title: Diagnosing abuse: a systematic review of torn frenum and other intra-oral injuries.
abstract: 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.
authors.affiliation: Department of Child Health, Cardiff University, Cardiff, UK. sabinemaguire@yahoo.co.uk
authors.forename: Sabine
authors.initials: S
authors.lastname: Maguire
authors.forename: Bruce
authors.initials: B
authors.lastname: Hunter
authors.forename: Lindsay
authors.initials: L
authors.lastname: Hunter
authors.forename: Jo Richard
authors.initials: JR
authors.lastname: Sibert
authors.forename: Mala
authors.initials: M
authors.lastname: Mann
authors.forename: Alison Mary
authors.initials: AM
authors.lastname: Kemp
mesh_terms: 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