Oral injuries in children presenting to a Japanese pediatric emergency room

Background: Oral injuries are common among children, but studies on oral injury according to the presence of foreign objects in the mouth are limited. The aim of this study was to compare injury patterns and their effects in children presenting to a Japanese pediatric emergency room (ER) with and without foreign objects in the mouth. Methods: Children who were brought to the ER at Tokyo Metropolitan Children's Medical Center with oral injuries between 1 January 2011 and 31 December 2012, were included. Information regarding mechanism of injury, object related to injury, required procedure, and disposition (i.e. placement after ER evaluation: hospitalization or discharge) was collected. Injured subjects with and without foreign objects in the mouth were compared. Results: Three hundred and nineteen subjects were included in analysis. Median age was 26 months. Labial mucosa, tongue, buccal mucosa, and teeth were major locations of injury. Tumble (i.e. fall from standing) was the leading mechanism of injury (50%). Seventy-one subjects (22%) were holding foreign objects in the mouth when injury occurred. A toothbrush was the most common object (31%). Subjects with foreign objects in the mouth were more likely to injure the posterior parts of the mouth, and to require imaging (P=0.04) and hospital admission (P<0.001). This was also the case for children with injury due to tumble. Conclusions: Tumble (i.e. fall from standing) was the most common mechanism of injury. Furthermore, requirement for medical resources increased if children had foreign objects in their mouth. Preventive measures should focus on educating parents about the dangers associated with children moving around while holding objects in the mouth.