J Korean Assoc Oral Maxillofac Surg 2023; 49(6): 369~370
Comments regarding the paper “Lesch–Nyhan syndrome: a case report” published recently by Park et al. in J Korean Assoc Oral Maxillofac Surg
Joseph Shapira
Department of Pediatric Dentistry, The Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
Joseph Shapira
Department of Pediatric Dentistry, The Hebrew University-Hadassah School of Dental Medicine, Jerusalem 91220, Israel
TEL: +972-2-6788659
E-mail: shapiraj@cc.huji.ac.il
ORCID: https://orcid.org/0000-0002-4143-2016
; Published online December 31, 2023.
© Korean Association of Oral and Maxillofacial Surgeons. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

To the Editor,

I have read an article concerning treatment for a patient with Lesch–Nyhan syndrome (LNS) that was published in your esteemed Journal of the Korean Association of Oral and Maxillofacial Surgeons (JKAOMS)1.

As a pediatric dentist who has treated children with special needs for many years, I was surprised to read that this 7-year-old child with self-injurious behavior (SIB) was treated with extractions of 7 teeth, mostly anterior primary teeth including canines, in addition to fabrication of a lower lip bumper. I assume that this is because other self-mutilating behavior methods did not work for the patient and extraction was thought to be the only remaining practical solution.

I know very well the role and importance of anterior teeth in healthy children and especially in children with special needs, such as the child with LNS. These are the teeth used for talking, laughing, and smiling, all of which affect a child’s image and self-confidence. I think that it is our duty to be preserve those teeth as much as possible.

Should we act according to the study’s recommendation and simply extract teeth of people who bite themselves or perhaps seek another form of treatment? This question should be posed not only to professional doctors, but also to society in general.

Many other published methods used intraoral appliances to effectively limit the damage caused by SIB and to permit rapid healing of existing injuries while preserving the dentition. Effort and thought should be invested to meet the expectations of parents who seek professional help for their children, with every possible attempt to avoid surgery.

In 2016, I and colleagues published an article2 on the same subject, “Overcoming the oral aspects of self-mutilation: description of a method,” proposing a technique other than tooth extraction. The proposed technique, to treat SIB, with more than 10 years follow-up, can be easily learned and applied by general dentists. Though my method has been performed on all our subsequent patients with LNS, the above-mentioned article does not mention it.

I am writing this letter to attend to the readers of JKAOMS who work with or are pediatric dentists to refer to the noted recently reported approach. I felt an obligation to share this information as I am deeply concerned about the future treatment of SIB patients.

Thank you very much for your attention.

Sincerely and with deep respect,

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

  1. Park HI, Kim GH, Ahn KM. Lesch-Nyhan syndrome: a case report. J Korean Assoc Oral Maxillofac Surg 2023;49:228-32. https://doi.org/10.5125/jkaoms.2023.49.4.228.
    Pubmed KoreaMed CrossRef
  2. Shapira J, Birenboim R, Shoshani M, Abdel-Kader A, Behar O, Moskovitz M, et al. Overcoming the oral aspects of self-mutilation: description of a method. Spec Care Dentist 2016;36:282-7. https://doi.org/10.1111/scd.12181.
    Pubmed CrossRef

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