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lüll Diagnosing abuse: a systematic review of torn frenum and other intra-oral injuries Maguire S; Hunter B; Hunter L; Sibert JR; Mann M; Kemp AMArch Dis Child 2007[Dec]; 92 (12): 1113-7INTRODUCTION: A torn labial frenum is widely regarded as pathognomonic of abuse. METHODS: 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 27 children and 24 [corrected] were fatally abused: 22 were less than 5 years old. Only a direct blow to the face was substantiated as a mechanism of injury. RESULTS: 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. CONCLUSIONS: 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.|Adolescent[MESH]|Child[MESH]|Child Abuse/*diagnosis[MESH]|Child, Preschool[MESH]|Gingiva/injuries[MESH]|Humans[MESH]|Infant[MESH]|Infant, Newborn[MESH]|Labial Frenum/*injuries[MESH]|Lacerations/etiology[MESH]|Lip/injuries[MESH]|Mouth/injuries[MESH]|Palate/injuries[MESH]|Tooth Injuries/etiology[MESH] |