Health Library Mouth and Dental InjuriesFrom Healthwise

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 health professional.

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.

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a health professional.

• Rapid swelling of your throat, tongue, or mouth
• Moderate to severe difficulty breathing occurs:
  • In children.
  • In adults and older children.

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

If you have any of the following symptoms, evaluate those symptoms first.

• A head injury: Go to the topic Head Injury, Age 4 and Older or Head Injury, Age 3 and Younger.
• Burn to the mouth: Go to the topic Burns.
• A problem related to mouth piercing: Go to the topic Body Piercing Problems.
• A problem caused by swallowing a piece of dental appliance: Go to the topic Swallowed Objects.

	Yes	Has your tooth been knocked out?
When to See a Doctor See significance of a knocked-out tooth if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: Immediate first aid and dental care are needed. If you are unsure whether the tooth was a baby (primary) tooth or a permanent tooth, answer “yes” to the question. Call your health professional immediately if you answer "Yes" to the following question. Yes Has a permanent tooth been completely knocked out? Note: If you are not able to contact your dentist, go to the nearest hospital emergency room immediately. A permanent tooth may be put back in the socket (reimplanted) if it is knocked out or torn away from its socket. The best results occur if your tooth is put back in its socket by a dentist within 30 minutes. For information on how to transport the tooth, see first aid for a tooth that has been knocked out. Call your health professional today if you answer "Yes" to the following question. Yes Has your child's baby tooth been completely knocked out? Note: Your child needs to be checked by a dentist even if the child's tooth was getting ready to fall out soon. If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Has your tooth come loose, moved, or been jammed into your gum after an injury?
When to See a Doctor See significance of a tooth that has come loose, moved, or been jammed into your gum if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If you are unsure whether the tooth was a baby (primary) tooth or a permanent tooth, answer “yes” to the question. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Is a permanent tooth very loose? Note: Bite gently on a piece of gauze to keep the tooth in place until you can consult your dentist. Yes Has a permanent tooth moved? Call your health professional today if you answer "Yes" to any of the following questions. Yes Is a permanent tooth slightly loose? Yes Does your child have a very loose baby tooth? Yes Has your child's baby tooth moved or become jammed into the gum? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have a cut, puncture, or tear in your lip, tongue, or the inside your mouth?
When to See a Doctor See significance of a cut, puncture, or tear to your lip, tongue, or the inside of your mouth if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: Deep cuts are likely to need stitches and should generally be stitched within 6 to 8 hours after the injury to reduce the risk of infection. This risk increases the longer the cut remains untreated. Some cuts may be able to be stitched up to 24 hours later. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Has part of your tongue been completely cut off? Note: Be sure to follow first aid measures for proper transport of your tongue. Yes Has the cut or puncture gone completely through your tongue? Yes Does moderate to severe bleeding continue after you have applied direct pressure for 15 minutes? Note: Be sure to follow the instructions in first aid for a bleeding wound. Yes Do you have a cut or puncture in the roof of your mouth or the back of your throat? Yes Has the cut or puncture gone completely through your lip or cheek? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you continue to have minor oozing of blood after applying pressure for 45 minutes? Yes Is a cut, puncture, or tear deeper than 0.25 in. (6.5 mm) and longer than 0.75 in. (20 mm)? Yes Did a cut, puncture, or tear that is deeper than 0.25 in. (6.5 mm)leave a flap? Yes Does a cut, puncture, or tear that is deeper than 0.25 in. (6.5 mm)gape open? Yes Does a cut, puncture, or tear that is deeper than 0.25 in. (6.5 mm) have jagged edges? Yes Do you have a cut, puncture, or tear on the lip or edge of the lip and you are concerned about scarring? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you know or think an object is in a mouth wound?
When to See a Doctor See significance of an object in a mouth wound if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: Suspect an object is in a wound if you are unable to find all the pieces of a broken tooth or broken dental appliance. Your dentist may have to X-ray your mouth to see whether an object is in the wound. Call your health professional immediately if you answer "Yes" to the following question. Yes Are you unable to remove an object from your mouth wound? Call your health professional today if you answer "Yes" to the following question. Yes Do you think you have an object in a mouth wound? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you know or think a mouth injury may have been caused by abuse?
When to See a Doctor See significance of abuse if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Was your mouth injury intentionally caused by another person? Yes Do you think a mouth injury may have been caused by abuse? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Did your tooth or dental appliance chip, crack, or break?
When to See a Doctor See significance of a chip, crack, or break to your tooth or dental appliance if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If you are unsure whether the tooth was a baby tooth (primary) tooth or a permanent tooth, answer “yes” to the question. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have bleeding from a permanent tooth? Yes Do you have moderate to severe pain? Yes Is a permanent tooth sensitive to heat, cold, air, or sweets? Yes Are you unable to remove a tooth fragment stuck in a mouth wound? Yes Are you unable to open or close your mouth normally? Yes Are you unable to remove a piece of dental appliance stuck in a mouth wound? Call your health professional today if you answer "Yes" to the following question. Yes Does your child have a broken or cracked baby tooth? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Are rough edges of a chipped or cracked tooth or dental appliance still irritating your mouth after 48 hours? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Do you have a crack in a tooth that is not causing any symptoms? Yes Do you have a chip in a tooth that is not causing any other symptoms? Yes Has the surface of your tooth chipped from grinding your teeth? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have pain after a mouth or dental injury?
When to See a Doctor See significance of pain after a mouth or dental injury if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you have severe pain that has not improved after 2 hours of home treatment? Call your health professional today if you answer "Yes" to any of the following questions. Yes Is moderate pain getting worse? Yes Do you have moderate to severe tooth sensitivity to heat, cold, air, or sweets? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Do you have moderate pain that has not improved after 12 hours of home treatment? Yes Do you have mild pain that has not improved after 24 hours of home treatment? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Are rough edges of a tooth or dental appliance irritating your mouth? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have any signs of infection?
When to See a Doctor See significance of signs of infection if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have diabetes? Yes Do you have a disease or take medicine that causes problems with your immune system? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have increased pain, swelling, redness, or warmth around a mouth wound? Yes Is the area around your mouth wound increasingly tender to the touch? Yes Do you have pus in or around the mouth wound? Yes Do you know or think you have a fever? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Have you had mild pain and swelling with redness less than 1 in. (2.5 cm) around a mouth wound for 24 hours or longer? Yes Have you had swollen glands (lymph nodes) in the jaw or neck or under the chin for 24 hours or longer? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Has a tooth changed color after an injury?
When to See a Doctor See significance of a tooth changing color after an injury if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If you are unsure whether the tooth was a baby (primary) tooth or a permanent tooth, answer “yes” to the question. Call your health professional today if you answer "Yes" to the following question. Yes Has a permanent tooth changed color within 2 weeks of an injury? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Has your child's baby tooth turned gray, black, or pink? Yes Has a permanent tooth been discolored for weeks or months? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you know or think you need a tetanus shot?
When to See a Doctor See significance of getting a tetanus shot if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If you need a tetanus shot, call your doctor to arrange for the shot as soon as possible. Your need for a tetanus shot depends on the seriousness of your wound and your tetanus shot history. Your doctor may be able to tell you over the telephone if you need a tetanus shot. Call your health professional today if you answer "Yes" to any of the following questions. Yes Were you cut by something clean and your last tetanus shot was longer than 10 years ago? Note: Something is clean if it does not have dirt, soil, spit, or feces on it. Examples include a broken water glass, a kitchen knife, or sewing scissors. Yes Were you cut by something dirty and your last tetanus shot was longer than 5 years ago? Note: Something is dirty if it has dirt, soil, spit, or feces on it. Examples include a garden tool, a dirty nail, or a piece of glass that has been buried in the dirt. Yes Are you not sure if you were cut by something clean or dirty and your last tetanus shot was longer than 5 years ago? Yes Are you not sure when you had your last tetanus shot? Yes Did you not get the first series of tetanus shots (primary vaccination series)? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Was your injury caused by grinding your teeth?
When to See a Doctor See significance of grinding your teeth if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: Be sure to answer the other questions in the Check Your Symptoms section to determine if grinding your teeth has caused an injury that needs treatment sooner than 1 to 2 weeks. You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Has the surface of your tooth chipped? Yes Are one or more of your teeth loose? Yes Does your jaw or teeth hurt from grinding? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Do you have any of the following symptoms?

• A toothache not related to an injury: Go to the topic Toothache and Gum Problems.
• Mouth problems not related to an injury: Go to the topic Mouth Problems, Noninjury.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

First aid steps

If you need to see a health professional for your injury, call to arrange for your care and follow these steps for:

• 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. Wrap the piece of tongue in a clean cloth or sterile gauze, if available. Put the wrapped piece of tongue in a bag of ice to keep it cool. Do not put the tongue directly on the ice. Do not immerse the tongue in ice water. Go to the emergency room right away. Take the bag with you.
• 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 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, or cottage cheese.
  • Meat and meat substitutes, such as tender meats or chicken, tuna, eggs, or 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 Tobacco Use.
• 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.

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

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment.

• New symptoms develop.
• Signs of infection develop.
• Home treatment is not helping relieve discomfort.
• Symptoms become more frequent or severe.

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 health professional if and when he or she recommends that you use a helmet and face guard to protect your head and mouth.

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

• Don't allow your child to walk or run with objects in his or her mouth.
• 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.

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

You can help your health professional 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 first aid or home treatment measures have you tried? Be sure to include any nonprescription medicines you have taken. 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?

• Basic Dental Care
• Body Piercing Problems
• Burns
• Cuts
• Facial Problems, Noninjury
• Gum Disease
• Mouth Problems, Noninjury
• Puncture Wounds
• Quitting Tobacco Use
• Scrapes
• Sinusitis
• Swallowed Objects
• Tooth Decay
• Toothache and Gum Problems
• Wisdom Tooth Problems

Author:	Susan Van Houten, RN, BSN, MBA	Last Updated: December 1, 2006
Medical Review:	Martin Gabica, MD - Family Medicine William M. Green, MD - Emergency Medicine Steven K. Patterson, BSc, DDS, MPH - Dentist
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