How should I treat a small (<5 mm) non‑gaping gingival laceration in a healthy pediatric patient?

Management of Small Gingival Lacerations in Pediatric Patients

For a small (<5 mm) non-gaping gingival laceration in a healthy pediatric patient, no suturing or surgical intervention is required—focus on gentle oral hygiene, soft diet, and chlorhexidine rinses to support healing by secondary intention. 1

Immediate Management

Pain Control

• Apply topical anesthetic if the child is experiencing discomfort, though most small gingival lacerations are minimally painful 2
• For significant pain, consider 2% lidocaine or 4% primacaine for local infiltration 2

Wound Assessment

• Inspect the laceration to confirm it is truly non-gaping and confined to gingival tissue 1
• Ensure no tooth fracture, luxation, or root involvement is present—these would require different management 1
• If any tooth mobility or displacement is noted, immediate dental referral is necessary 1

Home Care Instructions

Oral Hygiene Protocol

• Avoid mechanical cleaning of the injured area for the first week to prevent disruption of healing tissue 1
• Have the child rinse with 0.12% chlorhexidine solution twice daily for 1 minute for at least 3 weeks 1
• After the first week, resume gentle brushing with a soft toothbrush, avoiding direct trauma to the healing laceration 1

Dietary Modifications

• Restrict to soft foods for 10 days 1
• Avoid hot, spicy, acidic (citrus, tomatoes), or crusty foods that could irritate the wound 1
• Ensure adequate fluid intake to keep the mouth moist 1

Lip and Tissue Protection

• Apply white soft paraffin ointment to the lips every 2 hours if the laceration extends to the lip margin 2
• Do not use petroleum-based products chronically, as they promote mucosal dehydration and increase infection risk 1, 2

Monitoring for Complications

Signs Requiring Immediate Dental Referral

• Development of gingival swelling, abscess formation (parulis), or purulent drainage 1
• Increased pain or signs of infection beyond 48-72 hours 1
• Any tooth discoloration (gray appearance) suggesting pulpal necrosis 1
• Persistent bleeding beyond initial injury 1

Follow-up Timeline

• Re-examine at 3-5 days to ensure normal healing progression 1
• Most small gingival lacerations heal completely within 7-10 days with conservative management 1

Critical Pitfalls to Avoid

• Never use alcohol-containing mouthwashes, as they cause additional pain and tissue irritation 1, 2
• Do not initiate dental flossing in the injured area if the child was not previously using it regularly, as this can disrupt the epithelial barrier and cause bleeding 1
• Avoid overly vigorous oral hygiene in the healing area, as this can lead to further gingival trauma and delayed healing 3
• Do not prescribe systemic antibiotics routinely—they are not indicated for simple gingival lacerations in healthy children 1

When Suturing IS Required

Small non-gaping lacerations do not require suturing. However, if reassessment reveals the laceration is actually gaping, involves the vermilion border, or is under tension, then referral for layered closure with precise alignment is necessary 2. For true small gingival lacerations, healing by secondary intention with conservative management is the standard of care 1.