Child Abuse Homicide Case

History: This two-year-old child died after a short life of continuous abuse. One episode involved the removal of his lower anterior teeth either from traumatic avulsion or by use of a tool. After the fatal episode, the child was observed to have multiple injuries in various stages of healing and a torn maxillary frenum (Figures 17‑19). The ultimate question is simple: Was this needless death preventable had the abusive episodes been reported?

Figure 17.
Color image of injuries on the child’s face (A). The same injuries viewed in 425nm monochromatic blue light (B). Note the greater extent of the injuries when viewed in the blue light.
Figure 18.
Note the premature absence of some of the lower primary incisors (A) and the torn maxillary frenum (B).
Figure 19.
Medical kit used to hide the avulsed lower primary incisors (A) and the recovered incisors (B). Attempts to find tool marks using ultraviolet photography on the avulsed teeth were not successful.