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Diagnosing abuse: A systematic review of torn frenum and intra-oral injuries
  1. sabine A Maguire (sabinemaguire{at}yahoo.co.uk)
  1. Cardiff University, United Kingdom
    1. Bruce Hunter (bruce.hunter{at}cardiffandvale.wales.nhs.uk)
    1. Dental School, Cardiff University, United Kingdom
      1. Lindsay M Hunter (hunterml{at}cardiffandvale.wales.nhs.uk)
      1. Dental School, Cardiff University, United Kingdom
        1. Jonathan Sibert (sibert{at}cardiff.ac.uk)
        1. Cardiff University, United Kingdom
          1. Mala K Mann (mannmk{at}cardiff.ac.uk)
          1. Cardiff University, United Kingdom
            1. Alison M Kemp (wchamk{at}groupwise.cf.ac.uk)
            1. Cardiff University, United Kingdom

              Abstract

              Objective: A torn labial frenum is widely regarded as “pathognomonic” of abuse.We systematically reviewed the evidence for this, and to define other intra-oral injuries found in physical abuse.

              Methods: An all language literature search of primary studies, conference abstracts and references from 1950 to June 2006. Each study underwent independent reviews by two of 31 reviewers, drawn from paediatrics and paediatric or forensic dentistry. Standardised critical appraisal, and data extraction was performed. Studies were ranked by study design, and confirmation of abuse.

              Results: 19 of 154 studies reviewed were included, representing 591 children. There were no comparative studies of accidental and abusive torn labial frenum to enable a probability of abuse to be determined. Nine studies documented abusive torn labial frena in 27 children, 22 were less than five years old and 24 fatally abused. Only a direct blow to the face was substantiated as a mechanism of injury. 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.

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

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