Self-injurious behavior is deliberate harm to the body that may lead to factitious oral injuries. Management of patients with self-inflicted injury continues to be a challenge for the dental profession. The purpose of this article is to review clinical findings in a patient who presented with severe, painful gingival recession in the primary dentition. A case report of an 8-year-old girl with mental retardation is presented. The periodontal examination showed bilateral gingival recession of the mandibular canines and the mandibular first and second molars so severe that it was possible to clinically observe the exposed roots. The diagnosis of self-inflicted gingival lesions and self-injurious behavior was established. Although the lesions are no longer present, the self-injurious behavior persists. Psychologic support was suggested, and an oral removable appliance was fitted. Keywords: factitious injury etiology, gingival injuries, gingival recession, oral self-mutilation, self-inflicted lesions, self-injurious behavior