PT  - JOURNAL ARTICLE
AU  - Sabine Maguire
AU  - Bruce Hunter
AU  - Lindsay Hunter
AU  - Jo Richard Sibert
AU  - Mala Mann
AU  - Alison Mary Kemp
TI  - Diagnosing abuse: a systematic review of torn frenum and other intra-oral injuries
AID  - 10.1136/adc.2006.113001
DP  - 2007 Dec 01
TA  - Archives of Disease in Childhood
PG  - 1113--1117
VI  - 92
IP  - 12
4099  - http://adc.bmj.com/content/92/12/1113.short
4100  - http://adc.bmj.com/content/92/12/1113.full
SO  - Arch Dis Child2007 Dec 01; 92
AB  - 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.