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Torn labial frenum

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


As part of our oral injuries review, we sought to answer the question: Is a torn labial frenum diagnostic of physical child abuse?


The head is the commonest target organ in physical abuse 1, with 43% of abusive injuries occurring to the face and neck 2. Of these injuries, a torn labial frenum (often inappropriately referred to as frenulum) is frequently described as pathognomonic of child abuse 3, yet since it is a trivial oral injury in dental terms we wish to determine the probability that a torn labial frenum is due to physical abuse. Many mechanisms are proposed, including force feeding, twisting and direct blow 3,4. We wish to establish the evidence base for this assertion.


Following the original review, we are only including new studies from our update searches which relate to abusive torn frena when they feature more than one case. A recent comparative study is a welcome addition to the literature 5.


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  1. 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]
  2. Skinner AE, Castle RL. 78 Battered children: a retrospective study. London: National Society for the Prevention of Cruelty to Children (NSPCC: Battered Child Research Department), 1969
  3. Macintyre DR, Jones GM, Pinckney RC. The role of the dental practitioner in the management of non-accidental injury to children. British Dental Journal. 1986;161;3:108-110 [Pubmed citation only]
  4. Sperber ND. Bite marks, oral and facial injuries: harbingers of severe child abuse? Pediatrician. 1989;16(3-4):207-211 [Pubmed]
  5. Lopez MR, Abd-Allah S, Deming DD, Piantini R, Young-Snodgrass A, Perkin R, Barcega B, Sheridan-Matney C. Oral, jaw, and neck injury in infants and children: From abusive trauma or intubation? Pediatric Emergency Care. 2014;30(5):305-310 [Pubmed]

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   – Overall results
   – Age
   – Gender
   – Influence of ethnicity and socio-economic group

Abusive torn frenum

Accidental torn frenum

Implications for practice

Research implications

Limitations of review findings

Other useful references


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