Abstract
Three comatose patients admitted to the intensive care unit of Chiba Children's Hospital were referred to the division of dentistry for treatment of self-inflicted laceration of the lower lip and the tongue.
Case 1. a 15-year-old boy fell into coma due to diabetic keto-acidosis and had a considerable ulceration in the lower lip, owing to chewing it uncontrollably. In order to improve the uncontrolled jaw movement and the ulceration we used a removable acrylic dental appliance, prepared with coldcuring acrylic resin. The splint was instituted to covere the surface of the hard palate and involved the occlusal surface of the maxillary molars. Furthermore, the additional small amount of resin on the occlusal surfaces of the splint made it possible to obtain 4 mm-open bite between the interincisal space. Relief wax was placed on the dentition of the working model to facilitate removal of the dental appliance, and the space was filled with tissue treatment material (Hydro-Cast®) when the appliance was applied in the patient's mouth. To make sure he avoided swallowing by mistake, a small hole was made in the anterior portion of the appliance, and a suitable length of fine stainless steel wire was attached between the hole and the extra oral fixed place. The appliance was removed 37 days later when the normal muscular activity was restored.
Case 2. a 6-year-old girl with hydrocephalus was affected with severe pneumonia and treated with nasotracheal intubation. Her tongue was edematouly swollen with severe ulcers due to her chewing it during periods of unconsciousness. A removable acrylic dental appliance similar to a bite-block was prepared on one side of the dental arch. After 6 days, the ulcer was mostly cured.
Case 3. a 3-year-old boy who was in schok due to cardiac tanponade was affected by serious edema and ulceration on the tongue. A bite-block-like appliance was used such as in the previous case. After 19 days, the appliance could be removed, because the wound healed with disappearance of the self-mutilation.
These results led to the following conclusions: When a wound occurs in the tongue or lip by selfinflicted behavior in comatose patients, the wound can particularly heal well by using a suitable dental appliance without sacrificial tooth extraction.
