A 2-year-old child presented with pharyngeal perforation following a peroral injury with a toothbrush. Direct force applied to an object such as a toothbrush in the mouth may cause either superficial or penetrating injury within the oropharynx. A high index of suspicion is sometimes necessary to identify a pharyngeal perforation and if this is diagnosed we would advocate admission to hospital, restriction of oral intake, intravenous fluids and antibiotics, with close observation to ensure that healing occurs without development of further complications.