A 4-year-old girl who fell while brushing her teeth sustained a deep oral impalement injury that required surgical removal under intravenous anesthesia, according to a recent case report.
In the report, investigators described what they call a rare but potentially life-threatening injury in young children. They noted that impalement injuries to the oral cavity are common in preschool-aged children as a result of their tendency to fall while holding objects in their mouths, adding that toothbrush injuries are generally uncommon but can lead to severe impalement injuries in children.
The patient presented to the emergency unit at Trishuli Hospital in the Nuwakot District of Nepal after falling to the ground while brushing. She had stable vital signs and no loss of consciousness. Upon examination, the toothbrush handle was protruding from the left side of her mouth without external skin injury. Intraoral evaluation showed that the brush impaled in the left buccal mucosa and that her primary teeth were intact.
The child’s parents had attempted to remove the toothbrush at home but were unsuccessful. Initial attempts at removal under local anesthesia also failed, prompting surgical intervention under intravenous anesthesia. Approximately 5 cm of the toothbrush, including the head and shank, had penetrated the mucosa.
“A blunt dissection was carried out through the entry wound to the head of the toothbrush, which was then retrieved using soft pulling force,” according to lead report author Santosh Dharel, of the Department of Dentistry at Trishuli Hospital, and colleagues.
The toothbrush pierced the masseter muscle and buccal fat pad but spared the facial artery. Following removal, the wound was irrigated and closed with absorbable sutures. Radiographs were performed to rule out retained fragments or fractures. The patient received antibiotics and analgesics for 5 days and her parents were instructed to provide a soft diet and warm saline rinses.
At 24-hour follow-up, swelling was noted but resolved by the fourth day. The investigators said that satisfactory mucosal healing was observed in 10 days and persisted at 1 month postsurgery.
The case report underscored the spectrum of potential complications associated with oral impalement injuries. Common sequelae include fibrosis, abscess formation, and sinus tracts, according to the investigators. They noted that infection occurs in 4% to 8% of penetrating injuries and emphasized the bacterial load associated with used toothbrushes.
“The practice of young children mouthing objects presents a significant, life-threatening risk of impalement injury if they fall,” the report authors wrote, advising that in the event of an injury it may be critical to seek immediate medical care rather than attempting to remove the object.
The authors declared no conflicts of interest.
Source: Clinical Case Reports
Images reproduced from Dharel S, Kumar A, Kattel B, Gautam P, Yogi S, Magar SR. Buccal Space Implantation of a Toothbrush Following Traumatic Fall: A Case Report. Clinical Case Reports. 2026;14:e72002. https://doi.org/10.1002/ccr3.72002. © 2026 The Author(s). Published by John Wiley & Sons Ltd.