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Logo of archdischArchives of Disease in ChildhoodVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Arch Dis Child. 2007 December; 92(12): 1113–1117.
Published online 2007 April 27. doi:  10.1136/adc.2006.113001
PMCID: PMC2066066

Diagnosing abuse: a systematic review of torn frenum and other intra‐oral injuries

Sabine Maguire, Bruce Hunter, Lindsay Hunter, Jo Richard Sibert, Mala Mann, and Alison Mary Kemp, for the Welsh Child Protection Systematic Review Group



A torn labial frenum is widely regarded as pathognomonic of abuse.


We systematically reviewed the evidence for this, and to define other intra‐oral injuries found in physical abuse. Nine studies documented abusive torn labial frena in 30 children and 27 were fatally abused: 22 were less than 5 years old. Only a direct blow to the face was substantiated as a mechanism of injury.


Two studies noted accidentally torn labial frena, both from intubation. Abusive intra‐oral injuries were widely distributed to the lips, gums, tongue and palate and included fractures, intrusion and extraction of the dentition, bites and contusions.


Current literature does not support the diagnosis of abuse based on a torn labial frenum in isolation. The intra‐oral hard and soft tissue should be examined in all suspected abuse cases, and a dental opinion sought where abnormalities are found.

Keywords: abuse, frenum, intra‐oral injury, torn labial frenum, systematic review

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