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Mouth and Dental Injuries

Topic Overview

Mouth injuries are common, especially in children, and may involve the teeth, jaw, lips, tongue, inner cheeks, gums, roof of the mouth (hard or soft palates), neck, or tonsils. Sometimes mouth injuries look worse than they are. Even a small cut or puncture inside the mouth may bleed a lot because there are many blood vessels in the head and neck area. Home treatment of minor mouth injuries can help stop bleeding, reduce pain, help healing, and prevent infection.

Teeth may be injured during a fall or a sport activity. A tooth may be knocked out (avulsed). You may be able to replace a permanent tooth in its socket (reimplant) if it has been knocked out or torn away from the socket. Immediate first aid and dental care are needed when a permanent tooth has been knocked out.

An injury could crack, chip, or break a tooth, or make a tooth change color. A tooth also may be loose or moved in position (dental luxation) or jammed into the gum (intruded).

Other dental injuries may be caused by grinding your teeth, especially at night. Your teeth may hurt, chip, or become loose. Biting surfaces may become flat and worn down. A broken or loose dental appliance or an orthodontic wire or bracket may poke or rub the inside of your mouth and make your mouth sore.

An injury to your mouth or lips may cause a large, loose flap of tissue or a gaping wound that may need stitches. A smaller wound on the lip may be stitched for cosmetic reasons. If an object, such as a piece of broken tooth or an orthodontic wire, gets stuck in a wound, you may need to have it removed by a doctor. You can also have problems from a piercing in the mouth.

The piece of skin between your lips and gums or under your tongue (frenulum) may tear or rip. Usually this type of injury will heal without stitches. It is generally not a concern unless the tear was caused by physical or sexual abuse.

An injury to the roof of your mouth, the back of your throat, or a tonsil can injure deeper tissues in your head or neck. These injuries can happen when a child falls with a pointed object, such as a pencil or Popsicle stick, in his or her mouth.

Check your symptoms to decide if and when you should see a doctor.

Check Your Symptoms

Do you have an injury to your mouth or teeth?
Yes
Injury to mouth or teeth
No
Injury to mouth or teeth
How old are you?
Less than 4 years
Less than 4 years
4 years or older
4 years or older
Are you male or female?
Male
Male
Female
Female
Have you had a head injury?
Yes
Head injury
No
Head injury
Are you having trouble breathing (more than a stuffy nose)?
Yes
Difficulty breathing more than a stuffy nose
No
Difficulty breathing more than a stuffy nose
Would you describe the breathing problem as severe, moderate, or mild?
Severe
Severe difficulty breathing
Moderate
Moderate difficulty breathing
Mild
Mild difficulty breathing
Have you had rapid swelling of the mouth, tongue, or throat?
Yes
Rapid swelling of mouth, tongue, or throat
No
Rapid swelling of mouth, tongue, or throat
Did the injury involve the teeth?
Yes
Injury to teeth
No
Injury to teeth
Did the injury involve a permanent tooth?
Yes
Injury to permanent tooth
No
Injury to permanent tooth
Yes
Tooth knocked out
No
Tooth knocked out
Did a tooth come loose, move, or get jammed into the gum?
Yes
Tooth came loose, moved, or was jammed into gum
No
Tooth came loose, moved, or was jammed into gum
Has a tooth moved or become very loose?
Yes
Tooth is very loose or has moved
No
Tooth is very loose or has moved
Is a tooth or dental appliance (such as dentures or a crown) chipped, cracked, or broken?
Yes
Tooth or dental appliance is chipped, cracked, or broken
No
Tooth or dental appliance is chipped, cracked, or broken
Is the area around the tooth bleeding?
Yes
Bleeding from tooth injury
No
Bleeding from tooth injury
Can you open and close your mouth normally?
Yes
Able to open and close mouth normally
No
Unable to open and close mouth normally
Has a tooth changed color since the injury?
Yes
Tooth changed color after injury
No
Tooth changed color after injury
Do you have a mouth wound?
This could include a cut, puncture, or tear in the lips, the tongue, or the inside of the mouth.
Yes
Mouth wound
No
Mouth wound
Has a cut or puncture gone completely through the tongue, or has part of the tongue been cut off?
If part of the tongue has been cut off, wrap it in a clean cloth, and put it in a bag of ice to keep it cool until you can get medical help. Do not put ice or ice water directly on the tongue.
Yes
Puncture through tongue, or part of tongue cut off
No
Puncture through tongue, or part of tongue cut off
Is there a puncture wound to the roof of the mouth, the cheeks, the lips, or the back of the throat?
Yes
Puncture to roof of mouth, cheeks, lips, or back of throat
No
Puncture to roof of mouth, cheeks, lips, or back of throat
Are you bleeding?
Yes
Bleeding
No
Bleeding
Would you describe the bleeding as severe, moderate, or mild?
Severe
Severe bleeding
Moderate
Moderate bleeding
Mild
Mild bleeding
Is blood still oozing from the wound after 45 minutes of direct pressure?
Yes
Minor oozing of blood after 45 minutes of direct pressure
No
Minor oozing of blood after 45 minutes of direct pressure
Is a piece of tooth, part of a dental appliance, or any other object stuck in the mouth wound?
Yes
Object in mouth wound
No
Object in mouth wound
Is the wound more than 0.25 in. (0.6 cm) deep and 0.75 in. (2.0 cm) long with a flap of tissue, jagged edges, or sides that gape open?
Wounds like this often need stitches. If you need stitches, it's best to get them within 8 hours of the injury.
Yes
Wound more than 0.25 in. (0.6 cm) deep and 0.75 in. (2.0 cm) long with a flap, jagged edges, or sides that gape open
No
Wound more than 0.25 in. (0.6 cm) deep and 0.75 in. (2.0 cm) long with a flap, jagged edges, or sides that gape open
Is the wound on the face, lips, or any other area where you are worried about scarring?
Wounds in these areas may need stitches. If you need stitches, it's best to get them within 8 hours of the injury.
Yes
Wound on face, lips, or other area where scar is a concern
No
Wound on face, lips, or other area where scar is a concern
Do you think that the injury may have been caused by abuse?
Yes
Injury may have been caused by abuse
No
Injury may have been caused by abuse
Do you have any pain from the injury?
Yes
Pain after mouth or dental injury
No
Pain after mouth or dental injury
How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine?
8 to 10: Severe pain
Severe pain
5 to 7: Moderate pain
Moderate pain
1 to 4: Mild pain
Mild pain
Has the pain lasted for more than 2 days?
Yes
Pain for more than 2 days
No
Pain for more than 2 days
Are there any symptoms of infection?
Yes
Symptoms of infection
No
Symptoms of infection
Do you think you may have a fever?
Yes
Possible fever
No
Possible fever
Are there red streaks leading away from the area or pus draining from it?
Yes
Red streaks or pus
No
Red streaks or pus
Do you have diabetes or a weakened immune system?
What weakens the immune system in an adult or older child may be different than in a young child or baby.
Yes
Diabetes or immune problem
No
Diabetes or immune problem
Do you think you may need a tetanus shot?
Yes
May need tetanus shot
No
May need tetanus shot
Have you had any mouth or dental symptoms for more than a week?
Yes
Symptoms for more than 1 week
No
Symptoms for more than 1 week

Severe trouble breathing means:

  • The child cannot eat or talk because he or she is breathing so hard.
  • The child's nostrils are flaring and the belly is moving in and out with every breath.
  • The child seems to be tiring out.
  • The child seems very sleepy or confused.

Moderate trouble breathing means:

  • The child is breathing a lot faster than usual.
  • The child has to take breaks from eating or talking to breathe.
  • The nostrils flare or the belly moves in and out at times when the child breathes.

Mild trouble breathing means:

  • The child is breathing a little faster than usual.
  • The child seems a little out of breath but can still eat or talk.

Severe trouble breathing means:

  • You cannot talk at all.
  • You have to work very hard to breathe.
  • You feel like you can't get enough air.
  • You do not feel alert or cannot think clearly.

Moderate trouble breathing means:

  • It's hard to talk in full sentences.
  • It's hard to breathe with activity.

Mild trouble breathing means:

  • You feel a little out of breath but can still talk.
  • It's becoming hard to breathe with activity.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

  • Try home treatment to relieve the symptoms.
  • Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

Symptoms of difficulty breathing can range from mild to severe. For example:

  • You may feel a little out of breath but still be able to talk (mild difficulty breathing), or you may be so out of breath that you cannot talk at all (severe difficulty breathing).
  • It may be getting hard to breathe with activity (mild difficulty breathing), or you may have to work very hard to breathe even when you’re at rest (severe difficulty breathing).

Symptoms of infection may include:

  • Increased pain, swelling, warmth, or redness in or around the area.
  • Red streaks leading from the area.
  • Pus draining from the area.
  • A fever.

Call 911 Now

Based on your answers, you need emergency care.

Call911or other emergency services now.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

  • Call your dentist now to discuss the symptoms and arrange for care.
  • If you cannot reach your dentist or you don't have one, seek care in the next hour.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

  • Call your doctor today to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don't have one, seek care today.
  • If it is evening, watch the symptoms and seek care in the morning.
  • If the symptoms get worse, seek care sooner.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

  • Call your dentist today to discuss the symptoms and arrange for care.
  • If you cannot reach your dentist or you don't have one, seek care today.
  • If it is evening, watch the symptoms and seek care in the morning.
  • If the symptoms get worse, seek care sooner.

Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in adults are:

  • Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
  • Long-term alcohol and drug problems.
  • Steroid medicines, which may be used to treat a variety of conditions.
  • Chemotherapy and radiation therapy for cancer.
  • Other medicines used to treat autoimmune disease.
  • Medicines taken after organ transplant.
  • Not having a spleen.

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

  • Your age. Babies and older adults tend to get sicker quicker.
  • Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
  • Medicines you take. Certain medicines, herbal remedies, and supplements can cause symptoms or make them worse.
  • Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
  • Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

You may need a tetanus shot depending on how dirty the wound is and how long it has been since your last shot.

  • For a dirty wound that has things like dirt, saliva, or feces in it, you may need a shot if:
    • You haven't had a tetanus shot in the past 5 years.
    • You don't know when your last shot was.
  • For a clean wound, you may need a shot if:
    • You have not had a tetanus shot in the past 10 years.
    • You don't know when your last shot was.

If you can get to a dentist's office (or an emergency room) within an hour or two of the injury, the dentist may be able to reimplant the tooth in its socket.

To preserve the tooth until you get to the dentist:

  • Pick up the tooth at its top, not at the root.
  • Rinse the tooth with water. Do not rub or scrub it.
  • Put the tooth back in the socket. Bite down gently on gauze or a clean cloth to keep the tooth in place, or hold the tooth in place with your finger. (This is not a good idea for anyone who might swallow the tooth.)
  • Another option is to put the tooth in a small container of milk. Use tap water if you don't have milk.

Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in children are:

  • Diseases such as diabetes, cystic fibrosis, sickle cell disease, and congenital heart disease.
  • Steroid medicines, which are used to treat a variety of conditions.
  • Medicines taken after organ transplant.
  • Chemotherapy and radiation therapy for cancer.
  • Not having a spleen.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

  • Call your doctor now to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don't have one, seek care in the next hour.
  • You do not need to call an ambulance unless:
    • You cannot travel safely either by driving yourself or by having someone else drive you.
    • You are in an area where heavy traffic or other problems may slow you down.

Pain in children under 3 years

It can be hard to tell how much pain a baby or toddler is in.

  • Severe pain (8 to 10): The pain is so bad that the baby cannot sleep, cannot get comfortable, and cries constantly no matter what you do. The baby may kick, make fists, or grimace.
  • Moderate pain (5 to 7): The baby is very fussy, clings to you a lot, and may have trouble sleeping but responds when you try to comfort him or her.
  • Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds when you try to comfort him or her.

Make an Appointment

Based on your answers, the problem may not improve without medical care.

  • Make an appointment to see your doctor in the next 1 to 2 weeks.
  • If appropriate, try home treatment while you are waiting for the appointment.
  • If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

With severe bleeding, any of these may be true:

  • Blood is pumping from the wound.
  • The bleeding does not stop or slow down with pressure.
  • Blood is quickly soaking through bandage after bandage.

With moderate bleeding, any of these may be true:

  • The bleeding slows or stops with pressure but starts again if you remove the pressure.
  • The blood may soak through a few bandages, but it is not fast or out of control.

With mild bleeding, any of these may be true:

  • The bleeding stops on its own or with pressure.
  • The bleeding stops or slows to an ooze or trickle after 15 minutes of pressure. It may ooze or trickle for up to 45 minutes.

Pain in adults and older children

  • Severe pain (8 to 10): The pain is so bad that you can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain.
  • Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it's severe when it's there.
  • Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.
Head Injury, Age 4 and Older
Head Injury, Age 3 and Younger

Home Treatment

First aid steps

If you need to see a doctor for your injury, call to arrange for your care and ask what steps to take in the meantime.

  • A tooth that has been completely knocked out. A permanent tooth can sometimes be put back into its socket (reimplanted). The best results occur if a dentist puts the tooth back in the socket within 30 minutes. Chances of successful reimplantation are unlikely after 2 hours.
  • Bleeding in the mouth. Return any skin flap to its normal position. If necessary, hold the flap in place with a clean cloth or gauze.
  • A tongue or piece of tongue that has been cut off.
  • A broken tooth or dental appliance. Find any pieces of tooth or the broken dental appliance and take them with you when you go to see your dentist. Your dentist will want to check for missing pieces of tooth or dental appliance that may have been left in a wound, swallowed, or inhaled into the lungs (aspirated).

To reduce pain and promote healing

  • Apply a cold compress to the injured area, or suck on a piece of ice or a flavored ice pop, such as a Popsicle, as often as desired.
  • Rinse your wound with warm salt water immediately after meals. Saltwater rinses may promote healing. To make a saltwater solution for rinsing the mouth, mix 1 tsp (5 g) of salt to 1 cup (250 mL) of warm water.
  • Eat soft foods that are easy to swallow. Soft foods include:
    • Milk and dairy products, such as milk shakes, yogurt, custards, ice cream, sherbets, and cottage cheese.
    • Meat and meat substitutes, such as tender meats or chicken, tuna, eggs, and smooth peanut butter.
    • Fruits and vegetables, such as well-cooked or canned fruits and vegetables; well-ripened, easy-to-chew fruits; and baked, mashed, or well-cooked sweet potatoes.
  • Avoid foods that might sting, such as salty or spicy foods, citrus fruits or juices, and tomatoes.
  • Do not smoke or use other tobacco products. For more information, see the topic Quitting Smoking.
  • Do not drink alcohol.
  • If a jagged tooth or orthodontic wire or bracket is poking you, roll a piece of melted candle wax or orthodontic wax and press it onto the part that is poking you. Use a pencil eraser to press a broken wire toward your teeth. These are only temporary measures to use until you can see your dentist or orthodontist to fix the problem.
  • Try a topical medicine, such as Orabase or Ulcerease, to reduce mouth pain.
Medicine you can buy without a prescription
Try a nonprescription medicine to help treat your pain:

Talk to your child's doctor before switching back and forth between doses of acetaminophen and ibuprofen. When you switch between two medicines, there is a chance your child will get too much medicine.

Safety tips
Be sure to follow these safety tips when you use a nonprescription medicine:
  • Carefully read and follow all directions on the medicine bottle and box.
  • Do not take more than the recommended dose.
  • Do not take a medicine if you have had an allergic reaction to it in the past.
  • If you have been told to avoid a medicine, call your doctor before you take it.
  • If you are or could be pregnant, do not take any medicine other than acetaminophen unless your doctor has told you to.

To protect a slightly loose tooth: Teeth that are slightly loose but still in their normal position should tighten up in 1 to 2 weeks.

  • Eat a diet of soft foods for 1 to 2 weeks.
  • Be gentle when you brush or floss.
  • Wear a mouth guard or face protection if you participate in sporting activities.

To remove objects or food stuck between teeth

  • Use dental floss to remove objects or food stuck between your teeth. Guide the floss carefully between your teeth and avoid "snapping" the floss, which can cut your gums.
  • Do not use anything sharp to remove an object that is stuck between your teeth or under your gums.

To remove a very loose baby tooth in a child

  • First, tilt your child's head forward and down so that when the tooth comes out, it doesn't fall to the back of the throat, causing your child to choke or swallow the tooth.
  • Grasp the tooth with gauze or a washcloth, and pull firmly with a twisting motion.

Symptoms to watch for during home treatment

Call your doctor if any of the following occur during home treatment:

Prevention

Many mouth and dental injuries can be prevented by taking the following steps.

  • Have regular dental checkups. If your gums and teeth are healthy, you are more likely to recover from an injury quickly and completely. For more information, see the topic Basic Dental Care.
  • Use a seat belt to prevent or reduce injuries to the mouth during a motor vehicle accident. Always place your child in a child car seat to prevent injuries.
  • Wear a mouth guard while participating in sports. A mouth protector can be made by a dentist or purchased at a store that sells athletic supplies.
  • Wear a helmet and face guard in sports during which a face, mouth, or head injury could occur.
  • If you wear an orthodontic appliance, such as a retainer or headgear, follow your orthodontist's instructions about proper wear and care of it. Learn as much about your orthodontic appliance as you can.
    • Remove headgear and wear a protective mouth guard when playing sports.
    • Remove headgear before engaging in rough play.
    • Do not eat foods that are hard, chewy, crunchy, or sticky.
    • Do not pick at or pull on your braces.
    • Use orthodontic wax to protect the inside of your mouth from poking wires.
    • Store the appliance in the case provided by your orthodontist.
  • If you grind your teeth, ask your dentist whether he or she recommends a mouth guard.
  • If you have seizures or other medical problems that may increase your risk of falls, ask your doctor if and when he or she recommends that you use a helmet and face guard to protect your head and mouth.

More steps to prevent mouth and dental injuries in young children include the following:

  • Be aware of your child's chance of falling, and take steps to prevent falls.
  • When your toddler is using a bottle or sippy cup, have him or her stay seated. Don't allow your child to walk or run with any objects in his or her mouth.
  • Never leave a baby unattended in high places, such as on a tabletop, in a crib with the sides down, or even on a bed or sofa.
  • Do not leave a baby unattended in any infant seat or "sitting" toy, such as a swing, walker, saucer, or jumper. Use all the safety straps provided.
  • Be gentle when placing a bottle or spoon in a baby's or child's mouth. An object that is jammed into the mouth can tear the skin between the lips and gums or under the tongue (frenulum).
  • If your child has protruding teeth, have them examined by a dentist. Protruding teeth are more likely to be injured.

Preparing For Your Appointment

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your doctor diagnose and treat your condition by being ready to answer the following questions:

  • How and when did the injury happen?
  • Have you had a mouth or dental injury in the past? How was it treated? Do you have any problems now that were caused by the injury?
  • What mouth or dental appliances do you wear?
  • What first aid or home treatment measures have you tried? Did they help?
  • What nonprescription medicines have you tried. Did they help?
  • What makes the symptoms better or worse?
  • What is your routine for taking care of your teeth and gums?
  • Have you had regular dental care? When did you last see your dentist?
  • Were alcohol or illegal drugs involved with your injury?
  • Do you have any health risks?

Credits

By Healthwise Staff
William H. Blahd, Jr., MD, FACEP - Emergency Medicine
David Messenger, MD
Last Revised July 20, 2012

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

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