How to manage tongue bite in full mouth rehabilitation?

Management of Tongue Bite in Full Mouth Rehabilitation

The most effective approach to manage tongue bite in full mouth rehabilitation is to use a removable oral device that restrains the tongue to promote healing while allowing for proper oral hygiene, swallowing, mastication, and speech. 1

Assessment and Diagnosis

When a patient presents with tongue bite during full mouth rehabilitation, consider:

• Inspect the oral mucosa daily for injuries and abnormalities 2
• Evaluate occlusion and bite relationship, particularly in deep bite cases which may increase risk of tongue injury 3
• Assess for contributing factors:
  • Ill-fitting prostheses or sharp edges 2
  • Vertical dimension issues 3
  • Macroglossia (enlarged tongue) 4
  • Parafunctional habits

Management Strategies

Immediate Management

1. Protective Devices:

   • Implement a removable tongue restraint device that prevents repetitive tongue biting while allowing for oral hygiene, swallowing, and speech 1
   • Consider protective gels like Gengigel or Gelclair to form a protective barrier over injured areas 2

2. Pain Management:

   • Apply non-alcoholic analgesic rinses such as Difflam Oral Rinse (benzydamine hydrochloride 0.15%) before eating or brushing teeth 2
   • Use topical anesthetics for temporary pain relief 2
   • Consider systemic analgesics (NSAIDs) for pain control if needed 2

3. Prevent Secondary Infection:

   • Use chlorhexidine gluconate 0.2% rinse to prevent secondary infection and promote healing 2
   • Maintain good oral hygiene with a soft toothbrush 2

Addressing Underlying Causes

1. Occlusal Adjustments:

   • For deep bite cases, consider increasing vertical dimension to resolve problems associated with tongue biting 3
   • Evaluate the need for provisional restorations at increased occlusal vertical dimension (OVD) for 3 months to assess patient adaptation 3

2. Prosthetic Considerations:

   • Ensure proper fit of prostheses to eliminate sharp edges or improper contours 2
   • For denture wearers, remove dentures at night to allow tissues to recover 2
   • Clean dentures thoroughly daily and consider denture adhesives to improve fit 2

3. Surgical Interventions (for severe cases):

   • In cases of macroglossia contributing to tongue biting, partial glossectomy may be considered 4
   • Anterior maxillary osteotomy may be necessary in severe deep-bite cases to provide proper anterior-posterior and vertical relationships 5

Behavioral Modifications

1. Postural Training:

   • Implement the chin-down maneuver for patients with premature spillage and tongue positioning issues 6
   • Consider expiratory muscle strength training (EMST) to improve motor control 6

2. Dietary Modifications:

   • Avoid hot, spicy, hard, or sharp foods that may further irritate injured tissues 2
   • Stay hydrated to keep oral tissues moist 2

Follow-up and Monitoring

• Monitor healing progress and reassess occlusion regularly
• Schedule follow-up appointments every 3-6 months for persistent cases 2
• Evaluate the need for adjustments to prostheses or occlusal scheme
• If tongue bite persists beyond 2 weeks despite interventions, consider further evaluation for underlying conditions 2

Prevention

• Maintain good oral hygiene with a soft toothbrush 2
• Apply medicated lip balm regularly 2
• Stay hydrated to keep oral tissues moist 2
• Inspect oral mucosa daily for abnormalities 2
• For denture wearers, ensure proper fit and regular cleaning 2

By implementing these comprehensive management strategies, tongue bite in full mouth rehabilitation can be effectively addressed, promoting proper healing while maintaining function and comfort for the patient.