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When is an abnormal frenulum a sign of child abuse?
  1. L Chan,
  2. D Hodes
  1. Greenland Road Childrens Centre, 4 Greenland Road, London NW1 0AS, UK

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    A 5 year old child was referred to the child protection team following recurrent presentations to AE with vaginal discharge and concerns of maternal neglect. She was put on the child protection register and placed with her father. At review she was well, but examination revealed a small tag along the lower edge of the frenulum and a gap between her incisors. There were no subsequent concerns, and she was referred to the University Dental Institute. The tagged appearance of the frenulum was thought to have arisen congenitally although traumatic injury could not be excluded. An aunt and uncle also had similar frenula and a diagnosis of a midline diastema of developmental origin was made. She was followed up with a view to orthodontic space closure and frenectomy.

    It is frequently stressed that a torn frenulum may be evidence of physical abuse following a direct blow or forcing objects into the mouth,1 but alternative explanations should not be overlooked. An abnormal frenulum may be associated with midline defects, sinuses, and hypoplastic left heart syndrome.2,3 With concerns of abuse and neglect the cause of an abnormal frenulum can be difficult to diagnose. Dentists may see oral injuries from abuse and neglect such as tooth fractures, lacerations, palatal lesions, fractures, and multiple caries. Their role should not be overlooked4–7 and in this case they helped to differentiate a torn frenulum from a congenital abnormality.

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