Physical Abuse

Figure 3.
Photo showing a child with possible multiple bitemarks sustained from another child at a day care facility.
Child-on-child attack with possible multiple bitemarks sustained at a day care facility.

Physical abuse may result in numerous types of injuries including contusions, ecchymosis, abrasions, lacerations, fractures, burns, bites, hematomas, retinal hemorrhaging, and dental trauma. Head and orofacial injuries for which dentists should be alert include:

  • Head Injuries8-10
    • Scalp and hair – subdural hematomas (cause more serious injuries and deaths than any other form of abuse), traumatic alopecia, subgaleal hematomas, and bruises behind the ears
    • Eyes – retinal hemorrhage, ptosis, and periorbital bruising
    • Ears – bruising of the auricle and tympanic membrane damage
    • Nose – nasal fractures or an injury resulting in clotted nostrils
Figure 4.
Photo showing facial injuries of a child abuse victim
Facial injuries of child abuse victim. These images represent classic signs of abuse that should be explored, documented and reported to child protective services.
Figure 5A.
Photo showing child abuse homicide victim with facial, oral and peri-oral injuries
Child abuse homicide victim with facial, oral and peri-oral injuries.
Figure 5B.
Photo showing injuries photographed using 425nm blue light narrow band illumination highlighting the extent of the massive bruising the child sustained
Same victim in Figure 5A with injuries photographed using 425nm blue light narrow band illumination highlighting the extent of the massive bruising the child sustained before dying.
  • Orofacial Injuries9,11,12
    • Lips – lacerations, burns, abrasions, or bruising
    • Mouth – labial or lingual frenum tears (characteristic of more severely abused children), burns, ecchymosis or lacerations of the gingiva, tongue, palate, or floor of the mouth
    • Maxilla or mandible – past or present fractures to facial bones, condyles, ramus, or symphysis of mandible. Malocclusion or temporomandibular joint limitations may be a result of this type of injury
Figure 6.
Photo showing burns on the chin and other facial injuries of a child abuse victim
Child abuse homicide victim with burns on the chin and other facial injuries.
Figure 7A.
Photo showing child abuse homicide victim with torn labial frenum
Torn labial frenum on a child abuse homicide victim.
Figure 7B.
Photo showing torn labial frenum on a child abuse homicide victim.
Torn labial frenum on a child abuse homicide victim.
  • Bite marks
    • Many times misdiagnosed as simple childhood bruises but often associated with physical or sexual abuse
    • Typically oval or circular configuration
    • A central area of hemorrhage, may be found between markings of the upper and lower dental arches, suggesting physical or sexual abuse
    • Although marks may occur anywhere on a child’s body, the most common sites are the cheeks, back, sides, arms, buttocks, and genitalia
    • In addition to making a mandated report in a case where bite marks are indicative of abuse, the general dentist should include a recommendation for further evaluation by a forensic pathologist or odontologist in the treatment recommendations and referrals13,14
Figure 8.
Photo showing child-on-child attack at a day care leaving possible pediatric bitemark on victim.
Child-on-child attack at a day care leaving possible pediatric bitemark on victim.
Figure 9.
Photo showing child abuse victim with fracture left arm, facial injuries and a patterned injury on the right shoulder
Child abuse victim with fracture left arm, facial injuries and a patterned injury on the right shoulder. This child survived the attack.