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Implications for practice

An injury must never be interpreted in isolation and must always be assessed in the context of medical and social history, developmental stage, explanation given, full clinical examination and relevant investigations. Any unexplained injury that causes concern in a child should be investigated as appropriate


  • Any unexplained torn labial frenum should be fully investigated to exclude the presence of other occult injuries
  • There is inadequate evidence to support the view that torn labial frenum is pathognomonic of child abuse, if after a full investigation no occult injuries or social concerns are present in addition to the torn frenum
  • Where age is given, the majority of children are less than five years old
  • The limited comparative data means that a probability of abuse for torn labial frenum cannot be estimated
  • An accidental torn frenum should be a memorable injury for parents, as there is likely to be considerable bloody saliva from the child’s mouth following the injury
  • Accidental causes of torn frenum include falls or an accidental blow to the mouth


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