Frenectomy

What is a Frenectomy?

A frenectomy is simply the removal of a frenum in the mouth.  A frenum is a muscular attachment between two tissues.  There are two frena (the plural form of frenum) in the mouth that can sometimes obstruct normal function and are candidates for frenectomies.  These frena are called the lingual frenum, which connects the tongue to the floor of the mouth, and the maxillary labial frenum, which connects the inside of your upper lip to your gums just above your upper two front teeth.

Lingual Frenum and Frenectomy

The lingual frenum connects the tongue to the floor of the mouth.  Sometimes, the lingual frenum can run all the way to the tip of the tongue, causing a person to be “tongue-tied.”  This is shown in the photo below:

Lingual Frenum (Courtesy of Enigma51 on Wikimedia Commons)

Note the prominent lingual frenum below the

tongue that causes this person to be tongue-tied.

A restrictive lingual frenum is a common occurrence in young children.  Normally, children are able to accommodate well to a prominent lingual frenum and can surprisingly eat and speak normally.  If the attachment is extends all the way to the tip of the tongue, then a frenectomy may be the only choice to give the child normal tongue function.

A lingual frenectomy is a simple procedure and involves numbing the tongue with an anesthetic.  A small incision is then made which will free the tongue from the floor of the mouth.  The incision then will be sewn up to allow the tissue to heal.

Maxillary Labial Frenum and Frenectomy

The maxillary labial frenum attaches the upper lip to the gums just above the upper two front teeth.  If you move your tongue up between your upper lip and your teeth, you will feel this thin band of muscle.

Maxillary Labial Frenum Courtesy of Dale Rosenbach on WikipediaA Prominent Maxillary Labial Frenum

A prominent maxillary labial frenum can cause a large gap to occur between the upper two front teeth.  This can be a concern for parents.  However, unless the frenum is causing a lot of pain on the upper lips and gums, immediate treatment is not necessary.  Treatment should be delayed until the upper permanent teeth have come in.  Many times, the replacement of the baby teeth with permanent teeth will naturally close the gap between the two front teeth.  If the gap doesn’t close, then it can be treated using braces, as is shown in the above photo.

If the teeth begin to drift apart again after braces have moved them together, then a maxillary labial frenectomy can be considered if it is determined to be the cause of the gap.  A maxillary labial frenectomy should not be attempted before the gap is closed, because scar tissue can form making it impossible to get rid of the space between the upper two front teeth.

Here is a photo of how a maxillary labial frenectomy looks on the patient that is pictured above:

Maxillary Labial Frenectomy.  Photo Courtesy of Dale Rosenbach. This maxillary labial frenectomy was performed after the two front teeth had been brought together using braces.

Treatment & Timing

It is generally recommended only getting a frenectomy when the frenum is obviously causing pain or impeding normal function.

A lingual frenectomy should be considered if a child is having trouble eating, swallowing, or speaking.

A maxillary labial frenectomy should be considered during the “baby teeth years” only if it is causing the child pain.  If the maxillary labial frenum is causing a gap between the upper two front teeth, then a frenectomy should be considered only AFTER closing the gap with braces.  If a maxillary labial frenectomy is performed before the upper two front teeth are moved together, then the subsequent scar tissue could make it impossible to move the upper two front teeth together, leaving the child with a permanent gap between their two front teeth.