Wednesday, April 8th, 2009

| CWK Producer

Dr. Carden Johnston uses a stuffed toy to try to calm 11-month-old Hunter:  “There’s your bear … there ... hot diggity … Hunter looks great.” 

But the child didn’t look so great a couple of hours ago when he hit his face on a kitchen drawer.

“He had so much blood in his mouth, it took a while to get it all cleaned up and then when I did look, I thought I could see a big cut, and it looked like his skin was caught between his two front teeth,” says Hunter’s mother, Laura Thomas.

During the collision with the kitchen drawer, Hunter tore the little piece of skin that connects the lips to the gums – the frenulum.

“And it doesn’t perform a particular function so, if it tears, it doesn’t have to be repaired or replaced,” says Dr. Johnston, an emergency room pediatrician.

Three frenula exist in the mouth – two that attach the lip to the gums and a third one that attaches the bottom of the tongue to the floor of the mouth. They’re not terribly important pieces of anatomy, they heal quickly and complications are unlikely, according to Dr. Johnston.

“Never have seen any [complications], but the complication would be an infection, and the infection would come because tomorrow morning he would look like a fat lip … and then it [the infection] would start going up … into his nose and then into his cheeks,” Dr. Johnston says.

Still, Dr. Johnston expects no infection to occur because “… the mouth is a place that washes itself continuously with saliva and tends to wash the germs out, and it’s hard to get infected.“

The doctor adds that because Hunter’s was a head injury, causing a cut in his mouth, it can look a lot worse than it is.

“It’s just scary … but remember that the blood vessels from here up are just everywhere, and there’s lot of blood flow up there, and so a little bitty cut in this area will bleed a lot more than a cut on your hand or your arm or leg,” Dr. Johnston says.

Although it hurts and looks terrible, in a couple of days Hunter’s wound will be totally healed, the doctor says.

Tips for Parents

It’s almost inevitable: Children will get minor cuts, wounds and lacerations to the mouth and lips while playing, climbing or participating in sports. Most of these injuries can be handled at home with simple first-aid treatment. Parents need to keep in mind that the gums, tongue and lips have a rich blood supply, and when cuts occur, a great deal of bleeding can occur.

Experts at Lucile Packard Children’s Hospital cite the following common traumas to the mouth:

• Cuts of the tongue or inside of the cheeks (due to accidentally biting them during eating) are the most common mouth injury.
• Cuts and bruises of the upper lip are usually due to falls.  A tear of the piece of tissue connecting the upper lip to the gum (upper labial frenulum) is very common and always heals without sutures.
• Cuts of the lower lip are usually caused by catching it between the upper and lower teeth during a fall.  Most of these cuts do not connect (don’t go through the lip).
• Potentially serious mouth injuries are those to the tonsil, soft palate or back of the throat, such as from falling with a pencil in the mouth.

If the wound is on the outside of the mouth or on the lips, wash it well with soap and water. Children’s Hospital Boston recommends removing any dirt particles from the area and letting the water from a faucet run over it for several minutes. A dirty cut or scrape that is not well cleansed can cause scarring.

For mild mouth injuries, Lucile Packard Children’s Hospital offers the following “home-care advice”:

• Stop any bleeding:  For bleeding of the inner lip or tissue that connects it to the gum, press the bleeding site against the teeth or jaw for 10 minutes. Once bleeding from inside the lip stops, don’t pull the lip out again to look at it (the bleeding will start up again). For bleeding from the tongue, squeeze or press the bleeding site with a sterile gauze or piece of clean cloth for 10 minutes.
• Local cold:  Put a piece of ice (wrapped in cloth) on the area that was injured for 20 minutes.
• Pain medicine:  If there is pain, give acetaminophen or ibuprofen.
• Soft diet:  Offer a soft diet.  Avoid any salty or citrus foods that might sting.  Rinse the wound with      warm water immediately after meals.
• Expected course:  Small cuts and scrapes inside the mouth heal in three or four days. Infections resulting from mouth injuries are rare.

Call your doctor immediately (night or day) if you observe one of the following problems:

• A serious injury
• Minor bleeding that won’t stop after 10 minutes of direct pressure
• A deep or gaping cut that may need stitches
• A cut through the border of lip where it meets the skin
• Severe pain
• An inability to swallow or new onset of drooling
• Injury that was caused by a pencil or other long object placed in the mouth
• Mouth looks infected – fever, spreading redness, increasing pain or swelling after 48 hours (Keep in mind, any healing wound in the mouth is normally white for several days.)

How can you prevent mouth injuries? Children’s Hospital Boston suggests teaching your child never to walk or run while holding an object in his or her mouth; urging your child not to suck or chew on hard, sharp or pointed objects, such as pencils and require your child to wear a mouth guard for sports activities that could cause injury.

References

• Children’s Hospital Boston
• Lucile Packard Children’s Hospital

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