Should lacerations to the gingiva (gums) be repaired?

Management of Gingival Lacerations

Most gingival lacerations do not require suturing and can heal well with conservative management alone. 1

Assessment of Gingival Lacerations

• Gingival tissue has excellent blood supply and healing capacity
• Factors to consider when evaluating gingival lacerations:
  • Size of laceration
  • Depth of tissue involvement
  • Presence of bleeding
  • Location (attached vs. free gingiva)
  • Tissue viability
  • Presence of foreign bodies

Management Approach

Small Lacerations (< 5 mm)

• Conservative management is recommended
• Hemostatic minor lacerations generally do not require repair 2
• Allow to heal by secondary intention
• Oral rinses with alcohol-free mouthwash or warm salt water

Medium to Large Lacerations (> 5 mm)

• May require repair if:
  • Edges are not approximated
  • Significant bleeding persists
  • Flap of tissue is present
  • Laceration extends into deeper tissues

Repair Techniques When Needed

• Clean wound thoroughly with saline or potable tap water 3
• Local anesthesia may be required
• Options for repair:
  • Absorbable sutures (3-0 or 4-0 polyglactin or poliglecaprone) 2
  • Tissue adhesives for superficial lacerations in low-tension areas 3
  • Simple interrupted or continuous suturing technique

Postoperative Care

• Oral hygiene maintenance:
  • Gentle brushing around the affected area
  • Alcohol-free antimicrobial mouth rinses
  • Warm salt water rinses 3-4 times daily 4
• Soft diet for 24-48 hours
• Avoid irritating foods (spicy, acidic, hot temperature)
• Pain management with acetaminophen or NSAIDs as needed

Special Considerations

Sinus Membrane Perforations

For gingival lacerations associated with sinus procedures:

• Small perforations (<5 mm) may not need repair as the membrane tends to fold on itself 4
• Medium perforations (5-10 mm) may be managed with collagen membrane, fibrin glue, or platelet-rich fibrin 4
• Large perforations may require fixation of absorbable collagen membrane 4

Intraoral Wound Infections

• Routine prophylactic antibiotics are not indicated for most gingival lacerations 5
• Consider antibiotics only for:
  • Heavily contaminated wounds
  • Immunocompromised patients
  • Wounds with extensive tissue damage

Follow-up

• Evaluate healing within 1-2 weeks
• Monitor for signs of infection (increased pain, swelling, purulent discharge)
• Assess for development of gingival defects that may require periodontal plastic surgery 1

Common Pitfalls to Avoid

• Overtightening sutures in gingival tissue can cause tissue necrosis
• Failing to identify and remove foreign bodies
• Neglecting to provide adequate oral hygiene instructions
• Unnecessary repair of small, hemostatic lacerations that would heal well with conservative management

The excellent vascularity of oral tissues generally promotes rapid healing without the need for complex interventions. Most gingival lacerations can be managed conservatively, with repair reserved for larger or more complex wounds.