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Mouth Injury

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Definition

  • Injuries to the lips and mouth
  • Includes inner cheeks and the roof of the mouth (hard and soft palate)
  • Front of the mouth includes the tongue. Also, includes the flap under the upper lip (frenulum).
  • Back of the mouth includes the tonsils and the throat
  • Tooth injuries are not covered here

Types of Mouth Injuries

  • Tongue. Cuts of the tongue or inside of the cheeks are the most common mouth injury. Usually, due to accidentally biting them during eating. Bites of the tongue rarely need sutures. Even if they gape open a little, the cuts usually heal quickly. If the edges come together when the tongue is still, it needs no treatment.
  • Upper lip cuts and bruises are usually due to falls. The piece of tissue joining the upper lip to the gum is the frenulum. A tear of the upper frenulum is very common. It always heals without sutures. However, it will rebleed every time you pull the lip out to look at it.
  • Lower lip cuts are usually caused by the teeth. They occur when catching the lip between the upper and lower teeth while falling.  Most of these cuts do not connect (don't go through the lip). These do not need sutures unless the outer cut is gaping.
  • Serious injuries are those to the tonsil, soft palate, or back of the throat. Examples of these injuries include falling with a pencil or toothbrush in the mouth. Puncture wounds here can cause a deep space infection in the neck.
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When To Call

Call 911 Now

  • Major bleeding that can't be stopped
  • Trouble Breathing
  • You think your child has a life-threatening emergency

Go to ER Now

  • Minor bleeding (more than oozing) won't stop after 10 minutes of direct pressure
  • Injury to back of the mouth caused by long object (such as a pencil)
  • Large deep cut that will need many stitches

Call Doctor or Seek Care Now

  • Gaping cut of tongue or inside the mouth that may need stitches
  • No past tetanus shots. Note: tetanus is the "T" in DTaP, TdaP, or Td vaccines.
  • Gaping cut of the lip that may need stitches
  • Severe pain and not better 2 hours after taking pain medicine
  • Trouble swallowing fluids or spit
  • Can't fully open or close the mouth
  • Age less than 1 year old
  • Fever and mouth looks infected. Signs are increasing pain or swelling after 48 hours. Note: it's normal for a healing wound in the mouth to be white.
  • You think your child has a serious injury
  • You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Mouth looks infected and no fever
  • Dirty cut or hard to clean and no tetanus shot in more than 5 years
  • Clean cut and no tetanus shot in more than 10 years
  • You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • You have other questions or concerns

Self Care at Home

  • Minor mouth injury
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Care Advice

Upper Lip and Frenulum Bleeding - How To Stop:

  • Cuts of the inside of the upper lip are very common.
  • Often, the piece of tissue that connects the upper lip to the upper gum is torn. This tissue is called the upper labial frenulum.
  • The main symptom is oozing tiny amounts of blood.
  • This cut always heals perfectly without sutures.
  • For bleeding from the frenulum, use direct pressure. Press the outer lip against the teeth for 10 minutes.
  • Caution: once bleeding has stopped, don't pull the lip out to look at it. Reason: the bleeding will start up again.
  • It's safe to look at it after 3 days.

Lower Lip Bleeding - How to Stop:

  • Most children who fall and bite their lower lip have 2 cuts. They have cuts to both the outside and inside of the lip.
  • Catching the lower lip between the upper and lower teeth causes the 2 cuts. This tends to happen in children with an overbite.
  • Most of these small cuts do not connect with each other.
  • For bleeding from the lip, use direct pressure. Press the outer lip against the teeth for 10 minutes.

Tongue Bleeding - How to Stop:

  • Bites of the tongue rarely need sutures.
  • Even if they gape open a little, tongue cuts usually heal quickly. If the edges come together when the tongue is still, it needs no treatment.
  • For tongue bleeding, try to press on the bleeding site with a sterile gauze. You can also use a piece of clean cloth. Do this for 5 minutes if it's practical.
  • Cuts of the tongue normally tend to ooze a little blood for several hours. This is due to the rich blood supply in the mouth.
  • For constant oozing of blood, can use a moistened tea bag for 10 minutes. Reason: tannic acid released from the tea bag may stop the oozing.

Cold for Pain:

  • Put a piece of ice or popsicle on the spot that was injured.
  • You can also use a cold wet washcloth.
  • Do this for 20 minutes.

Pain Medicine:

  • To help with the pain, give an acetaminophen product (such as Tylenol).
  • Another choice is an ibuprofen product (such as Advil).
  • Use as needed.

Soft Diet:

  • Try to get your child to drink adequate fluids.
  • Goal: keep your child well hydrated.
  • Cold drinks, milk shakes, popsicles, slushes, and sherbet are good choices.
  • Solids. Offer a soft diet. Also avoid foods that need much chewing. Avoid citrus, salty, or spicy foods.
  • Rinse the wound with warm water right away after meals.

What to Expect:

  • Small cuts and scrapes inside the mouth heal up in 3 or 4 days.
  • Infections of mouth injuries are rare.

Call Your Doctor If:

  • Pain becomes severe
  • Mouth looks infected (mainly increasing pain or swelling after 48 hours)
  • Fever occurs
  • You think your child needs to be seen
  • Your child becomes worse

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Photos

FIRST AID Advice - Bleeding Wound of the Mouth

  • Apply direct pressure to the entire wound with a sterile gauze dressing or a clean cloth. Once the bleeding has stopped, cover with an adhesive bandage or gauze.

Source: Self Care Decisions, LLC
Used with Permission from Schmitt Pediatric Guidelines LLC.

Barton Schmitt MD, FAAP
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Copyright 2000-2024. Schmitt Pediatric Guidelines LLC.
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