5 mm apically to the CEJ (Figure 5). Volasertib Figure 3. Clinical view at 4 weeks post-surgery. The surgical site is still edematous and reddish. Figure 4. Clinical view at 4 months post-surgery. Normal appearance was established, with a significant increase of keratinized attached gingiva and a free gingival margin that is in harmony with the neighboring teeth. Figure 5. Clinical view at 12 months post-surgery. The gingival margin is in harmony with the neighboring teeth. The patient was followed for approximately 1 year postoperatively and complete tissue healing was achieved. The patient reported at her postoperative appointment that she had stopped her fingernail scratching habit. DISCUSSION Self-inflicted oral injuries can be premeditated or accidental or can result from an uncommon habit.

These injuries usually results from a foreign object or a patient��s fingernail that habitually causes an erosion of the gingival tissue in a specific area.19 There are varying degrees of self-injurious behavior from simple fingernail biting to extremes in self-mutilation.8,12,15,18,24 In the present case, the mechanical trauma caused by the almost constant self-injurious behavior is considered to have been the primary etiologic factor. This case serves as another opportunity to emphasize the necessity of a comprehensive history which obtains the more subtle information relative to etiology. Habitual fingernail scratching is a common behavior among children.19 This is probably true but such injuries are not limited to children, diagnosed adolescents and adults.

4,7,26 In this case, a teenage patient has a habitual fingernail scratching. Dentists need to be cognizant of the potential ramifications of fingernail scratching including not only physical injury but also gingival recession, potential bacterial contamination (infection), inflammation, attachment loss, bone loss, and even tooth loss. The case described here demonstrates that scratching is a potential cause of localized gingival recession, attachment loss, edema and ulceration. The etiology of self-inflicted oral injuries in adolescent and adult includes some emotional disturbance.20,22 In the case presented here, the anxiety and stress of exam are believed to have been the main reason behind the patient��s behavior. Management of patients with self-inflicted injuries is usually complicated by their lack of compliance and communication.

In cases of self-inflicted Batimastat injury it might be difficult the patient to stop the noxious behavior. There are no standard techniques to prevent or treat orofacial self-inflicted injuries. The treatment plan is established according to the special circumstances of the individual case. Sedation, behavior modification and restraints are usually utilized to control the destructive behavior.7,22�C24 Our patient was referred to a psychiatrist for evaluation and she was convinced that she should discontinue this habit.