Wounds from teeth

Did my baby bite me?

Babies with front teeth occasionally bite while breastfeeding, causing pain and sometimes skin damage. A bite causes sudden and sharp pain, and possibly bleeding and superficial damage on the nipple or areola. They may also cause pressure sores by consistently placing their top front teeth on the same spot on the areola during feeding. Pressure sores are common if bed-sharing and caused by top front teeth, because lower front teeth are generally covered by the tongue during breastfeeding. There is no sudden pain but the area where the top front teeth touch the areola will be tender and a small, red, flaky line may develop. If not stopped, a deep wound can open. Mothers should take steps to prevent both bites and pressure sores. If skin damage is present and not infected, it can be treated with purified lanolin and covered until it heals. If it’s infected, mothers will need antibiotic in the wound or by mouth. 

A) Describing pain and injuries from teeth

There are two breastfeeding problems that can be caused by teeth: bites and pressure sores. The former can be on the nipple or areola and the latter on the areola.

Both can cause pain and skin damage, which can become infected. Mothers should continue to breastfeed unless they are in too much pain.

B) Bites

While babies with teeth occasionally bite with their front teeth, skin damage is not that common.

While a baby can bite both breasts, bites severe enough to cause damage are usually isolated to one side.  

If the baby bites and the skin is broken, there may be blood on the nipple, the baby’s face, or in the baby’s mouth. Damage caused by biting is small, typically 2-5 mm (1/8 to ¼ in), linear in shape, and can occur anywhere on the nipple and central areola, with the nipple sides being the most common location.  

Bites produce a sharp pain. If the nipple is damaged, latching for subsequent feeds will be painful until the damage is healed. The pain can increase if the damage becomes infected.  

Skin damage can also be caused by the baby suddenly pulling away from the breast and scraping the skin with the teeth.

There may be reasons for biting and suddenly pulling off of the breast and this behaviour needs to be addressed and stopped.

Rarely the nipple is injured by a spiked or natal (born with) tooth.

C) Treating bites

1) Intact skin

Gentle bites may leave the skin tender and slightly inflamed but intact. These heal within a few days. 

2) Broken skin

Any non-infected skin damage should be treated with applying purified lanolin to the area and covering it with a non-stick dressing until it returns to normal and watched for signs of infection. Most bite wounds are superficial, do not get infected, and are usually healed within one week. 

D) How teeth pressure causes areolar skin damage

Deep pressure sore on the areola close to the nipple bottom.

1) How teeth pressure causes areolar skin damage

Pressure on the skin will keep blood from entering it. If the skin is not released, it will eventually breakdown because it does not have the nutrients it needs. Skin damage caused by this process is called a pressure sore. Examples of pressure sores are:

  • Bed sores, which develop over bony areas of the body and come from lying in the same position for extended periods.
  • Sores that develop in individuals with decreased feeling in their lower body, such as those with paraplegia or diabetes.

Pressure sores can also be caused by the baby’s top front teeth placed consistently on the same spot on the areola during extended periods of breastfeeding. This is especially common during bed-sharing, where a baby can remain latched as the mother sleeps.

The top front teeth can cause a tender area on the central areola or cause actual damage of the skin. The lower front teeth are covered by the tongue during breastfeeding and do not cause this problem.

Although pain can develop on both breasts, wounds are more commonly limited to one side.   

2) The pattern of skin damage caused by teeth pressure

a) Superficial skin change

Unlike a bite, mothers do not usually notice a sudden sharp pain when a pressure sore develops. Rather they may notice the appearance of a tender, red, line or spot where the top front teeth touch the areola during breastfeeding. This is usually within 1 centimetre (1/2 inch) from the nipple bottom. The skin is intact at this point. Pressure sores cause pain with latching.

b) Progression to a deep wound:

If the pressure is not stopped, this area may progress to a deep wound as follows:

  1. The line becomes flaky and slightly tender.
  2. Within a few days, a small, deep wound (Stage 3) can open.
  3. There may be some discharge from the wound.
  4. It does not heal without proper treatment.
  5. The wound may become infected.

Deep pressure wounds are painful and the pain can increase if the sore is infected.

E) Treating pressure sores caused by teeth

1) Intact skin

Pressure sores may just be tender and the skin remains intact.

In order to prevent further damage and to settle existing areas, mothers need to ensure that the baby’s top front teeth are no longer on this location while breastfeeding. This may require some creative positioning

If this does not help, there may need to be a change in the sleeping arrangements.

Only if positioning changes are not possible, mothers can try keeping the area covered with a safe adhesive dressing, such as Fixomull® stretch, while breastfeeding at night. These should:

  • Not cause skin irritation.
  • Not cause the baby to refuse to breastfeed.
  • Not be a choking risk to the baby.
  • Be removable daily so mothers can see the area and check for signs of healing or damage.

Unless mothers change their nightly breastfeeding routines, such skin damage may recur after treatment.

2) Broken skin

If the skin is damaged, the mother must ensure that the baby’s top front teeth are no longer in contact with the affected area.

If the area is flaky or oozing fluid, it is reasonable to start treatment. If clear damage is present, it must be treated by applying purified lanolin to the area and covering it with a non-stick dressing until it returns to normal.  

The damaged area should be covered until completely healed, which can take up to six weeks.

F) Infection of bites or deep pressure wounds

As with any contact between teeth and skin, infection is possible in both bites and deep pressure wounds (Griego 1995). We have found that infection is much more likely in the latter, possibly because pressure wounds tend to be deeper than bites.

An area of damage may be infected if:

  • It does not heal.
  • It becomes more painful.
  • It produces more liquid.
  • It leaks a thick, creamy liquid (pus) that sticks to your bra.
  • The skin around the damage becomes red, tender, or swollen and may spread beyond the edge of the wound.
  • You develop mastitis.

Infection must be treated with an antibiotic ointment or pill.

The antibiotics must be effective against bacteria found on the skin and against bacteria common in human bites (Stevens 2014). The choice of antibiotic varies among regions and countries. Please discuss this with your health-care providers.

References

Griego RD, Rosen T, Orengo IF, et al. Dog, cat, and human bites: a review. J Am Acad Dermatol. 1995 Dec;33(6):1019-29
 
Stevens DL, Bisno AL, Chambers HF, et al.; Infectious Diseases Society of America. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jul 15;59(2):e10-52