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Prevent Tongue Trauma

Children can get their tongues caught in the small openings of metal water bottles, causing serious health consequences.

Causes of Tongue Trauma
FIGURE 1. Children have entrapped their tongues in the small openings of metal water bottles, causing traumatic injuries.

Drinking water throughout the day is often promoted as a healthy habit, and Americans are listening—annual sales of bottled water exceed $12 billion.1 With growing concerns over the environmental impact of single-serve water bottles, the sale of reusable water bottles has grown to $1.5 billion annually in the United States.1 This increase in the use of reusable water bottles may be related to the advent of elementary school-aged children presenting with tongue trauma in hospital emergency departments. The trauma occurs when children get their tongues stuck inside metal water bottles, which typically have small openings (Figure 1).2–6

Within the past 2 years, at least four children, ranging in age from 6 to 11, have been treated in emergency departments with this type of tongue trauma.2–6 In two of the cases, the children were drinking from metal water bottles during recreational sports activities. In the other instances, the children were using the water bottles during meals. In all four cases, the children reported placing their tongues into the opening of the metal water bottle, at which point their tongues became entrapped. The children had to undergo immediate surgery to prevent possible asphyxiation from the tongue blocking the airway and loss of tongue function.2–6

Tongue entrapment within objects is not common.4 Thus, emergency medical personnel do not have established protocols for treating this life-endangering occurrence.2 Currently, the incidence of tongue trauma in metal water bottles is unknown, and research has yet to be conducted on why this injury has begun to occur.

Parents may be purchasing more metal water bottles due to concerns about the hormone-disrupting chemical bisphenol-A (BPA), which is found in plastic, including plastic water bottles.7 Many aluminum water bottles, however, are lined with an epoxy resin, which can contain five times more BPA than plastic bottles.7 Research assessing amounts of BPA released in different water bottles marketed as BPA-free found no BPA water contamination when they were used according to manufacturer instructions.7 Metal water bottles made with uncoated stainless steel or aluminum lined with a chemically inert liner were also found to have no BPA contamination.7 The popularity of metal water bottles may also be due to the fact they are 100% recyclable, lightweight, and keep beverages warm or cold for long periods of time.6

Example of Tongue Trauma
FIGURE 2. After the metal water bottle is removed, the tongue remains stuck in the thick “O” ring located within the bottleneck. This constriction of the tongue causes it to swell, which can lead to asphyxiation.


Many parents/caregivers and children are unaware of the tongue entrapment danger posed by metal water bottles.1–5 Made from either aluminum or stainless steel, metal water bottles have ridges in the neck, which enable the lid to be screwed on.

Tongue entrapment in young children can occur when the tongue is protruded inside a metal water bottle to retrieve the last few drops of water or from playing with the bottle by sticking the tongue inside.2–6 The tongue expands after it passes through the neck of the bottle, and when the child attempts to pull his or her tongue out, air is sucked in and a vacuum-like seal further confines the tongue inside the bottle.2–6 The tongue can also become lacerated on the tiny grooves inside the neck of the bottle.2,8 Addressing this trauma without causing emotional and physical stress to young patients presents a tremendous challenge for clinicians.

Removing the tongue from the metal water bottle is difficult because the bottle is constructed from a thick metal that cannot be easily broken. Treatment often involves admitting the patient to the intensive care unit so oxygen can be administered and a feeding tube can be inserted.4 Medical professionals may need to sedate the patient before cutting through the metal to release the tongue. Once the base of the metal water bottle is removed, a thick “O” ring is still attached to the tongue, which can cause asphyxiation (Figure 2). Heavy orthopedic pin cutters must be used to cut the ring off (Figure 3). This procedure must be performed with caution in order to avoid permanently damaging the lateral, ventral, and dorsal aspects of the tongue.3,4

In a recent case involving a 6-year-old who presented with metal water bottle tongue entrapment, medical professionals were unable to remove the bottle quickly, which resulted in severe edema of the tongue.4 Due to the risk of airway obstruction, the child was sedated and intubated. Nasotracheal intubation was required for several hours because the bottle was obstructing the oral cavity.3

Tongue Trauma Injury
FIGURE 3. To release the tongue, both the base of the metal water bottle and the ring that is found around its rim must be cut off without inflicting further injury to the patient.


The tongue plays a predominant role in the sense of taste, serving as the location for many types of papillae (taste buds).9 In ­addition to papillae, the tongue is home to veins, arteries, and nerves. Deep lingual veins and lingual arteries are found on the ventral surface, while the lingual nerve travels along the lateral surface of the tongue, and the hypoglossal nerve travels along the ventral surface.

The tongue is responsible for communication and digestion; without it, swallowing and speaking would be impossible. These actions are performed with the help of seven intrinsic and extrinsic muscles. The intrinsic muscles include the superior and inferior longitudinal muscles, transverse muscle, and vertical muscle, which help the tongue change shape.9 The extrinsic muscles include the genioglossus, styloglossus, and hypoglossus, which are responsible for depression and retraction. When entrapped in a metal water bottle, the muscles of the tongue become stretched and overworked from trying to free the tongue. The nerves also run the risk of being pinched in the rigid bottleneck.3 Because of the intricate musculature of the tongue, entrapment can lead to complete loss of function.2–7,9


Dental hygienists can play an important role in educating both adults and children on the dangers of tongue entrapment with metal water bottles. Clinicians can advise children and their parents/caregivers to choose a metal water bottle that is age appropriate. Some come with built-in BPA-free straws, and children should be advised to drink using the straw rather than removing the lid. Metal water bottles with wide bottle necks, which decrease the risk of the entrapment, can be purchased.2,3 Sippy-cup-like lids are also available that screw into the tops of these bottles.4 Reusable glass water bottles with protective coatings to prevent shattering are available with wide openings and/or built-in straws.10 BPA-free plastic water bottles are another option.8

When treating a patient with tongue entrapment, clinicians need to contact emergency medical help immediately. Reassuring the patient and helping him or her to remain calm is vital to preventing asphyxiation. With dental hygienists keenly aware of the risk of tongue entrapment in metal water bottles, they are well positioned to educate their patients and prevent this serious injury.


  1. Ng S. Newell Rubbermaid to buy maker of reusable water bottles. Wall Street Journal. July 21, 2014.
  2. Gorman A. Potential dangers lurk in water bottles. Available at: Accessed January 14, 2015.
  3. Guha SJ, Catz ND. Lingual ischemia following tongue entrapment in a glass bottle. Emerg Med J. 1997;15:637–638.
  4. Shah G, Sciarrino J, Barth P, Cook S, O’Reilly R. Tongue entrapment in aluminum waterbottle: discussion of removal and airway management. Int J Pediatr Otorhinolaryngol. 2012;76:757–760.
  5. Whited CW, Rocke DJ, Lee WT. Tongue entrapment in metal drinking bottle. Arch Otolaryngol Head Neck Surg. 2011;137:625–627.
  6. Fernandes VT, Ng E, Campisi P. Metal water bottle causing tongue entrapment in a child. CMAJ. 2014;186:1091.
  7. Cooper JE, Kendig EL, Belcher SM. Assessment of bisphenol A released from reusable plastic, aluminum, and stainless steel water bottles. Chemosphere. 2011;85:943–947.
  8. Because Water. Plastic, Stainless Steel, Aluminum or Glass Water Bottle? Available at: Accessed January 14, 2015.
  9. Fehrenbach MJ, Herring SW. Illustrated Anatomy of the Head and Neck. 4th Ed. St. Louis: Elsevier Saunders; 2012:104–106.
  10. Strom S. Wary of plastic and waste, some consumers turn to glass. New York Times. June 20, 2012.

From Dimensions of Dental Hygiene. February 2015;13(2):24–26.


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