Abstract
Congenital insensitivity to pain with anhidrosis belongs to the category of hereditary sensoryautonomic neuropathy type IV (HSAN N). This disorder is characterized by global insensitivity to pain, anhidrosis, unknown fever, and mental retardation.
We report a case of congenital insensitivity to pain associated with a huge decubitus ulcer of the buccalmucosa. The patient was a 16-year-old boy. Because he had extracted his teeth by himself, he had beenunder the care of pedodontists since he was 3-year-old. All mandibular teeth, excluding the right secondmolar and the maxillary bilateral central incisors, had been lost. He had a huge decubitus ulcer measuring 40mm×30mm and extending deep to the buccinator muscle in the buccal mucosa. The ulcer was caused bydisplaced eruption of the left maxillary third molar, but he did not complain of any pain in this area. Afterantibiotic therapy, the tooth was extracted without local anesthesia. The extraction wound healed withoutcomplications, and the ulcer disappeared in 14 days. Oral health care required for patients with this type of disorder is discussed.
