Oral Self-Mutilation

To the Editor: A 47-year-old male with schizophrenia who was in a mental hospital in Fukuoka, Japan, lost many of his lower front teeth within two months of admission, a period in which his mental condition was seriously unstable.

We later learned that every day, when he went to the toilet, he took the bottle of toilet cleaner, hid in a private room, and drank a little of the cleaner. The cleaner contained hydrochloric acid, which burned his throat and esophagus and caused severe pain. However, the fact that he ingested only small amounts each time saved him from serious illness or death.

After a few months, with his mental condition improving, the patient visited the hospital's dental department, where his teeth were found to be severely eroded. The strong acid solution had dissolved the enamel and dentin of his lower anterior teeth, disclosing dental pulp; almost all the crowns had been lost. Dental department records showed that his anterior teeth were intact two years before.

The patient acknowledged that he had continued his self-mutilative behavior, with severe pain and agony, over a period of two months. Because toilet cleaners contain concentrated chemicals such as hydrochloric acid, it is advisable to store them away from toilets of mental hospitals.

The authors are faculty members in the department of preventive dentistry at Kyushu University in Fukuoka, Japan.