Sir, I read with interest the letter describing an oral and maxillofacial surgery team's child protection referral for a three-month-old baby who presented with an isolated intraoral injury and was subsequently found to have multiple skeletal injuries indicative of severe physical abuse (Non-accidental injury; BDJ 2010; 209: 424). It sounds as if the timely actions of this team saved the little boy's life. The importance of making a timely referral when observing any oral injury in a non-mobile baby is sadly highlighted by three cases reported1 where this did not occur, and all three infants re-presented with severe abusive head trauma.

I write to draw attention to the value of publishing such reports, particularly if your correspondents were to consider taking this further and writing the case up in detail for publication in a peer-reviewed journal. At the present time there is a paucity of large well designed comparative studies of abusive and non-abusive intraoral injuries2,3 so this is a field in which a carefully-written individual case report can still make an important contribution to our knowledge.

Recent systematic reviews, particularly the work of the Welsh Child Protection Review Group,4 have clarified the evidence base for diagnosis and decision making in cases of child maltreatment. However, a systematic review of the literature related to intraoral injuries2 found that potentially relevant studies had to be excluded because of insufficient detail on the certainty of diagnosis that abuse had taken place: whether it was merely 'suspected' (ranked as level 5) or confirmed at case conference, civil or criminal court proceedings or admitted by the perpetrator (level 1).

If authors, assisted by journal referees, were to ensure that this information is included alongside a detailed description of the injuries present, occult and overt, and the mechanism of injury, where known, such case reports will be of greatest value for future reviews.