For this reason, it is essential that your child be carefully supervised by a responsible adult after dental treatment with local anesthesia to avoid any self-inflicted injury. The placement of cotton gauze in the mouth for the child to bite on is intended to help remind the child not to injure his or her self in such a manner.
If an injury occurs, the injured area should be kept clean. If the injury is on the lips or outside cheeks, application of a skin ointment or petroleum jelly is recommended. If the injury is in the mouth, application of a mild oral antiseptic is recommended. The area will generally heal in seven to ten days. However, if there is significant swelling in the surrounding tissue areas, your child should be examined by the doctor as antibiotic drug therapy may be necessary.
If you have any question or wish the doctor to examine the area, please call our office. There will be no charge for this visit.
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Clinical Practice Column
Column Editor: Maura MacPhee, PhD, RN
Lip Biting in a Pediatric Dental Patient After Dental Local Anesthesia: A Case Report☆Self-inflicted lip trauma is a potential complication of dental treatment involving local anesthesia of the inferior alveolar nerve, particularly among children. Children presenting with this self-limiting condition are often times misdiagnosed as having a localized bacterial infection. In some extreme cases, children have been unnecessarily hospitalized and treated with systemic antibiotics or surgical interventions. This case report describes a child who bit his lip after a dental appointment and was subsequently hospitalized for monitoring. Pediatric nurses are in a unique position to help parents and primary care physicians properly diagnose and manage this benign condition palliatively.
Key words
Pediatric dentistry
Complications of local anesthesia
Lip biting
Traumatic ulcer
Cited by (0)
Copyright © 2008 Elsevier Inc. All rights reserved.
The following is a list of some common concerns after your child has had dental treatment.
NUMBNESS ASSOCIATED WITH LOCAL ANESTHETIC
Local anesthetic is the most effective way to eliminate discomfort which may accompany dental treatment. The only downside to a comfortable dental visit and anesthetized teeth is the consequential numbness of the adjacent soft tissues, lips, cheeks and tongue. The effects and duration of numbness varies for every individual and based on the type of anesthetic agents administered.
We use the local anesthetic that best suits the treatment type and normally the numbness wears off within an hour after treatment. Some children may experience numbness for less than a half hour while others may be numb for four hours after treatment. Your child will notice their lips and/or tongue beginning to tingle as the feeling returns.
Watch your child carefully after dental treatment. Children can easily damage soft tissues by chewing on them or by sucking on their lips or cheeks.
Younger children will leave the operatory with a “tooth pillow,” which is a cotton roll or gauze. This is placed between the teeth to remind the child their tissues are asleep. Your child should not chew on the pillow as they may injure the soft tissues. We will give you extra cotton rolls to replace the original pillow if necessary. Children will be warned to not chew on their lips or tongue.
The lip, cheek and tongue will be numb on the affected area if we give your child local anesthetic to numb the teeth on the mandible or lower jaw. Only the lip and cheek should be numb if the affected tooth or gum is on the maxilla or upper jaw.
A child may drink liquid following dental treatment, but make sure they wait at least 40 minutes following extractions and that they do not use a straw.
Soft food may be eaten after treatment, when the soft tissues regain feeling. A regular diet may be continued the following day unless there has been an extraction. If your child has a tooth extracted, wait a second day before continuing a normal diet unless the dentist suggests otherwise.
NUMBNESS AND TISSUE BITING (CHEEK, LIP OR TONGUE)
If your child bites their lip, cheek or tongue following the administration of local anesthetic, call the office and inform the dentist of the incident. Please return to the office for observation if you are not satisfied with the advice or if the dentist feels it is necessary. You will not be charged. We want you to be comfortable and understand the injury and care.
Please keep your child well-fed and hydrated. Cold liquids and frozen treats such as milkshakes and popsicles may provide relief. Don’t give your child acidic and/or spicy food.
Infection is extremely rare in cases of these self-inflicted wounds and usually, antibiotics are not necessary. Do not use Vaseline or petroleum jelly-like products to coat the tissues, use vitamin E oil to coat the surface. Normal healing usually takes a week.
If there is excessive bleeding following dental treatment, please call the office and prepare to return to the office for a free observation.
The signs of lip trauma from biting are:
- A swollen lip (as much as three-times the normal size)
- Raw lip tissue
- Tenderness and sensitivity at the affected area to acidic and spicy food
- A white, membranous scab on the lip surface
The signs of cheek trauma from biting are:
- A raw and tattered inner mid-cheek area
- The cheek may be swollen and appear trapped between the teeth on the affected side
- Tenderness and sensitivity to acidic and spicy food
- A white scab
WHAT TO DO:
- Call the office and inform the dentist
- Call immediately if there is any bleeding
- Follow instructions regarding lip damage
- Keep your child on a liquid diet until they stop biting the affected area
THE SIGNS OF TONGUE TRAUMA FROM BITING ARE:
- A swollen and tattered-looking area on the tongue
- A deep cut and bleeding in the area of a tongue laceration
WHAT TO DO:
If there is bleeding and your child is old enough to understand:
- Place pressure on both sides of the tongue for five minutes
- Use finger pressure with gauze or tissue
- Call the office to inform them of the incident and to alert the dentist
If there is still bleeding, bring your child to the office
- If your child can not follow directions or is not old enough to understand:
- Call the office to inform them of the incident and to alert the dentist
- If there is bleeding, bring your child to the office
If the tongue is not bleeding:
- Follow instructions regarding cheek, lip and tongue trauma
GUM IRRITATION/DISCOMFORT AFTER TREATMENT
Although not all dental treatment is in close proximity to the gum tissue, it is not uncommon to have a minor irritation/soreness of the gum tissue adjacent to the treated teeth immediately after treatment.
Fortunately, oral tissues are some of the body’s most resilient tissues and most irritation will heal within a few short days. Any discomfort should improve within 24 hours and the affected area may look like a white scab.
Infection is uncommon in this case, however, should the area become inflamed please call the doctor at 775-823-9797.
IMPORTANT Reminder: A parent or guardian must accompany all patients under 18 years of age at all dental visits unless prior arrangements have been made with the office.