Diagnosing abuse: a systematic review of torn frenum and other intra-oral injuries.
BACKGROUND
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 27 children and 24 [corrected] 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.
Maguire
Sabine
S
Department of Child Health, Cardiff University, Cardiff, UK. sabinemaguire@yahoo.co.uk
Hunter
Bruce
B
Hunter
Lindsay
L
Sibert
Jo Richard
JR
Mann
Mala
M
Kemp
Alison Mary
AM
D000293:Adolescent; D002648:Child; D002649:Child Abuse / Q000175:diagnosis*; D002675:Child, Preschool; D005881:Gingiva / Q000293:injuries; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007742:Labial Frenum / Q000293:injuries*; D022125:Lacerations / Q000209:etiology; D008046:Lip / Q000293:injuries; D009055:Mouth / Q000293:injuries; D010159:Palate / Q000293:injuries; D018677:Tooth Injuries / Q000209:etiology