Carious lesions after orthodontic treatment in a patient with Trichotillomania and Mixed Behavior

Abstract

Introduction: Trichotillomania is defined as the repetitive hair pulling causing areas of alopecia, it is a Mixed Behavior and Emotion Disorder, and it is characterized by combining aggressive asocial behavior or persistent defiance, with evident and marked symptoms of depression, anxiety and emotional disorders. The COVID-19 pandemic brought with it the interruption of longterm dental treatments, lack of periodic control, favoring the appearance of negative effects on mental and dental health. Objective: To report the clinical case of a patient with Trichotillomania and Mixed Behavior and Emotions Disorder with incipient and cavitated caries lesions after bracket removal after not receiving controls during the COVID-19 pandemic. Case presentation: A 16- year-old female patient, diagnosed with Trichotillomania and Mixed Behavior and Emotion Disorder, medicated with Sertraline and Risperidone, comes for evaluation. The clinical examination shows active white spots on the buccal surfaces of all the teeth around the area of removed brackets, active cavitated brown lesions on the buccal surfaces of teeth II and III. The treatment is aimed at reducing risk factors and caries activity through behavioral adaptation of the patient, involving the family environment, brushing twice a day with 1400 ppm fluoridated toothpaste, remineralization therapy with 5% fluoride varnish once a week for 4 consecutive weeks and nocturnal topication with Mi Paste Plus® until remission of the activity of caries lesions and sensitivity is observed.