Lip or Gum Laceration

What is this? Child can swallow and bite teeth together without pain. After wiping with a wet towel, the bleeding or bruise is localized to lip or gum.

lip_gun_laceration
Situation: Lip or gum laceration with blood or hematoma (bruise without blood)

What else it could be:  Tooth subluxation (tooth tender to touch).
Through and through puncture wound

Is this an emergency, urgency or problem? Problem

Unless a lip injury is a puncture wound that goes from inside the mouth all the way to the outside, the child should recover without aid. The lip will swell quickly over 48 hours and then recede.

For a puncture wound or a wound where fat tissue or glandular tissue is protruding, antibiotics and referral for sutures to a dentist or emergency department is necessary.

Telling the parent: Explain the history of the injury, and that lips are very vascular and swelling will occur. Suggest ibuprofen or acetaminophen (Tylenol), given as directed on the bottle. Limit any activity that may re-injure the area. Suggest a trip to the dentist if concerned. The diet is usually self-limiting, but advise soft foods for two days.

First Aid: If bleeding, compress with a wet towel or ice. Provide over the counter analgesia.

Follow up: None necessary if minor. Refer as directed above.

Frenum Tear

What do you see? Child has a cut on tissue connecting gums to the lip. May be bleeding freely.

This is a Frenum tear

What else it could be: Lip laceration due to fall.
Foreign body puncture wound.

frenum_tear

Is this an emergency, urgency, or problem? Problem.

This is a frequent injury of childhood, decreasing in frequency as the child ages. The frenum on children has a low attachment and is very vascularized. With a fall that catches the lip or a sports collision, the lip will lift up and the frenum tears with a great deal of blood. For healthy children, the clotting stops the bleeding within 10 minutes if the child can calm and not move the lip or injury. No therapy is necessary and the frenum will heal in time.

What to tell the parent: Explain the history of the injury and that this injury happens to almost half of all children. The area will heal in 7 days but be sore if hit or tooth brushed. Careful brushing is a must. Sometimes a small bleb of tissue is left when the frenum heals forming a small bump, that too will remodel over time and will not interfere with speech or bite.

First Aid: Find the source of the bleeding and apply pressure with a wet towel or gauze. Some advocate a wet tea bag for clotting, but the bleeding will stop in 10 minutes.

Follow up: None necessary.

Lip Bite

lip_bite
What do you see? Child has a cut and white plaque on lip. May be oozing blood and broke open.

This is a Lip bite with a fibrin clot or a scab that has lost its pigment.

What else it could be: Lip laceration due to fall.
Foreign body puncture wound.

Is this an emergency, urgency, or problem? Problem.

This is a frequent injury of childhood, decreasing in frequency as the child ages. Following dental treatment, the lip remains numb for 2-3 hours. During this time, young children can bite quite hard upon that rubbery thing on their face, not realizing it is their lip. For healthy children, the white clotting stops the bleeding within 10 minutes if the child can calm and not move the lip. No therapy is necessary but the lip can also swell rapidly for 24 hours and re-injury is a concern. Time will heal this injury, but it upsetting to child and parent.

What to tell the parent: Explain the history of the injury and that this injury happens to lots of children. The area will heal in 7 days but be sore if hit or bit again. Careful brushing is a must. Swelling will go down quickly, so ice will not help. Ibuprofen is recommended for pain.

First Aid: If the child is still numb, place a rolled gauze between teeth and tell the child to hold in place to prevent chewing. For young children who cannot understand this, give them a snack. They will chew the snack and not their lip.

Follow up: None necessary.

Tongue Laceration

tongue_laceration

What do you see? Obvious cut or trauma to tongue. This cut may be deep but does not flap open. It slows then restarts bleeding with activity of child. Very painful with the occurrence, then betters quickly over next 30 minutes.

This is a: Tongue laceration from biting or foreign object

What else it could be: Irritation to tongue from orthodontic appliance
Infectious disease (look for blisters or ulcer, page XXX)

Is this an emergency, urgency, or problem? Problem

Unless a tongue cut is more that a centimeter wide or is so deep that muscle tissue is protruding, they will heal on their own without stitches. OTC pain reliever and calm behavior will allow the cut to eventually clot and heal. Oozing of blood is not a concern. A popsicle may help alleviate pain and keep the tongue in place. If a tooth chipped (rough or sharp incisor or inside cusp tip of molar) it is not a bad idea to feel the tongue with a gloved finger to look for the chip inside the wound. This is not a huge issue if it can not be accomplished due to behavior. No referral is necessary unless deep or has any protruding tissue.

Check health history for bleeding disorders that would slow clotting to more that 10 minutes (really long minutes if you are timing it).

What to tell the parent: Explain the history of injury and that the tongue is very vascular and muscular so oozing of blood is okay. Tell them if it bleeds like a nosebleed, seek emergency care. Suggest ibuprofen or Tylenol as directed on the bottle. Limit any activity that may re-injure area. Offer trip to dentist if concerned. Diet is usually self-limiting, but advise softer foods for 2 days.

First Aid: Wet towel if bleeding. Popsicle works better. OTC analgesia.

Follow up: None necessary if minor. Refer as directed above.