Frenectomies have been performed in the dental industry over the years to help with dentition and jaw alignment. More recently, they have been recommended for infants to improve sucking abilities in order to enhance their ability to breastfeed and drink from a bottle. There are differing opinions in the dental community on the
necessity of frenectomies and at what age they should be done. When carried out under the right circumstances, a frenectomy can be performed on children and adults to greatly improve oral health. As a dental professional, the key to knowing when one should be recommended is being aware of signs and listening closely to the concerns of patients.
The Purpose of Frenums
Frenums help stabilize the lips and tongue and are essential for talking, eating, and proper bone development. These connective tissues are located underneath the tongue and inside the upper and lower lip, just above and below the gums. The two that cause the most concern are the lingual frenum (tongue) and labial frenum (upper lip). During the developing stages, the frenum tissue can become thicker and tighter than normal. In infants, this can inhibit their ability to suck and eat properly. It not only causes frustration in both the baby and mother, but can lead to malnutrition and other serious conditions, such as bite disorders and speech impediments. The sooner side effects are treated, the greater chance a patient has of proper oral health development.
Early detection can help prevent:
- Lisps and other speech problems
- Sleep apnea
- Impaired breathing
- Jaw misalignment
- Orthodontic issues
- Smile imperfections, such as gaps in the front teeth
- Gum recession
- Oral motor development issues known to cause issues during breastfeeding
Does You Patient Need a Frenectomy?
A frenum that is too tight or too thick can prevent infants from effectively latching onto the breast or bottle nipple, resulting in prolonged periods of eating, infant weight loss, gassiness, as well as sore nipples and low milk supply for the mother. As a parent, it is only natural to want the best for your child, and when you see your baby losing weight and not able to eat, it can be extremely frustrating. Many women view breastfeeding as an opportunity to bond with their baby, and when they are unable to do so, it can also result in feelings of inadequacy. This disorder can be simply diagnosed as a tongue-tie or lip-tie and easily corrected with a frenectomy.
In cases of tongue-tie, also known as ankyloglossia, the tongue has limited range of motion, which can make eating difficult and painful, and cause problems with swallowing. As the child continues to develop, the restricted movement can cause them to overcompensate, resulting in speech issues that are unable to be treated with routine speech therapy. If the child has a v-shaped notch at the tip of the tongue when the tongue is lifted, it may be time to inspect the frenum underneath the tongue.
Other common challenges of a tongue-tie include:
- Trouble moving the tongue side to side
- Inability to touch the roof of the mouth with the tongue
- Inability to stick out the tongue past a certain point
- Jaw pain or clicking jaw
- Low jaw protrusion
- Difficulty licking ice cream and kissing
- Ill-fitting dentures
Patients with abnormal labial frenums (lip ties) often have difficulty closing their lips all the way. In infants, this prevents an adequate seal around the breast or bottle and excess gassiness. In older children, signs of a lip-tie can also include a large gap between the two front teeth and pain when eating. Over time, the restricted frenum can cause gums to start receding away from the upper teeth. Other challenges can include:
- Red and inflamed gums
- Difficulty brushing and flossing
- Increased risk of tooth decay and periodontal disease
Lingual Frenectomy and Labial Frenectomy
The type of frenectomy performed will depend on the patient’s side effects. When the patient has been diagnosed with a tongue-tie, the frenum below the tongue will be clipped during a lingual frenectomy. If a lip-tie is the issue, a labial frenectomy can be performed to release the tension between the upper lip and gums. In some cases, both a lingual and labial frenectomy can be done together to improve oral health.
A frenectomy can be comfortably and quickly performed using laser technology. Protective eyewear will be placed on the patient and a topical gel can be applied to numb the tissue. For older patients with dental anxiety, stronger sedation can be administered for optimal comfort. A soft tissue laser will then be used to sever and seal the tissue simultaneously. Because of this, sutures are not necessary and patients are able to resume normal activities almost immediately. Mothers are encouraged to breastfeed their babies immediately as the milk contains special healing properties. Once the frenum has healed, patients can enjoy improved flexibility and better oral health.
About the Author: Dr. Mickiewicz owns a private practice in Sacramento and lectures across the nation on TMD treatments. He is a diplomate of the American Academy of Pain Management and holds membership in many professional associations for dentistry, sleep medicine, and TMD. In addition, Dr. Mick, as his patients call him, founded Pacific Orofacial Pain Consultants, a team of experts in various disciplines, who tackle the issue of TMD pain and treatment, to help sufferers find relief from chronic pain. To talk with Dr. Mick, call his Sacramento dental office at 916-457-7710.