Non-extraction solution for self-injurious behavior in children with Lesch--Nyhan syndrome: a retrospective case series with up to 14 years of follow-up.

This article focuses on a conservative, non-extraction dental approach for managing oral self-injurious behavior (SIB) in children with Lesch–Nyhan syndrome (LNS), a rare X-linked disorder characterized by neurologic impairment and severe self-biting. It presents a retrospective case series of four patients treated over up to 14 years using customized dual-laminate thermoplastic intraoral appliances retained by composite bulges on teeth, resulting in complete cessation of oral self-injury, soft tissue healing, and preservation of dentition without reported complications. The study highlights this reversible, tooth-preserving method as a promising alternative to irreversible tooth extractions, particularly when applied in specialized or hospital-based dental settings experienced in managing medically complex pediatric patients. Limitations include the small sample size, retrospective design, and lack of standardized behavioral outcome measures.