What is the treatment for a self-inflicted tongue bite?

Treatment of Self-Inflicted Tongue Bite

Immediately irrigate the tongue bite wound with copious amounts of water or sterile saline, apply direct pressure if bleeding, and avoid closing the wound if it appears infected. 1, 2

Immediate Wound Care

• Irrigate the wound thoroughly with large volumes of warm or room temperature potable water or sterile normal saline to remove debris and reduce bacterial contamination 1, 2
• Apply direct pressure with clean gauze if actively bleeding 1
• Remove only superficial debris; avoid deep debridement as this may enlarge the wound and impair healing 1
• Do not close infected wounds - allow healing by secondary intention 1, 2
• Clean wounds seen within 8 hours may be approximated with Steri-Strips rather than sutures 1, 2

Wound Dressing and Protection

• Cover the wound with antibiotic ointment or cream and a clean occlusive dressing to promote healing and reduce infection 1
• For recurrent self-biting, consider protective measures such as a soft bite guard or oral appliance to cover the teeth and prevent further trauma 3, 4, 5
• In severe cases with uncontrolled muscular activity, a modified bite raiser that prevents jaw occlusion may be necessary 3

Antibiotic Prophylaxis

Administer prophylactic antibiotics early for all human bite wounds (including self-inflicted bites) regardless of wound appearance: 2

• First-line oral therapy: Amoxicillin-clavulanate 2
• Penicillin-allergic patients: Doxycycline, or fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin) plus metronidazole or clindamycin 2
• Intravenous therapy (for severe infections): Ampicillin-sulbactam or piperacillin-tazobactam 2

Tetanus Prophylaxis

• Verify tetanus immunization status and administer tetanus toxoid (0.5 mL intramuscularly) if outdated or unknown 1, 2, 6
• This is particularly critical as tongue bites represent an unusual but documented portal of entry for tetanus 6

Oral Hygiene and Supportive Care

• Maintain meticulous oral hygiene with gentle brushing using a soft toothbrush after meals and before sleep 1
• Rinse mouth with alcohol-free mouthwash at least four times daily 1
• Avoid painful stimuli including smoking, alcohol, citrus fruits, hot drinks, and spicy or crusty foods 1
• Keep the mouth moist by drinking ample fluids 1
• Apply lip lubrication with sterile petroleum jelly or lip balm (avoid chronic use of petroleum jelly as it promotes dehydration) 1

Pain Management

• Over-the-counter analgesics: Acetaminophen or NSAIDs (ibuprofen) for pain control 1
• Cold application: Ice or cold packs may provide local pain relief (place a barrier such as a thin towel between ice and tissue) 1

Follow-Up and Monitoring

• Follow up within 24 hours by phone or office visit to assess healing 1, 2
• Inspect the oral mucosa daily for signs of infection or worsening 1
• Consider hospitalization if infection progresses despite appropriate therapy 2
• For recurrent self-biting behavior, address underlying causes (seizures, developmental issues, behavioral problems) and consider protective appliances 4, 5

Key Pitfalls to Avoid

• Do not apply ice directly to the wound as this can cause tissue ischemia 1
• Do not place objects in the mouth during active seizures as this may cause further dental or tongue trauma 1
• Do not suture infected wounds or wounds with significant contamination 1, 2
• Do not delay antibiotic prophylaxis - human oral flora contains multiple pathogens including streptococci, staphylococci, and anaerobes that produce β-lactamases 1, 2