Mouth Injuries in Children

Introduction

     Mouth injuries in children are quite common. For the first years after someone learns to walk, falling onto the mouth is quite common. Read further for guidance on when to watch at home or when to seek medical attention.

Injured frenum or frenulum

     You may be asking “What is that?” A frenum or frenulum is the fleshy connection between the inside of the lip and the gums. A frenulum is a small frenum. These have quite a bit of blood supply and bleed easily if injured. Why many people no longer have an obvious frenum or frenulum is that they very likely injured it a long time ago, it bled, and then faded away and shrunk as it healed.

     Because they bleed easily, it can frightening to see when the frenum or frenulum is injured. Most children will cry for a few minutes, the bleeding will stop, and the area will look better in a few days. It is fine to offer Tylenol® or Motrin® for pain. If it is particularly sore, offering a Popsicle® or applying a cold cloth to the area should help. It may help to avoid acidic foods and citrus (for example, tomato sauce and orange juice) for a few days.

     We have not had a patient have this torn or injured frenum or frenulum that has needed stitches in the past. Having said that, if the bleeding did not slow to just an slow ooze after 20-30 minutes, we would recommend either contacting us or having your child seen at the Nationwide Children’s Close to Home Center Urgent Care or Emergency Department.

Injured lip

     Swelling and bruising of the lip or lips are common after mouth injuries. The lip, like the frenum or frenulum, often bleeds quite a bit if a cut occurs. Applying a cold cloth or ice pack often helps the swelling, although do not stress if your child does not tolerate this for just a few seconds. It is fine to offer Tylenol® or Motrin® for comfort sake.

     A cut lip often happens when the teeth bite into the lip with a fall. A deeper cut or one that the edges gap open easily often will benefit from being stitched. We do not do stitching here in the office and therefore recommend having your child seen at Nationwide Children’s Close to Home Center Urgent Care or Emergency Department if that would be needed. A shallow cut that does not gap and stops bleeding quickly will usually heal well in a few days without needing stitches.

Biting the inside of the cheek

     It can be super painful to bite the inside of the cheek. With a fall or with chewing, it is easy to accidentally bite the inside of the cheek. These may bleed a little but the bleeding often stops quickly. If a child is quite uncomfortable after a few minutes (when the pain is the worst), it is fine to offer Tylenol® or Motrin® for the pain. It may be helpful to offer a cold drink (ice water or cold juice) or a Popsicle® for the pain. Encourage your child to chew on the other side of their mouth for a few days.  If your child is old enough for chewing gum, avoid it for a few days afterwards also. Spicy, salty, or acidic (for example: tomato sauce and orange juice) foods should be avoided for a few days.

     These injuries generally do not need to be seen in the office. However, if the pain cannot be managed with the above measures or the bleeding cannot be stopped as described above, your child should be seen.

Injuries to the tongue

     Bites to the tongue with falls or chewing can be painful and bleed for a few minutes. If a child is quite uncomfortable after a few minutes (when the pain is the worst), it is fine to offer Tylenol® or Motrin® for the pain. It may be helpful to offer a cold drink (ice water or cold juice) or a Popsicle® for the pain. Spicy, salty, or acidic (for example: tomato sauce and orange juice) foods should be avoided for a few days.

     As scary as an injured tongue can be, the good thing is they rarely need to be stitched. If the edges line up well and the bleeding stops in less than 15-20 minutes, it will very likely heal well on its own in a few days. A tongue injury that did need stitches would need to be seen at Nationwide Children’s Urgent Care or Emergency Department. In addition, some pediatric dentists, oral surgeons, and some ENTs (otolaryngologists) also can treat these as needed.

Injuries to the teeth and gums

     These injuries occur most often with falls, bike and car accidents, and sports-related injuries. We think of these tooth or teeth injuries as falling into three categories:

-Mild injuries                 
Injury to the tooth and gum without loosening or change in position of the tooth.

Treatment: Tylenol® or Motrin® for pain; soft diet for 2 weeks; follow-up with the dentist as needed.

                                          

Injury to the tooth and gum with loosening of the tooth but no change in position of the tooth. There may be bleeding at the gum line and tenderness at the tooth.

Treatment: Tylenol® or Motrin® for pain; soft diet for 2 weeks; follow-up in the next in the next few days with the dentist.

                                           

-Moderate injuries        
Injury to the tooth and gum with loosening and change in the position of the tooth.

Treatment: Tylenol® or Motrin® for pain; soft diet for 2-4 weeks; see dentist in the next 24 hours.                                                 

Tooth is pushed into the gums by the injury.Treatment: See dentist immediately if a permanent tooth. For a primary or “baby” tooth, see the dentist within a few days, sooner if the pain is hard to control with Tylenol® or Motrin®. 

Tooth is partially knocked out of the socket. 
Treatment: see dentist immediately.

-Severe injury            
Tooth is completely knocked out of the socket. 
Treatment: Do not replace a primary or “baby” tooth. See the dentist within the first 24 hours. For a permanent tooth, replace the tooth back in the socket, making sure to place it correctly (for example, the front of the tooth faces the front). If the permanent tooth cannot be put back in place, place it is cold low-fat milk or saline and see a dentist immediately.

If an injury happens after hours and your child’s dentist is not available, we recommend your child be seen at the Nationwide Children’s Hospital Emergency Department where a dentist is available 24 hours a day.