The purpose of this presentation is to describe a method which has been successfully employed for patients with Lesch-Nyhan syndrome (LNS) with Self-Injurious Behavior (SIB), who have attended the Special Needs clinic in the Department of Pediatric Dentistry at the Hadassah Medical Center. Patients who present SIB can be considered a treatment challenge in the dental office or hospital setting. Several treatment modalities have been employed to manage the abnormalities or conditions that favor the appearance of self-mutilation or self-injurious behavior. The 4 groups of therapeutic modalities that have been tried in patients with SIB are: behavior modification (psychological), pharmacological, surgical procedures (extractions) and intra/extra oral devices. Among these the intraoral physical devices are the only methods enables self-injury to be prevented. They represent a direct barrier that prevents the patient from being able to bite his oral tissues: tongue, lips and oral mucosa. In 2016, our group published on this subject "overcoming the oral aspects of self-mutilation: description of a method", outlining a modern, creative, elegant and innovative technique with longer than 10 years of follow-up, in a way that any general dentists can learn and apply. This method has already been applied and performed on all our patients with the syndrome who approached us for help.

The method was invested in order to meet the expectations of parents who ask us as caregivers to find every possible way to save the teeth and not to extract them, in order to preserve the appearance of the child's smile and self-esteem.

Dr. Joseph Shapira is a Professor in Pediatric Dentistry and was the Chair of the Department of Pediatric Dentistry, at the Hebrew University-Hadassah Faculty of Dental Medicine, Jerusalem, Israel. Following his graduation at the Hebrew University - Hadassah Medical Center, he had specialized at CHOP the Children’s Hospital of Philadelphia, University of Pennsylvania, for two years residency program in Pediatric Dentistry and dentistry for Special Needs and High risk Medically Compromised Patients. He also serves as the Director of the Prevention Program for Oral Health at SHALVA -  the National Center for Care and Inclusion of Children with Disabilities. He has dedicated his professional life to the education, treatment, and research for children with special needs and high-risk medically compromised children, including the use of sedative agents to manage anxiety and behavior control.