A Case Report Of Dental Mutilation


Samira Adnan 1                                        BDS,FCPS

Farhan Raza Khan2                               BDS, MS, MCPS, FCPS


KEY WORDS: Tooth Extraction, Self-Injurious Behavior, Autistic Psychology.

HOW TO CITE: Adnan S, Khan FR. A Case Report of Dental Mutilation. J Pak Dent Assoc 2015; 24(2).


A 27 year old female came to our dental clinic having an otherwise healthy dentition, with only her upper left 2nd premolar exhibiting grade III mobility. This was her chief complaint, that the tooth had becoming excessively mobile and was bothering her while chewing. On further inquiry, it was found the some months before, this particular tooth was fine. One night, in a hypnagogic state, she had the urge of wriggling this tooth with her finger. After this specific episode, she established a habit of playing with this tooth, wriggling and twisting it all day long with her finger and tongue. Now the tooth had become so mobile that it was causing her discomfort, interfering with her bite and she wanted to get it extracted (figure 1, 2). Unfortunately, nothing could be done as to

Figure 1: Front view of the patient’s dentition with the mobile tooth out of occlusion.

save the tooth as it was just attached with the gingiva with no surrounding bone. Usually, cases of dental selfmutilation or auto-extraction have been reported more frequently in patients with either psychotic illnesses1, autism2-4 or those succumbing to peer-pressure5. This case is unusual because the patients had no history of psychiatric problem or sleep disorders, and was fully conscience of the fact that she was causing self-harm. Yet she was unable to stop herself from damaging the supporting tissues of the tooth, and had caused injury to such an extent that the tooth had become unsalvageable. The tooth in question was extracted after explaining to the patient the extreme damage that had resulted from her habit, and advising that if she developed the urge to practice such a self-destructive

Figure 2: Left lateral view of the patient’s dentition.

routine on any other tooth, she should not only seek dental consultation but also consult with a psychiatrist in order to assess the reason behind the self-mutilating behaviour. Her pre-extraction radiograph was taken but unfortunately wasnot properly saved in the clinic computer and thus got misplaced.


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  2. Armstrong D, Matt M. Autoextraction in an autistic dental patient: a case report. Spec Care Dentist. 1999;19:7274.
  3. Ross-Russell M, Sloan P. Autoextraction in a child with autistic spectrum disorder. Br Dent J. 2005;198:473474.
  4. Williams AC. Autoextraction of twelve permanent teeth in a child with autistic spectrum disorder.Int J Paediatr Dent. 2015; doi: 10.1111/ipd.12161.
  5. Agrawal A, Gupta SK, Saxena P, Agrawal S. Selfmutilation of teeth due to peer pressure: an aspect of child psychology. Brit Med J Case Rep. 2014; doi: 10.1136/bcr2014-203624.

  1. Former Chief Resident, Operative Dentistry, Aga Khan University, Karachi, Pakistan. < nnmst@hotmail.com >
  2. Assistant Professor, Operative Dentistry Dental Section, Aga Khan University, Karachi, Pakistan.

Corresponding author: “Dr Farhan Raza Khan ” < farhan.raza@aku.edu  >