Archives of Disease in Childhood 2007;92:1113-1117
Original articles
Diagnosing abuse: a systematic review of torn frenum and other intra-oral injuries
1 Department of Child Health, Cardiff University, Cardiff, UK
2 Dental School, University of Wales Hospital, Cardiff University, Cardiff, UK
3 Support Unit for Research Evidence, Cardiff University, Cardiff, UK
Sabine Maguire, Department of Child Health, Cardiff University, Cardiff, UK; sabinemaguire{at}yahoo.co.uk
Introduction: A torn labial frenum is widely regarded as pathognomonic of abuse.
Methods: We systematically reviewed the evidence for this, and to define other intra-oral injuries found in physical abuse. Nine studies documented abusive torn labial frena in 30 children and 27 were fatally abused: 22 were less than 5 years old. Only a direct blow to the face was substantiated as a mechanism of injury.
Results: Two studies noted accidentally torn labial frena, both from intubation. Abusive intra-oral injuries were widely distributed to the lips, gums, tongue and palate and included fractures, intrusion and extraction of the dentition, bites and contusions.
Conclusions: Current literature does not support the diagnosis of abuse based on a torn labial frenum in isolation. The intra-oral hard and soft tissue should be examined in all suspected abuse cases, and a dental opinion sought where abnormalities are found.
Keywords: abuse; frenum; intra-oral injury; torn labial frenum; systematic review
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Arch. Dis. Child. 2007 92: e12.
This article has been cited by other articles:
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Spivack, B. S.
(2008). Does a Torn Frenulum Indicate Abuse?. AAP Grand Rounds
19: 32-32
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eLetters:
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- Is a torn frenum diagnostic of child abuse?
- Sandra S Mascarenhas, et al.
- ADC Online, 13 Dec 2007 [Full text]
- Torn labial frenum - always abusive?
- Leena Menon, et al.
- ADC Online, 7 Feb 2008 [Full text]
- Torn labial frenum -pathognomonic in some circumstances?
- ian k mecrow
- ADC Online, 31 Mar 2008 [Full text]
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