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Intra-oral injuries recorded in physically abused children

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.


Comparative studies

  • One study examining 105 children aged less than 3 years within 24 hours of intubation demonstrated one broken tooth secondary to intubation, one hard palate injury secondary to foreign body insertion, and 8/14 abused children with oral injuries
  • 6 children sustained lip injuries including swelling, petechiae, bruising or lacerations
  • 3 included injury to the tongue, with erythema, laceration and a bite mark
  • 3 had torn frena
  • All of the above children had coexistent injuries including fractures, intracranial injury, burns, bruises, bites or eye injuries

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  1. 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]

Non-comparative studies

Details of injuries found (where enumerated) include:

  • The commonest recorded injury was laceration or bruising to the lip 1-14
  • The remaining injuries included: 1-14
    • Mucosal lacerations
    • Dental trauma (including fractures, intrusion and forced extraction)
    • Tongue injuries including an adult bite
    • Gingival lesions
  • No characteristics of these lesions were specific to an abusive aetiology


Lingual frenum laceration:

  • 3 month old twins with oral bleeding and lacerated lingual frena as a consequence of forceful insertion of fingers into mouth 3
  • Co-existent fractures and faltering growth in both twins 3
  • First recording of abusive oral injuries in multiple births 3


Two bizarre case reports of unusual injuries to the mouth include:

  • An adult biting the tongue of a 10 month old infant, associated injuries included multiple fractures, bruises, lacerations and an intracranial injury 5
  • The parents extracting their own children’s teeth, including their permanent dentition, as a form of punishment 2


A further case report of an unusual injury to the mouth:


  • Dummy obstructing airway, forced removal by parents causing laceration of soft palate and pneumothorax 15


Presentation with oral bleeding:


  • In four studies oral bleeding was a presenting symptom 3,6,11,12

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  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. Carrotte PV. An unusual case of child abuse. British Dental Journal. 1990;168(11):444-445 [Pubmed]
  3. Dhanani RM, Nield LS, Ogershok PR. Traumatized twins: a case report and discussion of the maltreatment of multiples. Clinical Pediatrics. 2006;45(2):173-176 [Pubmed citation only]
  4. Grace A, Grace S. Child abuse within the ear, nose and throat. Journal of Otolaryngology. 1987;16(2):108-111 [Pubmed]
  5. Lee LY, Ilan J, Mulvey T. Human biting of children and oral manifestations of abuse. A case report and literature review. Journal of Dentistry for Children. 2002;69(1):92-95 [Pubmed]
  6. Manning SC, Casselbrant M, Lammers D. Otolaryngologic manifestations of child abuse. International Journal of Pediatric Otorhinolaryngology. 1990;20(1):7-16 [Pubmed]
  7. Naidoo S. A profile of the oro-facial injuries in child physical abuse at a children's hospital. Child Abuse and Neglect. 2000;24(4):521-534 [Pubmed]
  8. Piatt JH Jr, Steinberg M. Isolated spinal cord injury as a presentation of child abuse. Pediatrics. 1995;96(4):780-782 [Pubmed]
  9. Schuman NJ, Hamilton RL. Discovery of child abuse with associated dental fracture in a hospital-affiliated clinic: report of a case with a four-year follow up. Special Care in Dentistry. 1982;2(6):250-251 [Pubmed citation only]
  10. Sobel RS, Kerns DL. A case of child abuse. In: Sanger RG, Bross DC, eds. Clinical management of child abuse. Chicago: Quintessence, 1983:159–64
  11. Stricker T, Lips U, Sennhauser, FH. Oral bleeding: child abuse alert. Journal of Paediatrics and Child Health. 2002;38(5):528-529 [Pubmed]
  12. Swann A, Glasgow J. Child abuse - we must increase our level of suspicion. Ulster Medical Journal. 1982;51(2):115-120 [Pubmed citation only]
  13. Symons A, Rowe P, Romaniuk K. Dental aspects of child abuse: review and case reports. Australian Dental Journal. 1987;32(1):42-47 [Pubmed citation only]
  14. Tate RJ. Facial injuries associated with the battered child syndrome. British Journal of Oral Surgery. 1971;9(1):41-45 [Pubmed citation only]
  15. Barrett TG, Debelle GD. Near-fatal aspiration of a child's dummy: design fault or deliberate injury? Journal of Accident & Emergency Medicine. 1995;12(2):154-155 [Pubmed]


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