What is the first‑line treatment for a mild tongue bite (superficial ulcer or small laceration without active bleeding)?

Treatment of Mild Tongue Bite

For a mild tongue bite with a superficial ulcer or small laceration without active bleeding, conservative management without suturing is the recommended first-line approach, focusing on oral hygiene, pain control, and monitoring for infection. 1, 2, 3

Immediate Wound Care

• Rinse the mouth thoroughly with warm saline or clean water immediately after injury to remove debris and reduce bacterial load. 1
• Clean the mouth daily with warm saline mouthwashes (can use an oral sponge for comfort if needed). 1
• No suturing is required for superficial tongue bites or lacerations less than 2 cm that do not gape at rest and do not involve through-and-through injury. 2, 3

Pain Management

• Use topical anesthetic mouthwashes (viscous lidocaine 2%) before meals to reduce discomfort during eating. 1
• Apply benzydamine hydrochloride rinse or spray every 3 hours, particularly before eating, to reduce inflammation and pain. 1
• Consider oral analgesics such as acetaminophen or NSAIDs for systemic pain relief if needed. 4

Oral Hygiene and Antiseptic Measures

• Use antiseptic oral rinses twice daily (0.2% chlorhexidine digluconate or 1.5% hydrogen peroxide) to prevent secondary infection. 1
• Apply white soft paraffin ointment to the lips every 2 hours to prevent drying and cracking. 1

Supportive Measures

• Avoid foods that exacerbate oral pain: eliminate tomatoes, citrus fruits, hot drinks, and spicy, hot, raw, or crusty foods. 4
• Drink ample fluids to keep the mouth moist and promote healing. 4
• Use mucoprotectant mouthwashes (e.g., Gelclair) three times daily if significant discomfort persists. 1

Expected Healing Timeline

• Most superficial tongue lacerations heal within 6–7 days with conservative management, with excellent functional outcomes and minimal scarring. 2, 3
• The tongue has excellent blood supply and heals remarkably well without intervention in the majority of cases. 2

When to Escalate Care

• Any tongue ulcer persisting beyond 2 weeks despite appropriate treatment warrants biopsy to rule out malignancy or other serious pathology. 5, 1
• Consider suturing only if the laceration is >2 cm, involves gaping wound edges at rest, is through-and-through, or involves the tongue tip. 3
• Monitor for signs of infection (increased redness, swelling, purulent drainage, fever, worsening pain) and escalate to systemic antibiotics if these develop. 4

Antibiotic Considerations

• Antibiotics are not routinely required for simple tongue lacerations in otherwise healthy individuals, as the infection risk is very low. 2
• The oral cavity's rich vascularity and saliva's antimicrobial properties provide natural protection against infection. 2

Critical Pitfalls to Avoid

• Do not suture superficial tongue bites unnecessarily—suturing increases recovery time (median 13 days vs. 6.2 days) and complication rates (25% vs. 3.3%) compared to conservative management. 3
• Do not use antiseptic solutions like povidone-iodine for wound irrigation; water or saline is superior. 6
• Do not delay evaluation if the ulcer fails to show improvement within 1–2 weeks, as this may indicate an underlying condition requiring further investigation. 5, 1