|  | |  | | | | Frenectomy
A frenum is a fold of tissue or muscle that connects the lips, cheek or tongue to the jawbone. A frenectomy is a procedure to remove one of these folds of tissue.
Some people have a large frenum under the tongue that prevents the tongue from moving freely and can interfere with speech. The condition of limited tongue mobility is called tongue tie or ankyloglossia. A lingual frenectomy removes this fold of tissue so the tongue can move more freely.
There are several periods during childhood when you may notice symptoms of tongue tie in your child:
- In infants, tongue tie can interfere with feeding, though this is rare.
- When your child begins talking — usually at 12 to 18 months — you may notice that he or she is having problems with speech.
- Some older children or teenagers may notice that the frenum under their tongue becomes stuck between their front teeth, or that they can't stick their tongue out as far as their friends can.
- Your dentist may notice that the frenum is pulling your child's gum tissue away from the lower front teeth, which can cause periodontal problems.
Sometimes a frenum is attached between the two upper front teeth. The procedure to remove this is called a labial frenectomy. This condition usually is noticed in children after their permanent upper front teeth have come in, but it also can be evident earlier, even before the baby teeth come in. If the tissue is attached too far down on the gum, it can create a space between the two front teeth. Even if an orthodontist closes the gap, the frenum can push the teeth apart again. The frenum also can be attached in such a way that it prevents the baby teeth from coming in. In this case, the condition would be noticed sooner.
Adults receiving dentures may need a frenectomy if the position of a frenum (usually one between the cheek and gum in the back of the mouth, or in the middle of the upper or lower lip) will interfere with the denture's fit.
Before recommending a frenectomy for your child, your dentist will consider several factors, including the probability that the condition eventually will fix itself without surgery.
If your child has tongue tie, he or she will receive speech therapy first to see if that can correct the problem. The therapy will involve special exercises to increase the tongue's mobility.
A surgeon can use a scalpel or a laser to remove a frenum. A laser minimizes bleeding, reduces the need for sutures and causes less pain. If a scalpel is used, you usually will need sutures.
People receiving a laser frenectomy must remain completely still during the operation, so younger children may require general anesthesia. In older children and adults, the procedure can be done with local anesthesia, with or without nitrous oxide.
The surgery can be done in as little as 10 to 15 minutes.
A frenectomy can take several weeks to heal completely. You can take over-the-counter nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin and others), for pain relief. Rinsing with salt water helps keep the area clean. Brush and floss carefully around the area. Depending on the type of stitches your dentist uses, you may need to return to the dentist to have your stitches removed or they may dissolve on their own.
If the operation does not solve the problem, it may need to be redone. Redoing a lingual frenectomy is somewhat common. Few labial frenectomies need repeating.
Any surgery carries a risk of bleeding. Because of the many blood vessels in the tongue, lingual frenectomies, as opposed to labial frenectomies, are more likely to result in excessive and prolonged bleeding. However, this complication is quite rare.
In adults receiving a frenectomy in the lower jaw to correct the fit of dentures, there is a risk of bruising the nerve that provides sensation to the lower lip and chin. This will cause numbness in the area that can last at some level for several months. However, your lip will not droop. The nerve does not affect movement, only sensation.
After a frenectomy, contact your dentist if you experience bleeding or if numbness continues after the first 24 hours.
If you are still having problems moving your tongue freely enough a month or more after a lingual frenectomy, contact your dentist. However, you may simply need to wait longer for the area to heal completely.
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