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My son has been self injuring himself for the last six months by biting through his lips and fingers. He had an endoscopy and an upper GI. Both tests came back normal. However, my son also has his two 6-year molars coming in. They were not noticed until four months ago because of the problem of him not opening his mouth. Could this be the problem for the behavior?

Answer of our experts

The eruption of the 6-year first permanent molars can take a long time. They can first enter the mouth as early as age 5 for girls and 5 ½ for boys. However, 6 to 6 1/2 years is more the norm. It can be a long process for them to settle into their eventual position within the dental arch, although three to six months is not unusual. Most of the time parents are not even aware of the teeth erupting into the mouth. The process is slow and uneventful. There is usually very little discomfort, not at all like the baby teeth erupting in an infant. Therefore, I would not attribute behavioral changes to the eruption of the six year permanent molars.

There can, however, be the presence of an infection (pericoronitis) when food gets trapped under the tissue, (operculum) that sits on the top of the molar as it erupts through the gums. This tissue eventually sloughs away but it can cause some discomfort if it gets infected. I suggest that the dentist look at the tissue and see if it is either gone or if it is still present, making sure it is not infected. It could be very uncomfortable and possibly cause irritational behavioral changes.

There also could be other hidden problems, such as dental abscess in another location, sinus infection, or and ear infection that should be ruled out.

RM/TK 7-13-10

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Feeding and Dental Difficulties

In every CdLS individual with prolonged and marked feeding difficulties, the multidisciplinary assessment (from healthcare workers across many disciplines) should consider (temporary) placement of a gastrostomy (surgical opening through the abdomen into the stomach) as a supplement to oral feeding.
In individuals with CdLS who have recurrent respiratory infections, reflux and/or aspiration (breathing foreign objects into airways) should be ruled out.
The palate should be closely examined at diagnosis. In case of symptoms of a (submucous) cleft palate, referral for specialist assessment is indicated.
Dental assessment and cleaning should take place regularly; a more thorough dental examination or treatment under anaesthesia may be necessary.


Self-injurious and aggressive behaviour

To identify the cause of self-injurious behaviour in individuals with CdLS, medical assessment, specifically looking for sources of pain, should be followed by behavioural assessment of self-restraint then functional analysis.
Treatment of self-injurious behaviour should include both medical and behavioural strategies.

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