Last updated date: 16-Jun-2023
Medically Reviewed By
Dr. Anas Walid Shehada
Originally Written in English
A frenum is a segment of soft tissue that connects the lips and gums. Breastfeeding, swallowing, and speech development might be hampered if the frenum is too short or too tight. A frenectomy is an oral surgical treatment that involves the removal or modification of binding tissue on the body.
What is Frenectomy Procedure?
Frenectomy is the surgical removal of connective tissue (called the frenum) from the top or bottom of the mouth, especially under the tongue or the upper gums. A frenulectomy, also known as a frenectomy or frenotomy, is an outpatient surgical operation in which your frenum is cut or removed. The frenum is the connective tissue membrane that connects one surface of the mouth to the next.
What is a Frenum?
The frenum (also known as the frenulum) is a little piece of tissue that joins your cheeks, tongue, or lips to your gums. Your body has numerous frenums. However, the ones that commonly necessitate frenulectomy are those found inside your mouth.
Types of Frenectomy
1. Labial frenectomy (upper lip):
The frenum connecting the top lip to the upper jaw is most commonly removed in youngsters as their teeth and gums mature. The upper labial frenum problem is usually one of esthetics, however this is not always the case. There are a few frequent difficulties if the frenum is too short or too tight. The ligament tissue can expand toward the two upper front teeth, causing a diastema or gap in the teeth and often complicating orthodontic work to correct the gap.
It can also cause "open mouth posture" by restricting lip mobility and preventing the lips from fully closing. This results in open mouth breathing, which hinders the development of nose breathing and, by extension, normal airway and jaw development in youngsters. It can also result in gum recession.
2. Lingual Frenectomy:
The lingual frenum is the tight tissue beneath the tongue that holds the tongue in place while it is at rest. Most people's tongues are flexible enough to move about and accomplish their roles for speaking and eating. It restricts the tongue too low if it is excessively tight or short.
This is referred described as tongue-tiedness, or ankyloglossia. In young children, holding the tongue excessively low may impede normal jaw growth, resulting in long-term orthodontic difficulties and perhaps airway concerns. Second, it can hinder the tongue from correctly resting on the upper palate during swallowing, instead squeezing it between the teeth and preventing the bite from closing completely over time. Finally, tongue-tiedness is a prevalent cause of lisping or speech difficulties.
3. Labial frenectomy (lower lip):
The lower lip frenectomy is performed for the same reasons as the upper lip frenectomy, namely to prevent periodontal disease and gum recession. However, it is also used in the fitting of dentures in elderly persons. The frenum can pull the dentures loose as the lips move, resulting in an improper fit.
How do I Know if My Child Needs a Frenectomy?
There are various indications that a frenectomy is required. This condition would make nursing, breastfeeding, or bottle feeding difficult in newborns. Because toddlers can't extend their tongue as far as other children can, they may have difficulty speaking. In severe situations, it may make swallowing difficult.
Extended maxillary labial frenum can cause orthodontic issues by interfering with the proper growth and spacing of the upper two front teeth, leaving a gap between them.
Every newborn or toddler who comes in for a consultation will have adequate opportunity to discuss symptoms with the doctor in detail. We want to be certain that the operation is recommended and will benefit the patient. Following a consultation, we advise some patients against undergoing the procedure.
Call our offices if you believe your child may require a frenectomy or if you have any questions about frenectomies.
What Issues Can a Frenectomy Fix?
A frenectomy can help with a number of issues that young children and toddlers can face, such as:
- Breastfeeding issues. A frenectomy can help infants have the correct mouth and tongue position when breastfeeding. This allows the infant to feed easily and painlessly.
- Feeding issues. Children who receive frenectomies often have functional improvements with eating, and often are able to eat faster.
- Breathing/airway issues. When the tongue is constrained, it can adopt a lowered posture, which can affect palate development and lower jaw growth. As a result, the airway becomes smaller and more prone to collapsing during sleep.
- Speech issues. Freeing up the tongue and lips makes speech easier and more natural for children.
How do I prepare?
Your doctor will give you instructions to help you prepare for the surgery. Depending on whether or not anesthesia will be used for the procedure, you may be asked to refrain from eating or drinking for a few hours beforehand. Prescriptions should be filled ahead of time so that they are ready when you return home.
How is a Frenectomy Performed?
The frenum is clipped during the frenectomy to allow it to partially separate from the gum. It is then moved up into the vestibule so that it no longer tugs on the tissue. The frenum may rejoin over time. The frenal tissue is scarred down to prevent reattachment. The treatment itself takes only a few minutes, and patients can resume their usual daily activities right away. This operation is highly delicate, has very little postoperative discomfort, and may be performed in the office with only local anesthesia.
Overall, this fast, minimally invasive technique offers a slew of long-term advantages. Following the labial frenectomy, the patient has a lower risk of recurrence of orthodontic therapy (i.e. braces), a lower risk of recession, and more efficient dental hygiene.
In summary, the pediatric dentist numbs the region and performs an incision to relax the frenum - either to release it from its tight state or to completely remove it. Sutures are only required if the frenum problem is large and severe. Laser surgery is a more contemporary "surgical" approach that causes less tissue damage and less bleeding for enhanced post-operation recovery.
Fortunately, most patients benefit immediately from a successful frenectomy. The actual dental procedure normally just takes a few minutes and is rather straightforward. Despite the fact that it is surgery, the patient is in and out quickly with minimal discomfort in the days following.
What should I Expect During Recovery?
- There may be bleeding from the surgical site. If you notice that the bleeding won’t stop, use a sterile gauze pad and press gently against the surgical site until the bleeding stops.
- You may experience swelling and pain. Your doctor may prescribe pain medicine to help during recovery. Be sure to take any medicine as instructed by your doctor.
- You may be able to resume normal activities in just a few days. The typical recovery time is about a week.
Frenectomy in Adults
Adults who have an over-sized frenulum can experience a number of problems that an elective frenectomy can fix. These common problems include:
If you’re experiencing any of these symptoms below, your issue might not be the often diagnosed condition, temporomandibular joint (TMJ). These symptoms include:
- Soreness in your jaw
- Chronic pain
- Sensation of "clicking" while opening and shutting your mouth
A tight frenulum can cause you to develop different chewing and talking patterns, which can cause pain later on. If you've been diagnosed with TMJ and are currently receiving treatment that isn't working, have your doctor check to see if your frenulum is the source of the problem.
A tight frenulum can make eating difficult. Food is naturally pushed towards your esophagus when chewing, but this requires your tongue to move freely in your mouth. When you have limited tongue mobility, the food you consume does not follow its normal course, leading you to have difficulties swallowing. This can prevent you from eating your favorite meals and perhaps lead to malnutrition. This issue can be resolved by a frenectomy.
When a frenulum issue prevents food from flowing through your mouth as rapidly as it should, it can lead to poor dental health. You can't clean your molars with a sweep of the tip of your tongue between meals, so food particles stay in your mouth and on your teeth for longer. Rinsing your mouth after eating might be beneficial. It is, however, far easier to get your frenulum repaired.
A frenectomy might assist to stop this dental condition if your frenum is pushing at your gums and causing them to retreat.
If you're receiving dentures and your frenum position is interfering with how your dentures fit, you may require a frenectomy. When obtaining braces, you may require a frenectomy in some situations.
You may have learned to talk around your tongue limits as a youngster due to untreated frenulum difficulties. However, these tongue constraints might make it difficult to stay heard and understandable while speaking at greater or lower levels than usual.
Problems with Kissing
If you don't think you're talented enough or like kissing, it might be due to physical limits. It might be difficult to kiss correctly if your frenulum is overly tight.
Difficulties Playing Certain Instruments
If frenulum issues are interfering with your ability to play certain musical instruments, such as the trumpet, where your lips and tongue tip are involved, you may decide to have a frenectomy.
What are the risks and/or side effects?
Your physician will discuss the risks and potential side effects before the procedure. Common risks of a lingual frenectomy include:
- General risks from anesthesia (if used during the procedure)
- Nerve damage to the mouth and tongue
- Reattached frenulum (rare)
Laser frenectomy with CO2 surgical lasers
The soft tissue 10,600 nm CO2 laser, with predictable and repeatable tissue response, fast ablation, and instant hemostasis, can be used to safely and efficiently release frenectomies. The CO2 laser is an excellent choice for frenectomy treatments due to its exceptionally accurate cutting, low collateral damage, and clean and bloodless operating field. In comparison to scalpel incisions, CO2 laser oral surgery has less wound contraction and scarring or fibrosis.
Frenectomies VS. frenotomies: What's the Difference?
Frenectomies and frenotomies are two frequent operations for correcting these defects. Though they are occasionally used interchangeably, their objectives are significantly different. A frenectomy includes fully removing the frenulum, whereas a frenotomy involves snipping and slightly relocating the frenulum.
Both treatments will need an initial consultation during which the dentist or doctor will examine the frenulum to determine the best course of therapy. To numb the area, topical anesthesia is applied to the tissue, and the frenulum is snipped with a scalpel or cauterizing instrument such as a laser.
Unless the frenulum is thicker and tighter, which can result in extra bleeding and delayed healing without stitches, these procedures usually do not require stitching. Some practices have upgraded to using lasers to perform these procedures, which significantly reduces the risk of infection and bleeding.
Orthodontics and Frenectomies
In cases where a short frenum is causing the patient to push the lower jaw out to eat or speak more comfortably, or if you are unable to elevate the tongue, which helps to naturally expand the top jaw and create more orthodontic room, a lingual frenectomy may be performed prior to orthodontic treatment. The removal of the lingual frenum can help to ensure long-term orthodontic success.
A maxillary frenectomy may be indicated before or after the removal of dental braces for patients who have a gap between their front teeth to prevent the teeth from separating again once treatment is done. This will also aid enhance oral hygiene by making brushing by the gumline between the top front two teeth more easier.
What is a tongue-tie?
This disorder, also known as ankyloglossia, limits the range of motion of the tongue. It develops before birth and, because to the excessively thick and short frenum, restricts the tongue's normal activities. Because the lingual frenum is small, it may overburden itself and create these additional dental difficulties.
- Breastfeeding—A tongue knot can cause a low tongue position, making it difficult for the baby to maintain his or her tongue over the lower gum to nurse. Malnutrition results in severe instances.
- Speech difficulty—Tongue-tie causes speech impediment and interfere with your child’s ability to pronounce specific letters like “l,” “t,” “s,” “z,” “d,” and “th.”
- Swallowing—The tongue should rest against the roof of your mouth when you swallow, but a short frenum may not be able to reach that far and cause tongue thrusting.
- Other challenges— Simple things like talking and eating can be made uncomfortable by tongue-tie. At the same time, gaps between teeth and other cosmetic difficulties may interfere with your day-to-day living and general confidence. Thick frena can even make it difficult for parents to assist their children in brushing their teeth without injuring the surrounding soft tissue.
A frenectomy is a straightforward surgical operation in which one or both frena are removed from the mouth. A may help babies, children, and adults with speech, digestive, airway, periodontal (gum), and orthodontic spacing problems, among other things.
Medically Reviewed By
Dr. Anas Walid Shehada