Oral injuries: systematic review

Child Protection Evidence is a resource for clinicians across the UK and internationally to inform clinical practice, child protection procedures and professional and expert opinion in the legal system.


Facial and intra-oral trauma has been described in up to 49% of infants and 38% of toddlers who have been physically abused A torn labial frenum (often referred to as frenulum or phrenum) is widely believed by paediatricians to be pathognomonic of abuse, and has been described as the most common abusive injury to the mouth.

This systematic review evaluates the scientific literature on abusive and non-abusive oral injuries in children published up until June 2014 and reflects the findings of eligible studies. The review aims to answer two clinical questions:

    • Is a torn labial frenum diagnostic of physical child abuse?
    • What other intra-oral injuries are caused by physical abuse to children?

Key findings:

    • Evidence to date indicates a child with a torn frenum should undergo a full child protection evaluation but if no other injuries nor any social concerns are identified, the presence of a torn frenum alone is not diagnostic of physical abuse
    • The update in 2014 identified an important study comparing injuries during intubation to abusive injuries. Further literature recently picked up in our searches highlighted the significance of oral injuries as sentinel injuries for severe abuse, present in 11% of cases, and tribal practices, including removal of the “killer” canine.
Disclaimer: This 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.

Original reviews and content © Cardiff University, funded by NSPCC

Published by RCPCH July 2017

While the format of each review has been revised to fit the style of the College and amalgamated into a comprehensive document, the content remains unchanged until reviewed and new evidence is identified and added to the evidence-base. Updated content will be indicated on individual review pages.

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