Begin by examining the child's lips. Are there lacerations or scars from trauma, burns from heated implements, or rope marks in the corners of the mouth from a gag being placed over the mouth?
View the palate, particularly at the junction of the hard and soft palate, for any unexplained petechia or bruises that may be indicative of forced oral sex (fellatio). Contusions in the floor of the mouth also suggest this type of sexual abuse.
Are there fractured or non-vital teeth that appear to be from non-accidental trauma?
Are there bruises on edentulous ridges or severe lacerations of the oral mucosa?
Are any teeth missing or displaced for which there is no obvious explanation?
Is the labial frenum lacerated from forced feeding or from blunt trauma from an instrument or hand? Frenum tears may be common in small children learning to walk and falling frequently. However, this same injury in a child adept at walking or in an infant not yet walking should arouse suspicion of abuse.
Are there burns in the mouth from caustic substances or scalding liquids? This will appear as a white slough from necrotic epithelium. In addition, the child may salivate excessively, drool and have difficulty swallowing.
Do the radiographs exhibit healed or recent fractures?
Are there venereal warts (condyloma acuminatum) present that may indicate sexual abuse? These pedunculated, cauliflower-like warts may be present on the child's lips, palate, gingiva or tongue. Syphilis may present as a mucous patch or a papule which ulcerates to form a chancre, while gonorrhea can appear as pharyngitis, tonsillitis, gingivitis or may even be asymptomatic in the oral cavity. Sexually-transmitted herpes may also be present.
Are HIV-associated lesions present, such as oral candidiasis? These lesions also may indicate sexual abuse.
Does the child's tongue have scars or abnormal mobility from repeated trauma or damage from forcibly biting down?