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Oral Injuries

The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.

 

Review last updated in June 2012

Facial and intra-oral trauma has been described in up to 49% of infants and 38% of toddlers who have been physically abused 1,2. A torn labial frenum (often referred to as frenulum or phrenum) is widely believed by paediatricians to be pathognomonic of abuse 3, and has been described as the most common abusive injury to the mouth 4,5. The most recent update has only identified one further study for inclusion, however this is a case series of torn frena deemed to be accidental 6.

 

Evidence to date indicates a child with a torn frenum should undergo a full child protection evaluation 7 but if no other injuries nor any social concerns are identified, the presence of a torn frenum alone is not diagnostic of physical abuse.

 

The review seeks to answer the following review questions:

  1. Is a torn labial frenum diagnostic of physical child abuse?

  2. What other intra-oral injuries are caused by physical abuse to children?

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References

  1. Becker DB, Needleman HL, Kotelchuck M. Child abuse and dentistry: orofacial trauma and its recognition by dentists. Journal of the American Dental Association. 1978;97(1):24-28 [Pubmed]
  2. McMahon P, Grossman W, Gaffney M, Stanitski C. Soft-tissue injury as an indication of child abuse. The Journal of Bone and Joint Surgery (American volume). 1995;77-A(8):1179-1183 [Pubmed]
  3. Jessee SA. Detecting and reporting child maltreatment: dentists’ obligations. General Dentistry. 1994;42(3):218–221 [Pubmed citation only]
  4. Benusis K. Child abuse: what the dentist should know. Northwest Dentistry. 1977;56(6):260–263 [Pubmed citation only]
  5. Laskin DM. Editorial: the battered-child syndrome. Journal of Oral Surgery. 1973;31(12):903 [Pubmed citation only]
  6. Kidd AJ, Beattie TF, Campbell-Hewson G. Frenal injury in children is not pathognomic of non-accidental injury. Emergency Medicine Journal. 2010;27(1):52. [Pubmed]
  7. Thackeray JD. Frena tears and abusive head injury: a cautionary tale. Pediatric Emergency Care. 2007;23(10):735-737 [Pubmed]

 

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