Mouth injuries are common in children under the age of six. Our little adventurers are full of energy and enthusiasm but often lack the motor coordination for the activities they want to be involved in. They are also too young to be aware of dangers in their environment, such as slippery, wet tiles. Written by Dr Maraschin, expert paediatrician.
My little granddaughter is a perfect example. At just 19 months old, she wants to climb stairs on her own, swing on poles, ride her little bike, and jump on the bed. When I see her start to wobble or miss a step, I will admit to holding my breath.
When it comes to mouth injuries, I like to refer to the nursery rhyme: “Five little monkeys jumping on the bed. One rolled off and bumped his head. Mama called the doctor, and the doctor said….”
If:
- There is still bleeding after 10 minutes.
- There is a broken, loose, or missing tooth.
- There is a large or gaping cut inside the mouth, on the face, or on the tongue.
- The teeth have gone through the lip.
- There is an object stuck in the roof of the mouth, cheek, tongue, or throat (do NOT remove the object).
- There’s a cut on the lip that extends through the lip’s border and into the surrounding skin.
- Your child is having difficulty swallowing or breathing.
- You, as the parent, are worried.
… then please seek medical help.
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Common Mouth Injuries and How to Respond
Generally, a parent will call me and describe how the injury happened and what they are seeing. Here are some common scenarios:
Scenario 1
“Hello, Doctor. Angus was playing ball with a friend. The ball hit him in the mouth. There is a lot of blood, but I can’t see any noticeable cuts.”
“It is most likely that your child has injured the frenulum. This is a small, rope-like piece of tissue that connects the upper lip to the gum. Since it has a good blood supply, it tends to bleed quite a lot at first. The bleeding should stop within a few minutes, and the area will look better after a few days. If your child is in pain, you can give them some paracetamol. A cold cloth should help with pain and swelling. Avoid acidic foods for a few days, such as orange juice and tomato sauce. Even though the bleeding may look scary, it is not usually a serious injury.”
Scenario 2
“Hello, Doctor. Tommy fell off his little black motorbike and hit his face on the driveway. It is bleeding a lot.”
“If there is a cut on the lip, it will bleed quite a bit. Apply a cold cloth to stop the bleeding so you can assess how bad the injury is. Teeth often bite into the lip when a child bumps their mouth. A small cut will heal easily, but if the cut is large or if the teeth have gone through the lip, your child will likely need stitches. Please take him through to an emergency centre. Swelling and bruising are common after this kind of injury.”
Scenario 3
“Hello, Doctor. Alice was running up our stairs. Her foot slipped, and she bashed her chin on the tiles. She has bitten into her tongue.”
“This is one of the most common mouth injuries. Rinse her mouth with water so you can see where she has bitten her tongue. Check for any pieces of tooth embedded in the tongue. If her tongue is swelling, use a small ice cube wrapped in a cloth to reduce swelling, but do not place ice directly on the tongue. Once the bleeding stops, assess the severity of the injury. If the tongue continues to bleed excessively, apply pressure with sterile gauze or a clean cloth.
The tongue is a complex organ essential for speaking, eating, and breathing. A bitten tongue doesn’t usually need stitches, even if the bite gapes slightly—it should heal naturally. If the cut edges come together when the tongue is still, no treatment is needed. However, if bleeding does not stop within 15 minutes, if part of the tongue appears amputated, or if the bite is larger than 2 cm, seek medical help immediately.”
Scenario 4
“Hello, Doctor. Bongi was jumping on the bed. He fell and hit his mouth on the side table. The tooth seems a little loose, but it hasn’t changed position. There is some bleeding at the gum line.”
“If the tooth hasn’t moved and there is minimal bleeding, this is likely a minor injury. Give him some paracetamol and ask your dentist to check it out. A soft diet is recommended for the next two weeks.”
Scenario 5
“Hello, Doctor. Kimberly slipped in the bath, hit her mouth on the porcelain, and one of her teeth appears to have been pushed into her gum.”
“Since Kimberly is only three years old, this is likely a baby tooth. While not as serious as a permanent tooth injury, it is still a moderate concern. Give her some paracetamol and have a dentist assess the extent of the damage to the tooth and its root. A soft diet for the next two weeks is recommended.”
Scenario 6
“Hello, Doctor. Lucky was playing cricket with his friends in the garden. He got hit in the face with a bat and came running inside with his tooth in his hand. I am freaking out, and he is hysterical. It is his permanent tooth.”
“This is a major injury, but it is essential to stay calm and reassure Lucky. Try to save the tooth.
- Hold the tooth by the white end and avoid touching the root.
- Rinse the tooth in milk.
- If Lucky will allow it, gently try to place the tooth back into the socket and ask him to bite down on a clean facecloth or gauze to hold it in place.
If he will not let you reinsert it, place the tooth in a cup of milk and seek emergency dental care immediately.”
Scenario 7
“Hello, Doctor. Sammy was standing on a little step while brushing her teeth. She slipped with the toothbrush in her mouth. There is a lot of blood, and I am extremely worried that she has injured her soft palate or the back of her throat.”
“This is a very dangerous injury. Puncture wounds in this area can lead to a deep-space infection in the neck. If the toothbrush has punctured near the tonsils, it may have injured a large vessel at the back of the throat, called the carotid artery. Get to the closest emergency centre immediately, as a surgeon needs to assess Sammy urgently.”
Conclusion
Mouth injuries are the second most common childhood injury. Most occur within the first three years of life. Preventing injuries in young children is difficult, but some safety measures can help. Teach your children that they should:
- Never run with an object in your mouth, such as a lollipop stick, pencil, or toothbrush.
- Stand clear of anyone playing with a bat or racket.
- Walk slowly on wet or slippery surfaces.
Safety equipment is key for older children. Helmets are essential for cycling, and mouth guards protect teeth and gums. The American Dental Association (ADA) states that athletes are 60 times more likely to suffer dental injuries when not wearing a mouth guard, and those who wear them are 82-93% less likely to experience dental trauma.
A child running to you with a bleeding mouth or missing tooth is every parent’s nightmare. Take a moment to gather yourself, calm your child, and assess the severity of the injury. If in doubt, seek medical advice.
References:
- https://www.msdmanuals.com/professional/dental-disorders/lip-and-tongue-disorders/tongue-trauma#Treatment_v39370334
- https://gpdsmile.com/first-aid-for-a-bitten-tongue-or-lip-in-kids/
- https://my.clevelandclinic.org/health/body/frenum-mouth-frenulum
- https://www.seattlechildrens.org/conditions/a-z/mouth-injury/
- https://publications.aap.org/pediatrics/article/133/2/e466/30896/Management-of-Dental-Trauma-in-a-Primary-Care
- https://www.sciencedirect.com/science/article/abs/pii/S0031395505702583
- https://jada.ada.org/article/S0002-8177(14)64802-9/abstract
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