Mouth Wounds

• Many mouth wounds do not require any medical treatment. Some may need a tetanus booster and stitches.
• Most mouth wounds are caused by trauma, either by blunt trauma, a sharp object, and/or the individual's own teeth.
• Mouth wound symptoms include:
  • bleeding,
  • lacerations,
  • tissue flaps,
  • puncture wounds, and/or
  • cuts across the lips' vermilion border (the cosmetic line that marks the border of the lips on the face).
• Treatments range from conservative care (wound cleaning and bandaging) to stitching, antibiotics, and conscious sedation. Treatment of severe mouth wounds should be done emergently at a trauma center in consultation with a surgeon.
• Many mouth wounds do not require stitches. Healed mouth wounds may leave minor scarring; if there is any concern by the individual about potential scarring, a maxillofacial or plastic surgeon consultation should be consulted.
• Mouth wound prevention is difficult especially in children and in individuals that play contact sports. For those who play contact sports, helmets, facemasks, and mouth guards may help prevent some mouth wounds; avoiding risky activity (for example, boxing, skateboarding, and other similar activities or falling hazards in the elderly) also may reduce the chance of mouth wounds.
• Most mouth wounds heal without intervention in about 7 days and have an excellent outcome with no complications even when they require stitches. However, the prognosis decreases if wounds become infected or those wounds that require stitching are left untreated.

Injuries to the mouth often result in a lot of bleeding because there are a lot of blood vessels in the soft tissues of the mouth. Consequently, even a small laceration of the lips, mucosa, gingiva (gums), and/or tongue may bleed freely for short period of time. Most lacerations and/or puncture wounds of the mouth stop bleeding before the person arrives in the emergency department.

In the emergency department the doctor will decide if your wound needs stitches and how best to repair it. This article is designed to cover relatively minor mouth wounds. Serious mouth wounds involving major trauma (multiple areas of tissue disruption, mouth and/or dental tissue loss, and associated facial fractures) is not covered in this article. Individuals with serious mouth wounds need to be emergently evaluated at a trauma center by a surgeon.

Mouth wounds are usually caused by either blunt trauma that cuts tissue, sharp objects, and/or by the persons own teeth (for example, a child or an adult hitting their mouth during a fall).

Mouth wound symptoms include

• pain,
• bleeding,
• a cut (laceration) of the tissue,
• tooth injuries,
• swelling,
• bruising, or
• minor (less than a centimeter) tissue loss, and/or small tissue flaps.

Some may be deep and reach the musculature while others may penetrate all the way through the mucosa and through the skin and some may cross the vermilion border of the lips.

Initially, the person should be checked for associated injuries such as problems breathing or swallowing, facial fractures, loose or missing teeth, and/or more serious tissue loss. Patients should receive a tetanus vaccine if their tetanus shot is not up-to-date. Serious facial wounds should be treated at a trauma center by a surgeon.

Very often, treatments include observation for many wounds (usually under about 1 cm in length and less than about ¾ cm in-depth) and do not involve the vermilion border (the cosmetic line that marks the border of the lips on the face). However, lacerations that bleed for more than 15 minutes after holding pressure may require stitches. Tissue flaps, cuts through the vermilion border, and deep lacerations that involve the musculature usually require stitches as do those lacerations that penetrate all away through the skin, and those with jagged, irregular edges and deeper than about ¾ centimeter in depth. In addition, the skin at the right and left corners of the mouth may have a tendency to bleed freely and also may require a stitch to prevent bleeding and further damage.

Wounds that require stitching can be numbed (anesthetized) with lidocaine/epinephrine and then cleaned with saline solution. The doctor will choose from different types of stitches (absorbable or non-absorbable) to repair a mouth wound. Deep wounds involving musculature should have the musculature sutured first with absorbable sutures and then the overlying mucosal surface sutured with absorbable sutures. All mouth wounds that penetrate all the way through to the skin should be sutured with absorbable sutures. Patients with deep lacerations and/or patients with sutured wounds may be given penicillin or erythromycin to prevent deep tissue infections.

Children may become uncooperative when mouth wounds need to be sutured. Consequently, for many children and a few adults, conscious sedation may be required. In addition, traction may need to be placed on certain areas (for example, the tongue) and many individuals may find this to be very uncomfortable without conscious sedation.

If there are any major concerns about appearances or functionality (for example, scars, tongue movement), immediate consultation with a maxillofacial or plastic surgeon may be offered to the patient. All patients should be informed that lacerations, sutured or unsutured, may have some scar formation as they heal.

Participation in many different activities that involve contact (boxing, hockey, football, baseball, soccer, skateboarding, and many others) can increase the risk of mouth wounds. Helmets, facemasks, and mouth guards may help prevent some mouth wounds caused by these contact sports.

Elderly individuals and other people that require assistance for mobility are at increased risk of falls and subsequently, mouth wounds. Avoiding these activities can reduce the risk of mouth wounds but it is unlikely that most individuals, especially children, will be able to reduce their risk. Small mouth wounds are common occurrences children and young adults.

Because most mouth wounds are minor, and require little or no intervention or stitches, the wounds heal within about seven days and have no consequences. Those wounds that do require stitching also have an excellent prognosis if washed out and stitched appropriately. Wounds that are not properly treated may leave scars or even result in some compromise of oral function which results in a less favorable prognosis.