What is a Frenectomy and When is it Necessary?

A frenectomy is a simple surgical procedure that involves the removal of one or both frena from the mouth. The frenum is a connective tissue membrane that attaches one surface within the mouth to another. The primary frena in the mouth are as follows:

• Lingual frenum – The vertical band of thin tissue that connects the tongue to the bottom of the mouth

• Labial frenum – The connective webbing that attaches the lips to the gum above the top two front teeth and below the bottom two front teeth

• Buccal frena – The thin strands of tissue that connect the gums to the insides of the cheeks

When is a Frenectomy Needed?

In infants, an elongated lingual frenum may make it difficult to nurse or to feed sufficiently from a bottle. A child with this condition is commonly referred to as being “tongue-tied.” If the abnormality is left uncorrected until the patient has reached the toddler years, parents and caregivers may notice that the child affected experiences a more difficult time of speaking than his peers. The condition is not always detected by a pediatrician or general dentist during routine checkups. In fact, it may be first noticed when the child enters pre-kindergarten or elementary school. A child with an elongated frenum may not be able to extend the tongue as would be considered normal. In extreme cases, the child may even experience difficulty and discomfort while swallowing. Fortunately, a typical frenectomy can usually be performed quickly and with minimal pain during the first few weeks of birth.

In the case of an extended maxillary labial frenum, the issue of concern is the potential for orthodontic problems. If the frenum here extends too far down near the gum line, it can interfere with proper growth and spacing of the upper two front teeth. This results in the development of a large gap between these two teeth. Though many parents may worry about this gap from an aesthetic perspective, believing it to signal the need for braces, it is generally recommended that orthodontic procedures be delayed until the child’s permanent teeth have emerged. If, after braces have been placed, the gap remains between two permanent teeth, the labial frenectomy should be considered as a solution to the abnormal spacing. In many cases, the emergence and growth of adult teeth result in a natural closure of the gap caused by the labial frenum’s length.

Performing the Procedure

If it is discovered that you or child are suffering the undesirable side effects of an elongated frenulum, a frenectomy may be recommended as a permanent solution. Your oral surgeon will assess the frenum or frena in question to determine whether or not the procedure is necessary. Generally, unless the existing frenum is causing a problem with feeding, such as breastfeeding in infants and toddlers, or is complicating speech, more natural and noninvasive approaches are considered first. If the surgery is deemed necessary, it is performed in the oral surgeon’s office. The entire procedure typically lasts only 10 to 15 minutes. Recovery is considered complete within a matter of two weeks, during which time the patient often receives pain relief medication to help with soreness at the surgical site. Proper aftercare procedures, including keeping the area clean and avoiding unnecessary movement of the tongue, are explained to the patient prior to leaving the oral surgery center.

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