What is a Frenum?
A frenum is a fold of skin or a mucous membrane passing from a more fixed to a movable part, serving to limit or control the movement of an organ or body part. Oral frena connect the tongue to the floor of the mouth and the lips to gums.
When these connections are too tight, short, or thick it can cause what is commonly referred to as a lip and/or tongue tie, as proper movement is restricted and, oftentimes, functionality is compromised.
Exam Tip: Sit on the floor with babies head in your lap. Place your index finger under the tongue and sweep it across the floor of the mouth from one side to the other. A small “speed bump” is generally not a problem. However, if you feel a “wall”, there is most likely a tie.
What are some Long Term Effects of a Lip/Tongue Tie?
The lips and tongue have a number of important roles to play within the mouth. As a child grows their tongue helps shape/form their mouth and palate. It helps cleanse the mouth of any food and is also (as most of you know) an integral part of speech. When the tongue is restricted to the floor of the mouth and unable to rest at the top of the mouth, as it normally would, the palate and jaw can’t form properly.
This can have a negative effect on airway causing mouth breathing and snoring. It can also cause speech development and articulation issues. A restricted tongue can make it difficult and sometimes painful to move food around the mouth or cleanse the mouth after eating which commonly creates “picky eaters” and/or food aversions.
Ties can make it painful to brush or floss leading to poor oral hygiene and cavities and a thick labial frenum can cause a persistent gap between the two front teeth making the need for braces more likely.
A surgical release, or frenectomy, is the treatment of choice for lip and tongue ties. During a frenectomy the excess tissue is removed so that the lip and tongue are allowed more mobility and function.
A laser frenectomy poses many advantages over the traditional cut-and-suture procedure, such as:
- complete removal of tissue
- minimal bleeding and swelling
- shortened healing time
- little discomfort
- unlikely need for sutures
- a quick procedure, typically only a few seconds
A frenectomy is typically a simple procedure that takes little time and, when performed by an experienced provider, has a high success rate.
When Is a Frenectomy Necessary?
A frenectomy is only necessary when functionality is compromised. For example, there is a problem with suction while breastfeeding, articulation issues are beginning to develop, snoring, mouth breathing or other signs of airway obstruction are apparent, etc.
It is impossible to tell how a tie is going to affect a child long term. Some children with ties and have no problems at all, while others, struggle at every turn. It’s different from child to child, person to person. We recommend an infant frenectomy for babies who are tied and struggling to breastfeed. If there are no issues with feeding then we like to wait and monitor the child as they develop. This helps to ensure procedures aren’t performed unnecessarily.
The Importance of Overall Health
Choosing to get a frenectomy depends on individual circumstances. For younger children, waiting for the arrival of permanent teeth before considering how a troublesome frenum reacts, might be the best option. Others may benefit from the completion of orthodontic work before deciding to go through with the procedure.