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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 2014

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.

Evidence to date indicates a child with a torn frenum should undergo a full child protection evaluation 6 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 update in 2014 identified an important study comparing injuries during intubation to abusive injuries. Further literature recently picked up in our searches highlighted the significance of oral injuries as sentinel injuries for severe abuse, present in 11% of cases 7, and tribal practices, including removal of the “killer” canine 8.

 

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. Thackeray JD. Frena tears and abusive head injury: a cautionary tale. Pediatric Emergency Care. 2007;23(10):735-737 [Pubmed]
  7. Sheets LK, Leach ME, Koszewski IJ, Lessmeier BS, Nugent M, Simpson P. Sentinel injuries in infants evaluated for child physical abuse. Pediatrics. 2013;131(4):701-707. [Pubmed]

  8. Welbury RR, Nunn JH, Gordon PH, Green-Abate C. "Killer" canine removal and its sequelae in Addis Ababa. Quintessence International. 1993;24(5):323-7 [Pubmed]

 

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