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Diagnosing abuse: a systematic review of torn frenum and other intra-oral injuries
  1. Sabine Maguire1,
  2. Bruce Hunter2,
  3. Lindsay Hunter2,
  4. Jo Richard Sibert1,
  5. Mala Mann3,
  6. Alison Mary Kemp1
  1. 1
    Department of Child Health, Cardiff University, Cardiff, UK
  2. 2
    Dental School, University of Wales Hospital, Cardiff University, Cardiff, UK
  3. 3
    Support Unit for Research Evidence, Cardiff University, Cardiff, UK
  1. Sabine Maguire, Department of Child Health, Cardiff University, Cardiff, UK; sabinemaguire{at}yahoo.co.uk

Abstract

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.

  • abuse
  • frenum
  • intra-oral injury
  • torn labial frenum
  • systematic review

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Footnotes

  • Competing interests: None.

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    BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health