauma. During the communication, I found that it might not be as simple as I thought. This little girl basically didn't talk to me. It was her mother who kept talking about her condition. I knew clearly that she had not been injured, and it was not the first time. In addition to the bruises on her cheeks, there were also large areas of ulcers on the oral mucosa, and the pain was severe. During the physical examination, I found that the mucosal ulcers on her cheeks had obvious tooth marks, which looked like bites. Afterwards, I asked her and her mother very carefully whether she had bitten them on purpose. The answer is of course yes. The little girl also told me that when she was unhappy, she liked to bite her cheeks. It was very comfortable and very stress-relieving when she bit. Hearing this, the diagnosis was actually very clear-"self-injurious oral ulcers", which often occur in children with ADHD, and can also be seen in children with anxiety and depression.

Clinically, there are more and more such children, which makes people feel sad and confused. In the process of communicating with them, we found that some children have bad habits such as biting cheeks, tongues, and lips repeatedly, some children have the bad habit of biting sharp instruments such as pen tips, and some children have the bad habit of repeatedly piercing the oral mucosa with pen tips... These children usually tell us that they feel itchy in their mouths and habitually bite with their teeth, and even feel very comfortable and relieved in the process of biting, which forms self-injurious oral ulcers.

Self-injurious oral ulcers are very different from recurrent oral ulcers. First, these ulcers are fixed in position and recur in the same position. Second, the tissue at the edge of the ulcer is slightly raised and white in color. It is larger and deeper than recurrent oral ulcers. Carefully observing the behavior of the children, it is not difficult to find that they have the habit of repeatedly rubbing their teeth with their tongue or biting the ulcer wound with their teeth.

Many parents cannot accept the doctor's diagnosis of "self-injurious oral ulcers" and will loudly scold their children in front of outsiders. We have found in clinical work that such parents are often the main cause of children's self-injurious behavior. In such situations, on the one hand, we suggest that parents should first accept the reality, face their children's condition correctly, find the cause of self-injury, and correct the self-injurious behavior. If the situation is serious, they should go to the psychology department for treatment in time and should not be afraid of seeing a doctor; on the other hand, we will give children local medication to promote the healing of ulcers and reduce pain.

Clinically, there is also a type of "non-self-inflicted oral ulcers", which are oral ulcers caused by trauma to the oral mucosa, not by active biting. After the onset of the disease, it is similar to recurrent oral ulcers, with obvious pain symptoms, affecting the patient's diet, sleep, communication, etc.

Adults are more likely to have this type of oral ulcer, and the main cause is the ulcer caused by long-term chronic mechanical damage such as residual roots and crowns, sharp edges of teeth, misaligned teeth, and poor restorations. In this case, patients need to go to the dentistry department in time to remove the cause, because long-term traumatic ulcers in adults are prone to malignant changes and other serious conditions.

I believe everyone has a new understanding of this type of oral ulcer. It is not terrible to have self-injurious oral ulcers. What is terrible is that blind treatment without finding the cause often has little effect, thus delaying the disease.

Author: Department of Stomatology, Affiliated Hospital of Guangdong Medical University

Jiang QianDeputy Chief Physician