Table 2.

Clinical Protocols to Diagnose and Manage Children Presenting with Lip Biting Following Dental Local Anesthesia
History Taking	• Take a complete medical and dental history
	• Ask about recent dental visits (within the past 3–5 days), particularly those that involved dental local anesthesia
	• Ask if lower or upper teeth were anesthetized
Clinical Assessment	• Determine if the traumatic lip ulcer is located on the same side of the mouth that was anesthetized
	• Check if the lip ulcer crosses the midline of the lip. Traumatic lip ulcers can present unilaterally or bilaterally, depending on whether the child received a unilateral or bilateral mandibular nerve block and how the child bit his or her lip
	• Examine the patient to identify the presence of additional intraoral ulcers. Traumatic lip ulcers can be accompanied by buccal mucosal (cheek) or tongue ulcers on the same side of mouth
	• Look for the five signs of infection: redness, pain, fever, swelling or edema, and generalized malaise. Redness and localized edema are common findings in traumatic lip ulcers. If the other signs are also present, the lip may be secondarily infected
	• Localized edema should not be confused with a purulent infection
Interventions	• If a diagnosis of lip biting secondary to dental local anesthesia is made, treat the ulcer palliatively with over-the-counter analgesics the patient reports pain. The patient can also be given a prescription for chlorhexidine gluconate (0.12%) that is used daily to gently debride the ulcerated tissue
	• No systemic antibiotics are indicated unless the lip becomes secondarily infected
	• No surgical intervention (e.g., incision and drainage) is indicated
Follow Up	• Reassure the caregiver that treatment of lip biting is limited to palliative care
	• Final healing can take up to several weeks
	• Ask the caregiver to contact the child’s dentist to ensure proper follow up care
	• Educate the caregiver that the child should be closely monitored following future dental appointments that involve dental local anesthesia to prevent soft tissue trauma
	• Contact the child’s dentist to ensure proper information sharing