[Psychological factors and comprehensive intervention in factitious oral ulcer among children and adolescents: a real-world study].

Objective: To investigate the role of psychological factors in the development and progression of factitious oral ulcer (FOU) among children and adolescents, and to evaluate the clinical efficacy of a comprehensive intervention strategy based on standardized psychological assessment. Methods: In a prospective real-world study, 35 patients aged 3-16 years with FOU who visited the Department of Stomatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine were enrolled from April 23, 2024, to August 30, 2025. Stratified by age, systematic psychological assessment was performed using the parent symptom questionnaire (PSQ), strengths and difficulties questionnaire (SDQ), screen for child anxiety related emotional disorders, and depression self-pating scale for children. All patients received topical recombinant bovine basic fibroblast growth factor and oral health education. Those with abnormal psychological scores received individualized psychological education and clinical psychology referral. Patients with low serum zinc concentration received zinc supplementation. The overall clinical effectiveness rate, ulcer area, pain visual analog scale (VAS) score, cessation of self-injurious behavior, psychological scores, and recurrence were assessed at baseline, 2, 4, and 12 weeks post-treatment. Results: All 35 patients completed the study, with a mean age of (8.34 ± 2.79) years and a male proportion of 65.7% (23/35). Abnormal psychological scores were present in 82.9% (29/35) of patients. At 12 weeks post-treatment, the clinical effectiveness rate was 91.4% (32/35), with a cure rate of 88.6% (31/35); significant reductions in ulcer area and pain VAS score were observed compared to baseline (both P<0.001). The entire cohort showed significant improvements in the PSQ total score (conduct problems) at 4 and 12 weeks (both P<0.05), and the SDQ total difficulties score at 12 weeks compared to baseline (P<0.05). By week 12, 37.1% (13/35) of patients had successfully ceased self-injurious behavior. Multivariate logistic regression identified cessation of self-injurious behavior as an independent protective factor against ulcer recurrence (OR=0.080, 95%CI: 0.007-0.918, P=0.042). Conclusions: Psychological factors play a central role in FOU, with a high prevalence of anxiety, emotional, and behavioral problems among affected children. A comprehensive intervention strategy, guided by precise psychological assessment and integrating topical treatment, psychological-behavioral intervention, and nutritional supplementation, effectively promotes ulcer healing, improves psychological and behavioral status, and reduces recurrence.