Citation

Reading R. Child Care Health Dev. 2007; 33(5): 650-651.

Copyright

(Copyright © 2007, John Wiley and Sons)

DOI

10.1111/j.1365-2214.2007.00778_6.x

PMID

17725794

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. Standardized critical appraisal and data extraction were performed. Studies were ranked by study design and confirmation of abuse. Results Nineteen 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 5 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.

See also Arch. Dis. Child. 2007; 92(12) -- Duplicate publication?

Language: en