What is the treatment for an intraoral burn?

Treatment of Intraoral Burns

Immediately cool the burn with clean running water for 5-20 minutes, then provide supportive care with pain management, oral hygiene, and monitoring for complications. 1, 2

Immediate First Aid

• Cool the burn immediately with clean running water for 5-20 minutes to limit tissue damage and reduce pain 1, 2, 3
• Begin cooling as soon as possible but no later than 30 minutes after injury for maximum benefit 1
• Avoid using ice or ice water directly on the burn, as this can cause additional tissue damage 1, 2
• For chemical burns (alkaline or acidic substances), rinse the mouth thoroughly with water to remove the causative agent 4, 5

Pain Management

• Administer over-the-counter pain medications such as acetaminophen or NSAIDs for burn pain 2, 6
• Cold liquids (5°C) are more effective than room temperature solutions for reducing mouth burn sensation 7
• Rinsing with cold whole milk or 10% sucrose solutions can provide additional symptomatic relief 7
• Multimodal analgesia should be titrated based on validated pain assessment scales 1

Wound Care and Monitoring

• After cooling, maintain good oral hygiene with gentle cleaning using tap water or isotonic saline 6, 8, 4
• Leave burn blisters intact, as breaking them significantly increases infection risk 1, 6
• For minor intraoral burns, symptomatic treatment with oral care is the primary management strategy 4
• Monitor for signs of infection including increased pain, swelling, or purulent discharge 6, 8

Nutritional Support

• Assess the patient's ability to swallow and maintain adequate nutrition 4, 5
• Patients may need to be NPO initially if dysphagia is severe, with gradual resumption of diet as tolerated 5
• Nutritional management is essential during the healing phase, particularly for extensive burns 4

When to Seek Advanced Medical Care

• Obtain immediate medical evaluation for chemical or electrical burns regardless of apparent severity 3, 5
• Seek urgent assessment if there are signs of airway compromise, difficulty breathing, or extensive oropharyngeal involvement 5
• Consider endoscopy for alkali or acid ingestion to evaluate esophageal and gastric involvement 4, 5
• Otolaryngology or burn unit consultation is warranted for deep burns, extensive mucosal involvement, or burns affecting critical areas like the palate or posterior pharynx 5
• Approximately 12% of pediatric oral burns require intubation, and 18% need surgical intervention 5

Antibiotic Considerations

• Do not use prophylactic antibiotics for uncomplicated intraoral burns 3
• Reserve antibiotics for clinically evident infections with systemic signs 1, 8
• If infection develops, antibacterial therapy such as cefmetazole sodium may be appropriate 4

Common Pitfalls to Avoid

• Do not apply butter, oil, or other home remedies to intraoral burns 6
• Avoid breaking blisters, which dramatically increases infection risk 1, 6
• Do not delay cooling—effectiveness decreases significantly after 30 minutes 1
• Do not use ice directly on burns, as this causes further tissue damage 1, 2
• Avoid prolonged use of silver sulfadiazine on superficial burns, as it may delay healing 6, 8

Special Considerations

• Check tetanus immunization status, as burns are tetanus-prone injuries 3
• For elderly patients or those with cognitive impairment, prevention of re-injury is critical 4
• Chemical burns from household products (particularly hair relaxers and alkaline substances) are common causes of pediatric intraoral burns 5
• Burns that are slow to heal or become infected should be discussed with a burn unit 3