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What a Frenectomy is and Why Your Child Might Need One
Lisa, a reader from Idaho recently took her children to the dentist. The dentist remarked that one of her children might need a frenectomy. Unsure of exactly what a frenectomy was, Lisa opted to learn more about the procedure instead of subjecting her child to surgery.
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:
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.
A 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:
This maxillary labial frenectomy was performed after the two front teeth had been brought together using braces.
Conclusion
In conclusion, I would recommend 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.
If you have any questions about frenectomies, please don't hesitate to ask them in the comments.
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Hi, I'm Tom. I'm currently a 4th year dental student in the USA. I started this blog to help people take better care of their teeth. You can 
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I am 30 years old. I just started having bad pain about a week ago. I looked inside my upper lip and see I have what looks like a skin tag on my maxillary labial frenum. The pain has lasted for about a week. I don't see anything to worry about for adults, mostly children. Is this concern, or should I look into having this removed if the pain continues, thanks.
Hi Jennifer - I just had an oral pathology class this semester (took my final on Monday!). The only thing that comes to mind is that it could be what's known as a frenal tag. A frenal tag is just a small outgrowth of tissue that usually occurs on the upper labial frenum. They are normally asymptomatic. They are also rather common -- I have one, I'll try to post a picture at the end of the week when I'm done with finals.
Try pulling your upper lip back and looking in the mirror to see if it looks like there is a tiny growth on your frenum. If there is, then it is most likely a frenal tag, but you'd want to see a dentist to be sure.
As far as it hurting, I have irritated mine in the past and it's been a little painful for a few days. I'm not sure if it was something I ate, or if I just stretched my frenum too far when opening my mouth or something like that. If the pain persists, I would definitely have it checked out.
I hope that helps. Thanks for the comment!
-Tom
I am 34 year male. I have been in braces for 10 months. I had a space between my two upper center teeth. At the beginning of orthodontal treatment the orthodontist closed the gap between my two center upper teeth and wrapped a wire around the two brackets to keep the teeth together. However, after that I have been feeling a constant soreness between those teeth - the two center upper teeth. I asked the orthodontist what she thinks it is and she did not have an explaination for the soreness. So, I have been continually feeling the soreness for 10 months. It feels like something is being squeezed or pinched in between those two teeth. All my teeth feel fine. Do you think it could be an issue with the frenum?
Thanks in advance for you assistance.
Hi Ben, Does it feel like it is right between the two front teeth, or perhaps closer to the tongue side or lip side?
Here is an image of the tongue side of someone's mouth on MedScape: http://img.medscape.com/pi/emed/ckb/clinical_procedures/1048885-1080850-1702.jpg
As you can see, right behind their front teeth on the tongue side there is something called the incisive papilla which looks like it might be slighty irritated in that picture. If you feel with your tongue, does that feel sensitive?
In some of the surgical photos I have seen of frenectomies, they have not only removed part of the frenum on the lip side, but they have gone through behind the teeth to trim down some of that excess tissue that may be continuous with the labial frenum.
My guess is that you have some excess tissue that is not accustomed to having your teeth so close together. Now that your teeth are close together, this tissue is irritated because is is being compacted between your two front teeth. Over time, the tissue may adjust and get smaller and the irritation will go away. If not, you may want to get a consultation with an oral surgeon to truly diagnose the source of your pain and see what they can do to alleviate it.
I hope that helps. Thanks for the comment!
My daughter is 5 y/o and the dentist is recommending a labial frenectomy because she has a gap. I am hesitant because it is surgery and this "problem" doesn't disturb my daughter expect for the cosmetic reason of having a gap between her teeth. Should I still go through with it?
Thanks!
Hi Bonnie - This actually happened to my sister. She took her daughter (I think she was around 8 years old) to the dentist and he recommended a frenectomy. She opted not to because she didn't want to put her daughter through it and the next time she went, the dentist didn't mention anything.
At five years old, I would say to hold off, but then again, I haven't seen your daughter in person. In the book McDonald and Avery's Dentistry for the Child and Adolescent it shows a case of a preschool child who had a frenectomy and then the adult teeth came in perfectly without a gap between them. It also says that "The decision regarding treatment of the labial frenum should be made only after a careful evaluation to determine whether the result will be undesirable if the condition is allowed to remain."
In the book Pediatric Dentistry by Pinkham, (which I referenced when I originally wrote this article) it recommends not performing a frenectomy until the space is closed with orthodontic brackets (braces) so that scar tissue doesn't interfere with the closing of the space.
As you can see, there does seem to be a slight difference of opinion depending on the source. If it were my child, I would hold off on a frenectomy until the permanent teeth had come in. Usually spaces close by themselves once the permanent canines have erupted. If not, there shouldn't be any reason why you couldn't close the space then with braces and then have a frenectomy if it is interfering with the orthodontic work.
I hope that helps. Thanks for your question - it helped me learn a bit more about this from other sources!
My 8-year-old daughter just had this done two months due to gap and large frectum attached between her top teeth to inside her lip (they recommended once her permanent teeth were in) and they look like they are already coming together!!!
I also had this procedure done when I was 8 or 9 years old and my teeth came together beautifully after that and I never had to wear braces. I think most dentists today want to recommend braces because its ALOT of money for them because it is very expensive for patients. BTW - this procedure for my daughter was nothing - laser frectomony - only a 10 minute procedure and she was outside playing that same day!!! This procedure will cost you around $500.00 compared to thousands of dollars for braces.... I say GO for it once permanent teeth come in and you have a better change of not getting braces!! It worked for my mother, it worked for myself and looks like it is working for my 8-year-old!!!!
Hi Dnikas - Thanks for your comment! We've been taught that a frenectomy shouldn't be done until the permanent canine teeth come in because those teeth often push the front four teeth together and close the gap naturally - without braces or a frenectomy.
When I was about 8, I had a gap between my front teeth that I could fit a nickel between (it was about 2 mm wide). A couple of years later after my canine teeth had come in, the gap had closed by itself - without braces! This may not happen to everyone, but I'm more conservative when it comes to surgical procedures like a frenectomy.
Hi Tom,
I have a 9 year old girl. She just finished a 9 month phase of orthodontia which closed the gap between her front teeth. She has all 4 upper permanent incisors and we are waiting for the permanent upper canines to come in. I saw the gap in her front teeth widen just a bit during the week that we were waiting for her retainer to be made, but now that she is wearing the retainer each night the gap is not noticeable. She has a prominent maxillary labial frenum.
The orthodontist is strongly recommending a labial frenectomy within the next month, and also stating that the gap will re-open soon if the surgery isn't done.
For us the cost is not an issue; I just want to make sure that I'm not subjecting her to surgery unnecessarily or too soon. When I saw your comment above about waiting until the canine teeth come in first, it made me pause.
Here is my question: Do you think it is reasonable to obtain a second opinion under the circumstances, or should we just do what her orthodontist is telling us?
Thanks,
Jennifer
Hi Jennifer - I'm not sure if you read my other articles, but I do reference some quotes from an orthodontics textbook and a pediatric dentistry textbook. Here's one on frenectomies and braces and another one talking about at what age should a child get a frenectomy. Take a look at those and then read over the quotes from the textbooks I referenced. They both seem to recommend holding off on the frenectomy until after the canines have come in. However, it is important to consider the fact that your daughter's orthodontist knows her individually and is trying to provide treatment that is in her best interest.
If I were you, I would probably talk to your daughter's orthodontist to see why he is recommending it now, when most textbooks recommend waiting until after the canines have come in.
I hope that helps - let me know if you have any other questions. Thanks for your comment, Jennifer!
I am a 29 yr old female, I am scheduled for a frenectomy for a gap in my front teeth. My gap has been closed with the braces only to reopen. My gap has closed again and all teeth are in place...my gap is completely gone....does this still mean I need a frenectomy, or could my gap stay closed on it's own with the use of a retainer?
Hi Shannon, your gap may or may not stay closed with a retainer. Your dentist/orthodontist will be able to answer that question for you better.
In most cases where something isn't right in the mouth, you want to not only correct it, but remove the cause of the problem. In your case, you have corrected the gap, but you probably want to remove the cause (the frenum) in order to help the gap stay closed.
Hopefully that answers your question. Thanks for your comment!
Hi i've just started to read up about this area as i think my ten yr old has problems his 2 front teeth have a sizable gap and it's getting worse, they are now slanting across ways in his mouth, the next two teeth are through almost behind the front two. Looking closely at them his frenium (?) actually starts at the bottom of his gum inbetween his teeth, there is about 2.5mm thickness of gum and tissue. He is now complaining that his front 4 teeth are painful when he eats. When he last saw the dentist she said she wanted to wait till she looked at his bite (i think that was what she was looking at, his front teeth are very far forward compared to his lower teeth) but as this is now causing him discomfort eating should this part of the problem be dealt with sooner rather than later? Any advice would be gratefully recieved so i have an understanding before emergency dental appointment tomorrow, thanks
Hi Sarah - My frenum used to come down pretty far. It would sometimes hurt off and on as I was growing up. Eventually, it ended up tearing slightly when I was eating which helped my front teeth come closer together. I still needed an orthodontic appliance to move them even closer together. However, my lateral incisors didn't come in behind my central incisors, like in your son's case. I do remember being able to fit a nickel through my two front teeth (I was an odd child!), so it was a fairly wide gap.
Without seeing your child, it does sound like he will need some form of orthodontic therapy such as braces to help correct his bite. Once this is taken care of, I believe his bite would no longer be painful and he will have a normal relationship between his upper and lower teeth. As long as he doesn't have a finger-sucking or tongue-thrusting problem, his teeth would probably stay well-aligned.
Take this advice with a grain of salt, as I am still a dental student, trying to learn a lot and have not seen your child in person.
You forgot to mention that a freneum can also occur in the lower region, between the lingual side of lower lip and attached to just below two front, lower, teeth. People should look for this in their childrens' mouths to prevent eventual gum recession. I had a lower freneum as a child; one dentist finally noticed, when I was twelve, that it was startting to pull the gum down a bit under one of my front, lower teeth (looks like a very slight gum recession). Luckily, at age 50 that gum recession hasn't worsened. However, I am always having to explain to a knew dentist or hygenist that this occured decades ago from a pulling down by the original freneum before it was trimmed a bit, not due to my gum suddenly receding in that region due to something else. I suspect that gravity had something to do with that original pull of the lower freneum on gum tissue over the first twelve years of my life.
Hi Renata - That's true, thanks for pointing that out. Some people do have a prominent frenum between their lower lip and lower gums, although it's not as common as a prominent frenum on the upper lip or under the tongue. I'm glad you got it taken care of when you were young!
If you run your tongue all the way around your mouth between your gums and your cheek, you can feel several smaller frena (plural of frenum) that help attach the cheek/lip to the gums. Thanks for your comments!
dear
i would be very appriciated if you answer my 2 questions
1-i had jaw ,maxila surgery and gummy simle ,the surgeon removed my upper LABIAL FRENUM and now i feel my upper lip's distacnce to the bottom of my nose is so long and my upper lips seems now to thin and comming to low after passing 4 years of sugery.however i do not have that gummy simle that much but i am not happy with my look too.is there any possibility to have taht tissue again?if yes,how doo they make it?and from which part of my body they will cut that tissue ?
2-as i mentioned ,distance of my upper lip to the nose is so high and it will give me a little menly look..is taht any possibility to make this distance shorter and fuller lips?
thansk alot
Hi Elie,
1 - It is probably possible to reattach the frenum by stitching your upper lip back to the gums. It most likely wouldn't ever return to how it was originally. However, even if you had that done, I don't think that it would bring your lip back up very much.
2 - I know that some periodontists perform an upper lip lengthening procedure, and they would probably be able to remove some tissue to make your lip look shorter.
You may want to discuss this with a plastic surgeon who could give you more options on how to make your lips fuller and make them appear to be shorter than they really are. Sorry that I couldn't be of too much help, but this is a bit beyond my area of expertise. Thanks for your comment, Elie!
Dear Tom,
thanks alot for responding me fast
may i ask you how they would reattach the frenum by stitching my upper lip back to the gums while there is not remained any tissue now?how they will make the tissue to stich it again?
2-why it does not look the same as before?
3-what is the best way for tooth to be whiten ?is that safe to do it yearly?i think i have done lazer (blue light)whitening 2 years ago and it works for me alot...like 3-4 lightening shade and now i need it.any idea please?
4-do you know how much it cost if a surgeon will make my lips fuller ,like surgery one and how does it look?would it be look natural?
4-i do not mean i have a wide lips but i meant the distance between upper lip to the end of my nose is long,can they make it shorter??by brining the upper lip alittle up and make it fuuler at the same time?
thanks alot again and best of luck in your career.
Hi Elie - For some reason, I was thinking you still had some tissue there. In a frenotomy, they leave some of the frenum and just cut through it. But, since you had a frenectomy, it was probably all removed. There could be a way to reattach it, but I have not ever heard of that procedure.
Due to all of the surgery you said you've had (four years worth), I don't think that simply trying to re-attach the upper lip back to the gums would make everything go back to how it was. These are just my thoughts, and to be honest I'm not experienced in those types of surgeries, so I'm probably not the best person to ask
I would recommend getting in touch with the oral surgeon or periodontist who you've been working with to see if there's any way to obtain the results you want. Since they've worked with you, they would know much better than me what is possible with your anatomy.
The blue light whitening method seems to work very fast. Unfortunately, teeth whitening can begin to "fade away" rather quickly. Since everyone is different, I can't tell you how often it is safe for you to have the whitening done. The two most common complications of whitening are irritation of the pulp inside the tooth, which causes sensitivity and irritation of your gums if the whitening gel comes into contact with them. Your dentist will be able to let you know which whitening method will work best for you.
I'm not sure about the costs of a surgeon making your lips fuller. That's more in the realm of cosmetic surgery. Again, with the lip procedures, I really haven't learned too much about how those work, so I'm not positive what could be done for you. Sorry I couldn't be of more help, but I hope that helped you at least a little bit! Thanks for your questions, Elie!
Dear Dr Tom,
thansk again for responding
may i know which of the tooth whitening is long lasting?
and the cost please?
now i like to say thanks for reviwing my questionas and answering them,
wish you more suceess
Hi Elie - No problem! Your teeth can get discolored for a number of reasons. Sometimes bleaching will get them whiter, sometimes it won't. It all depends on what it was that caused your teeth to get discolored in the first place. Sometimes dentists need to open up teeth that have had root canals to put bleach on the inside of the tooth, sometimes all you need is a whitening toothpaste to remove stains from your teeth.
I do have a few articles up about teeth whitening, which you can read here. I would recommend you read through this one about Six Reasons Why You Should Visit Your Dentist Before Trying to Whiten Your Teeth.
Until I write some more, here is a good web page that talks about a few different types of teeth whitening and how much they cost.
I hope that helps, Elie. Thanks for your questions!
My daughter is 17 months old, and just had a dental visit. The dentist said her frenum (sp? or correct word?) was attached really low on the top between her lip and gums. She said that explained why she was literally screaming her head off every time I brushed the top teeth, but not her bottom teeth. It is really hard to get her top teeth clean and she has residual plaque because I can't get it all due to her lip being attached so far down. I also can't get her lip up to see due to this. She doesn't have a gap in her teeth, and it only seems to be in pain when I brush. I just worry that her teeth won't get clean enough because of this. Is this reason to have a frenotomy done? Which would leave some of it there right...if not, what can I do to speed up the process of it tearing on it's own? (That's what the dentist said would happen eventually. But I don't like causing her pain every night and bleeding. Any advice and where would she have this procedure done, pediatrician or dentist?
Hi Sarah - A prominent frenum can often tear on its own when children fall or hit their head on something - they end up giving themselves a frenotomy! If it causes her pain and bleeding every night while making it difficult for you to get her teeth clean, I would recommend talking to a pediatric dentist about having a frenotomy done. The pediatric dentist may or may not want to do the frenotomy. If not, they should be able to give you some recommendations on how to make sure that you are keeping your daughters teeth clean with the frenum in the way.
The book Pediatric Dentistry by Dr. Pinkham says the following (with my words added in brackets!), "A prominent maxillary frenum, [what your daughter has] often accompanied by a large midline diastema, [a space between the two front teeth] is a common finding in children. It is often a cause for concern by parents and health care providers. Unless the frenum attachment exerts traumatic force on the facial attached gingiva of a permanent tooth (an uncommon situation), immediate treatment is unnecessary."
Basically, it looks like the author of that book in general would advise you to wait and see what happens with the permanent teeth. However, since it is obviously painful for your daughter and making her not like the whole brushing the teeth routine, it is probably best to find a pediatric dentist in your area to get a consultation and see what they recommend. Pediatric dentists are better trained in this area than general dentists. I hope that helps -- it's hard to offer a definitive suggestion when I haven't seen your daughter or what her frenum looks like.
By the way, I was born with a prominent maxillary frenum. I had a huge space between my permanent front teeth. I ended up tearing the frenum one afternoon playing either football or basketball.
Have a great weekend, Sarah. Thanks for your comment!
I am just curious to know how many times should you have a frenotomy? Is it possible that it can grow back?
Hi Felicia - It all depends on how much the frenum was cut during the frenotomy. While I couldn't find any scientific papers talking about how often the frenum grows back, I talked with one of my professors and he told me that he has seen them grow back, which is why he recommends a complete frenectomy.
I tore my frenum while playing as a kid, and it remains torn to this day; it hasn't grown back. I think whether or not it grows back depends a lot on the person and how the frenum is cut. I hope that helps. Thanks for your comment!
THANKS TOM! i ASK BECAUSE MY SON HAD HIS CUT AT 2MTH OLD, AND RECENTLY HAD TO HAVE RE DONE! hE'S NOW 2YR'S OLD?
No problem, Felicia. Did your son have the frenum under his tongue cut or the frenum between his lip and upper teeth cut?
I talked with one of my periodontics professors about this and he said he sees a lot of frenotomies grow back, which are commonly done with lasers.
He mentioned that most complete frenectomies do not relapse. I hope that helps, Felicia.
Both time's it was cut under the tongue.
Thanks for the response, Felicia. Unfortunately, we haven't learned too much in the area of lingual frenectomies so I only know what I've read in my textbooks.
I would assume that relapses are just as common in the lingual frenectomies as they are with the labial frenectomies.
Whether or not they grow back probably depends on several factors - I guess you can cross your fingers that you don't have to have it cut again. Good luck!
Hello, My son is about 6 months into his orthodontia procedure and his Orthodontist has required he have a lingual frenectomy because the Frenum is pulling his mouth closed which interferes with the work she's trying to accomplish. No one has ever told me he has had any problems being tongue-tied. His speech is fine and he doesn't really have any physical handicaps related to his mouth, except maybe that he cannot whistle. I am having an ENT look at him because insurance will cover it if it is medically necessary but not if it is only cosmetically necessary. Have you ever heard about this kind of problem? What kind of disabilities should I consider in making my case for the medical need? What speech problem should I look for to determine if he actually has them and I just never noticed?
thanks,
Karen
Hi Karen how old is your son? And my son (2ys Old) has been in speech therapy almost a year! Since the surgery his speech has improve.
Hi Karen,
I did an electronic search for the word frenectomy through the entire Contemporary Orthodontics book by Proffit. Unfortunately, I didn't find anything about a lingual frenectomy - only multiple references to labial frenectomies. We only get a few classes covering basic orthodontics in dental school, so unfortunately since I couldn't find any information in the book about it, I can't help you in reference to orthodontics and lingual frenectomies.
As for doing a lingual frenectomy, some reasons we would do them are:
- Problems with speech (research indicates that only severe tongue-ties affect speech, however. Since you state you haven't noticed anything, he probably doesn't have any problems. It would most likely affect sounds where he'd need to touch his tongue to the roof of his mouth, like the "t" sound. If he can say "tongue-tied" he probably doesn't have any problem with speech relating to being tongue-tied!)
- Problems with sucking/feeding (for infants)
- Problems with keeping the teeth clean. One of the pediatric dentists that teaches us stated that if you can't touch the whole front surface of your lower front teeth, then they will consider doing a lingual frenectomy.
I haven't heard of doing them for orthodontics, but like I said, we haven't learned too much in orthodontics, so it could very well be common.
Here's an article from the Journal of Periodontology that addresses treatment for ankyloglossia (tongue-tie) in more depth. Let me know if you have any other questions, Karen. Thanks for your comment!
Hi my son is due to have a maxillary labial frenectomy before removal of his brace. He has never had a gap in the top front two teeth and I am still concerned that this operation is not necessary. Will he be able to play the saxophone as he is a very keen member of his local band?
Hi Sheila - The main reasons that I have been taught in dental school to perform a maxillary labial frenectomy are:
1 - To help close a gap with braces
2 - To prevent the gums from receding (if the frenum appears to be pulling them down and away from the teeth)
3 - To help dentures fit better
I think the only reason left that might apply to your son is #2. It could be that the frenum is pulling on his gums and that it would be good to get it removed. If I were you, I would ask your orthodontist why the frenectomy is necessary.
As I've mentioned in a comment above, the book we use at my dental school recommends to not do the frenectomy until the braces have been off, the gap has re-opened, and then been closed again with braces. It does seem to be a less invasive approach than many practicing orthodontists take, but our pediatric dentistry department abides by most of the principles of that book, and that is how we've been taught.
If it were my child and they said that the only reason they wanted to do the frenectomy was to prevent a gap from forming in the future, I would probably not have the frenectomy done.
As for his saxophone playing - no guarantees - but I'm almost positive that it would not be affected. If it were, he would most likely quickly re-learn how to position his lips to make beautiful music.
I hope that helps! Sorry for the long-winded answer. Thanks for your question, Sheila.
I cancelled the op and will see if there is any gap in later life, am relieved and happy with my decision. Thanks for the advice.
Thanks for the update, Sheila. It sounds like Michelle (in the comment below) is facing the same decision you went through.
It seems like this is more common recently... I have a pretty prominent maxillary frenum and I don't believe that the orthodontist ever recommended a frenectomy to me... My wife had braces and they didn't do a frenectomy on her either.
Hello Dr. Tom,
I have been told that both of my children, ages 12 and 13 need to have maxillary mid-line frenectomies. They have had the gaps in their front teeth closed with orthodontics and he now wants this procedure completed before the braces come off. My concern is that neither of them appear to have very large maxillary labial frenums ,certainly no larger than mine or my husbands'. I also had braces to correct the gap in my front teeth and it never returned. I'm very concerned about having surgery done that may not be required. They have already endure a palette separator and the braces themselves. Is there any way to be sure that this procedure is really necessary? Are there questions I can ask the orthodontist? Do some frenums require surgery more than others? They seem a bit annoyed when I don't jump on the band wagon in regards to this procedure. I just feel this matter requires more research before I schedule the appointments for surgery. Thank you so very much for your time and assistance in this matter. Any suggestions are greatly appreciated.
Michelle
Hi Michelle - Unfortunately some doctors and dentists seem to want to spend more time doing procedures that their patients don't really understand. In response to your main question: You kids' gaps might return with or without the frenectomy and their teeth might stay closed with or without the frenectomy.
It seems like many orthodontists want to perform the frenectomy "just in case" it causes the teeth to move back apart.
Personally, I would rather not subject my children to surgery that may not be necessary. I tend to agree with the author of my pediatric dentistry book when he says the following (with my emphasis added on the last sentence):
"No matter which type of treatment is used to close a midline diastema, retention can be a problem and should be planned. In most cases, a removable appliance maintains the space closure...If the diastema reopens during or following retention, the incisors should be realigned. At that time, a surgical procedure, frenectomy, can be performed if the frenum is thought to be the cause of the diastema's reopening."
Note that a diastema is just our fancy dental word for a space between the front two teeth.
Basically he says that in most cases you can use a retainer to keep the space closed after it has been closed with braces. Then he says that if the space re-opens, you should close the space and then consider a frenectomy if it is thought to be the cause of the re-opening.
From what I've been taught in my three years of dental school, I have to say that I agree with Dr. Pinkham on this issue. Many times you can't be sure that the frenectomy is what is causing the space to re-open, if it re-opens at all. There is actually some controversy on this topic in the professional world.
You could ask the orthodontist if this is something that they routinely do on all of their patients or if they think that your children have an especially large/thick frenum that would cause their space to re-open. You could also ask if they think that a retainer, rather than a frenectomy, would be able to keep the space closed. Some frena are thicker than others and might require more tissue to be removed, but the procedure is basically the same.
Most likely, the worst thing that would happen if you got it done would be that you would have paid for and subjected your kids to unnecessary surgery. The worst thing that could happen if you don't get it done is that their teeth might open back up and you'd need to have the space re-closed and then consider getting the frenectomy. I'm sure that either of those choices have worked out well for many people, so it's probably not a huge deal.
I hope that helps, Michelle. Have a great day, and good luck with your decision!
Hi Michelle and Sheila - Both of you along with my sister inspired me to write an article talking about whether or not it is necessary to have a frenectomy done after braces treatment.
I just finished it and it will get published as tomorrow morning on the front page of Oral Answers. I included quotes from the leading orthodontics and pediatric dentistry books.
Hopefully it will provide a greater explanation of what to do in these situations than my comments have.
I'm having post frenectomy blues....my 6 1/2 year old daughter had one yesterday. We were told she needed one because of the gap between her two front (permanent) teeth. I was not prepared for the idea that she might look different! I am hoping this is normal swelling after the procedure, but if it's permanent I'll be pretty upset. Her upper lip seems large and her profile looks different....her lips don't meet the way they used to. So I'm looking for an answer...does a frenectomy normally alter the appearance??? Or will her beautiful smile return to normal?
Hi Nicole - Many surgical procedures can cause a degree of swelling after they are done. I do have good news for you though - from what I've been taught in dental school, a frenectomy should not alter the appearance of your daughters smile or lips. Her beautiful smile should return to normal after she has healed from the frenectomy.
Thanks for your question, Nicole. Let me know if you have any other questions about frenectomies.
Thank you for all of this info on the maxillary frenectomy. I have a toddler with a very thick and short labial frenum. I wrongly assumed this type of problem was like a severe ankyloglossia - clipped easily as an infant and with more difficulty as they grow. So I was unnecessarily worried that I missed my 'window of opportunity'! Thanks to you and your site - I can relax a little. One question about the scar tissue from an early frenectomy possibly leaving a gap between permanent teeth. I know each case is different but in general - Do most people who have a short labial frenum eventually have a natural tear from eating or sports injury? In general wouldn't a natural tear from eating or sports injury leave more scar tissue than than a precise and controlled surgical frenectomy? Thank you for such an informative site!
Hi Mel - Thanks for your kind words! I'm not sure on the exact numbers, but we talked about lots of kids that tear their labial frenum due to falling, playing sports, etc. I'm not sure if it happens to most people, but it is fairly common.
When a frenectomy is performed, the frenum is removed completely, so it can leave scar tissue on the inside of the upper lip and on the gums between the two upper teeth. When my frenum tore, it tore in the middle and it did leave some scar tissue in the middle of the frenum where it tore, but none on the inside of the upper lip or on the gums. I hope that made sense!
The pediatric dentistry instructors at my school along with the pediatric dentistry book that I quoted don't recommend getting a labial frenectomy until the permanent canines have come in. Usually the canine teeth will push the incisors together and close the gap between the two front teeth.
I hope that helps. If you have any other questions, just reply to this comment. Thanks for your comment, Mel!
Our orthodontist told us our son needs to have his lingual frenum trimmed, he is 9 years old. His father's side of the family has a history of being 'tongue tied'. They want to knock him out for this, is it really necessary to put him under?
Hi Jane - Whether or not to put someone under general anesthesia for a procedure has to do with how well they would cope if they were aware of what was going on. I attended a presentation by a pediatric dentist a few months ago and he said that he has cut the lingual frenum of infants (when they couldn't suck well enough to get milk) without even using local anesthesia. He described it as a quick cut that bled a little bit, but then healed pretty quickly.
A lingual frenectomy can be a fairly quick, easy procedure. You can look at this post to see some videos of a lingual frenectomy. As you can see, if done with a laser there is usually little to no bleeding and the procedure is pretty quick.
I would talk with your son and orthodontist to see if they think that general anesthesia is the best option. Local anesthesia may turn out to be just fine.
I hope that helps somewhat. Let me know if you have any other questions. Thanks for your comment, Jane!
Thank you, that did help. After a consultation our periodontist does not feel it's necessary to put our son under general anesthesia, something I was hoping to avoid for a seemingly minor procedure.
Hi Tom,
My 7 year old is scheduled for a maxillary frenectomy tomorrow (18/02). Her permanent teeth is already in place, she has quite a big gap between the front teeth and she struggle with her speech. (She also had difficulty with sucking as a baby). I've only read now, that it's suggested to first close the gap with braces before doing surgery, as the scar caused by an operation might make it difficult later on. I guess I need to know if it is the right thing to do at this age?
Regards
Marionette
Hi Marionette - Obviously some dental professionals tend to want to perform the frenectomy before the gap is closed. There is a lot of debate among orthodontists about whether the frenum even causes a space or not.
If that's what your dentist has decided, then it may be the best treatment for your daughter. You may want to consider reading this article about the age at which a child should get a frenectomy.
I hope that helps. Let me know if you have any other questions!
Hi,
Just some feedback on my 7 yr old. Everything went really well with her frenectomy on Friday, my daughter had no swelling and no pain. She got her braces yesterday (5 days after the frenectomy) and is very proud of it.
God bless!
I'm glad everything worked out, Marionette! Thanks for keeping us updated.
I'd never heard of this frenectomy procedure before my Japanese dentist recommended it today for my child (age 6). My son doesn't seem to have any problems at all, but the dentist says that he'll probably have a gap between his front teeth if we don't have the surgery.
From what I've read in your kindly advice so far, you seem to lean towards not having the procedure and then later just correcting the gap with braces/retainers. But wouldn't braces and retainers be much more troublesome than (what seems like) a simple procedure?
While I'd normally be against having an elective surgery for cosmetic purposes on my child, I had braces and I hated them.
Is this surgery more serious than it seems? What would be the big reason for not having it done? My son just lost both his front baby teeth. It seems like a great time to have it done before his permanent teeth come in. Any advice would be appreciated. I have no idea what I'm about to do.
thank you.
Hi Johney - This page talks about at what age and if a child should get a labial frenectomy.
Everything I have read says that there isn't even any clear evidence as to whether a prominent frenum causes spacing. Also, it normally SHOULD NOT be done before someone is 11 or 12 years old according to the major textbooks.
Doing it early not only may be unnecessary surgery, but it may create scar tissue that will make it harder for a gap to close when the canines come in and naturally close the gap.
Your dentist does know your child's unique situation, so it's probably best to follow their advice.
If it were my child, I would ask them if it's really necessary and on what evidence they are basing this decision. If you have any other questions after reading the article I linked to above, let me know.
Hi Tom,
I'm 28 years old male. No problem with speech however having difficulty pronouncing /r/ properly. I pronounce /r/ like the French, Dutch, and German do. Do you think lingual frenectomy can help me pronouncing /r/ properly?
Thanks.
Hi Steve - Are you able to touch the tip of your tongue to your gums on the lip side of your lower front teeth? If so, then chances are that your tongue is able to move around enough to speak correctly. If it feels like your lingual frenum is pulling on your tongue when you talk, then the frenectomy may help.
I hope that helps. Let me know if you have any other questions. Thanks for your comment, Steve!
My 16 month old daughter hit her mouth on the edge of the coffee table and tore her labial frenum. What should I do? Will she need surgery to reattach it or does it happen on its own? Could this have serious consequences if it doesn't get treated soon? Is there some kind of topical medicine for the pain and irritation and to stop it from getting infected? How long will it take to heal? Will this affect the spacing between her front teeth? What will a dentist do in this kind of situation? Sorry for asking to many questions. It's just that I had never heard of this happening and I don't know anything about it. I'm just worried about my daughter.
Thanks for your help.
Hi Rafaela - Many labial frenum injuries occur without any problems. I injured mine when I was little, it healed up well and I haven't had any problems with it. If it was just a minor tear, the dentist would probably just monitor it to make sure it heals well. I doubt that it would affect the spacing of her teeth. If you have any specific questions, it would be best to take your daughter to a pediatric dentist to have them look at it.
I hope that helps, Rafaela. Let me know if you have any other questions. Thanks for your comment!
Hi Tom,
I took my 4 year old daughter to the dentist and they informed me that she has a significantly large frenum on the top causing the gap in her two front teeth and that sometime in the future she will need a frenectomy. I am wondering what the specifics are for this procedure, like: should she have this done now with baby teeth or when they fall out or after her adult teeth? I also did some research online and found an article that said the gap had to be closed with braces before the frenectomy can take place, is this in fact the case? And if/when she gets this procedure done will they "put her to sleep" for it? And last, but not least, can this be the cause of her lisp?
I would have asked these questions at my dentist's office, except I had never heard of this before and didn't know it was an issue, so I was taken back a little by it.
Thanks in advance for your help!
Hi Kaylyn - Everything I've read states that the frenectomy should be done after the gap has been closed with braces. Some dentists/oral surgeons might put her to sleep. It really isn't that bad of a procedure, but if your daughter needs to be put to sleep for it, I'm sure it could be done.
Let me know if you have any other questions. Thanks for your comment, Kaylyn!
Tom,
I'm 43 years old and at my last dental appt. my dentist told me I needed to have a phrenectomy because of the recession of my gums between my two lower teeth. Is this a common procedure done to help this condition? I'm really nervous about it?
Thanks
Hi Tammy - A frenectomy is common to help prevent gum recession and periodontitis. It's usually not too bad depending on how much of the frenum actually needs to be removed. You can ask your dentist about your options for getting numb and see if they can offer you laughing gas to help with any anxiety that you may have.
I hope that helps, Tammy. Let me know if you have any other questions.
Hi,
Quick question a lil over a yr ago i took my now 2 and half year old to a dentist and he said the same about the labial frenum that you posted about only cutting it once she's a teen however i've now notice it's casue her 2 top front teeth to split apart seriously and it now looking as though it's splitting the gum in half, should i now get a secong opinion?
Hi Lisa - You might want to get a second opinion, however we usually don't recommend doing them until the permanent teeth come in to see if the gap closes on its own.
I hope that helps - Thanks for your comment! Let me know if you have any other questions, Lisa.
Tom thank you for your responses to my concerns, there is one that I am very concerned about, if you can please help me with this, I'm a little worried and need to know if I must take action right away.
An invasive procedure was performed by reccommendations of our dentist to have a certain oral surgeon make incisions in the roof of my daughter's mouth to pull her canine teeth down. Now I have read many, many, questions and concerns regarding getting those canine teeth down. However, right now that is not my main concern, because they never did come down. But the oral surgeon could only get one chain attached to the tooth, he could not succeed on the other side. He then stiched her up on the side with the chain and left the chain inside. Since the dentist was not informing me of much and had been rude to me as her parent from the start, I trusted he was doing everything in her best interest, but was not very personable.
My question is, the braces came off about 4 months ago and that chain is still inside the roof of her mouth, I don't get it. Is this a cause for future problems, Please be honest so that my daughter does not end up with any major health problems. I just don't think this is a good thing. The total time that chain has been up there is about a year now.
Please tell me, do I need to do something ASAP,?? or is this ok, the surgeon nor the dentist addressed any issues of that metal chain being left in the roof of her mouth...I'm having a problem understanding this and that no health problems will arise with this metal chain in the roof of her mouth.
Sincerely,
Hi Diana - You mentioned that the braces came off four months ago. Are they not planning on moving that tooth down? Usually it's a good idea to get impacted teeth down into the mouth or get them extracted so that there's no future problems associated with them (like a cyst for example.) I would think that it's probably not the best idea to simply leave the chain on the tooth unless they are planning on using it soon to help the tooth erupt into the mouth.
You'd get a better answer by calling the oral surgeon and asking him if it should be removed soon.
I hope that helps - Thanks for your comment, Diana. Let me know if you have any other questions.
Hi Tom - I have an 8 year old who had an upper lip frenctomy done at 3 yrs old by our dentist. When we started going for ortho consults this year, 2 orthos saw and mentioned that she should be seen for a frenctomy in front of the lower front two teeth as it is so tight on one tooth that the gum has quickly pulled back. We are trying to avoid a gum graft at this point. My dentist wants to do it but I am not happy with finding out that the frenectomy that he insisted on at 3 years old will have to be redone later due to the fact that it only released the top tissue but never removed the tissue (all orthos have suggested this should have been done). We are seeing a periodontist this time for the lower front. Any specific care instructions, suggestions. for us? I do believe that in this case it is necessary as I can see the recession in the gum. we are at the dentist for cleanings every 6 months and as this hasn't been mentioned before, I suspect it's progressed quickly. are we doing the right thing? thanks for any suggestions.
Hi Kim - One of the reasons that a frenectomy should be done is if it is causing gum recession. It sounds like the "frenectomy" on top was really just a "frenotomy." A frenectomy removes the frenum and the tissue underneath, while a frenotomy is simply a cut in the frenum to release the tension.
If it is indeed causing the gum recession, it sounds like you're doing the right thing. I can't offer specific care instructions, but the periodontist will be able to let you know if there's anything special that needs to be done.
I hope that helps - Thanks for your comment, Kim. Let me know if you have any other questions.
Hello, my daughter was born with a gap on her upper gumline (where 2 front teeth usually grow in). It looks as though it never fully developed, but does not continue back toward the upper palate. She is now 4 mos old and the ENT is wanting to do the labial frenectomy. I dont know how they will do this, or hold her still, she is strong! What is your suggesion? I am thinking of waiting, is this common? Thanks...
Hi Brooke - I'm not sure I understand correctly. Is there a gap where the labial frenum is? Or does it look like she is missing bone there?
In any case, have you asked the ENT if it is something urgent or if it can wait? If it's not interfering with feeding, I'm not sure that there would be a rush to get it done, but this does fall outside of what I've learned so far in school.
I hope that helps, let me know if you have any other questions.
Hi
I have a 15month old daughter. She had a fall and tore her lip short frenum and it is now caught between the two front teeth. It goes through her front teeth and looks like it links up with her gum behind the teeth.
I have had a pediatric doctor & dentist look at it, but they are not comfortable with surgical intervention due to her age. They say it should heal by its self. So far it has been 11 days and has not changed. The frenum is easily disturbed and will bleed on a daily basis due to little things like her rubbing her mouth, the use of a dummy at night, eating hard food, any accidental bump to her mouth.
I don't understand how a caught frenum will heal itself and how long is this expected to take? Would this require surgical intervention and should i pursue this avenue with a pediatric surgeon?
Any advice on what should be done in a case where the frenum is caught between the upper incisors?
Thank you so much.
Hi Mia - I tore my frenum when I was a child. It did heal by itself and now i have a little flap of tissue on it. It should heal itself - our bodies are able to naturally heal many of the cuts and scrapes that we get as we grow up. It will heal best if it is not irritated frequently, which can be hard, especially at your daughter's age. The frenum does normally pass from the lip side onto the tongue side of the roof of the mouth. If your daughter's doctor and dentist recommend waiting, that's probably a good idea.
If you're still worried, it never hurts to get a second opinion.
I hope that helps - Let me know if you have any other questions. Thanks for your comment, Mia.
Hi. I have an eighteen month daughter. Her frenum is attached between her two front teeth. I took her to my pediatrician who recommended a pediatric dentist. He said that in most cases he would recommend waiting until her permanent teeth came in, then waiting until she needed braces and performing the frenectomy at that time so that there was less chance of scar tissue pushing the teeth together. But in the case of my daughter, he actually felt the connection was prominent enough to perform the procedure immediately, because he worried that if she were to hit her mouth it would cause a fairly traumatic injury.
I am very hesitant, however, to have the procedure done because of her age. I'm not really comfortable having her put under anesthesia if it can be avoided. It seems to me the risk of her hitting her mouth hard enough to cause damage is rather low. I would just like your opinion as to whether or not you see any other benefit to having the surgery done now, and whether or not you think the risk of injury is high enough to justify surgery at such a young age.
Thank you so much for your advice.
Kelli
Hi Kelli - We've also learned that you should wait until you get the permanent teeth coming in until a frenectomy is performed. You can read more along with some comments on the subject at this article: At What Age Does a Child Need a Frenectomy?
Since every child is different, your pediatric dentist knows what is best in your daughter's specific situation. If you're uncomfortable, you may want to get a second opinion. I also had a prominent frenum that tore slightly when I was playing - it didn't hurt bad and it hasn't caused any problems. I didn't even end up needing to get a frenectomy.
I hope that helps - Let me know if you have any other questions. Thanks for your comment, Kelli!
Hi there
I am wondering if my son has an unusual frenulum. He has normal movement of his tongue, no mishapenness and no speech problems, apart from a tiny lisp.
However, the frenulum doesn't attach to the floor of his mouth, but instead there are two little strings attached to the inside of his bottom gum. It seems to be pulling the gum a little out of shape, but as he has just lost his milk teeth, it's too early to tell if the adult teeth are being pulled out of place.
He is having gastric trouble and I have read that there may be a connection between tongue tie and gastric problems because the chewing and swallowing action is compromised. Have you heard of this?
TIA
Hi Tom,
My 9 year old son has his three front adult teeth but is missing his right front tooth. We discovered via a panoramic x-ray that he has a supernumery?? tooth, not properly formed, in his gum directly above where the right front tooth should be. As a result, the adult front tooth is pushed over and sideways at about 90% up in his gum. His baby front teeth came in fine and all came out on their own except the right front baby tooth that had to be extracted as nothing was pushing it out.
He is scheduled to have surgery to remove the extranumery tooth matter up in his gum so the adult tooth can come down, even if it is sideways but they are also recommending a frenectomy. I'm not sure that it is necessary, he does not have a large or long frenum. I'm concerned obviously about putting my son through such extensive oral surgery and I've read that removing the frenem can cause scar tissue to form that can stop the front teeth from coming together. I'm also concerned that removing his normal freneum could cause him to have the big "gummy" smile which he doesn't currently have now. The orthodontist is saying it may prevent the sideways adult tooth from being able to come down in his mouth? We realize that he will need braces eventually. Would love to hear your comments on this.
Thanks, Sarah
My 8 yr old daughter went to see the orthodontist, who 'prescribed' a frenectomy because her gum tissue was preventing her two front teeth from being close to each other. (There's a gap.) The orthodontist told me to have my dentist do it, so I gladly added that to the regular check up visit that she was going to be having. I also had my 11 yr old daughter scheduled for a dental check up at the same time. To my horror, the dentist performed the frenectomy on my 11 yr old who didn't need it. I understand that mistakes happen, but I'm very concerned. This has made my 11 yr old, who already had extreme anxiety issues when it comes to the dentist, hate the dentist even more. I'm also wondering if there are adverse issues that could arise because this procedure was performed when it was not needed.
I am 29 years old and had my braces removed 2 years ago. Shortly after my gap between mu front teeth immediatly returned. I went in for a consultation for veneers and was advised that having a frenectomy and returning to my braces would be a better option. I have been researching this option and notice most advise to close the gap FIRST then have the frenectomy. Please advise! ! I have an appointment scheduled in 3 weeks to have the procedure, should I wait until after the braces??
My daughter's orthodontist wanted her to have a frenectomy first, before braces are considered. I suppose it depends on your mouth. My daughter's frenum was so low that it was preventing her two front teeth from being close together. So now that the extra tissue has been removed, we're hoping that the gap will slowly close. If not, then we'll do braces.
It could be that your frenum/gum tissue is acting like a wedge between your front teeth. My thought is that the frenectomy would need to be removed first so that the job that the baces do would be permanent this time. But I'm not a dentist. I'm just explaining what makes sense to me based on my experience. Hope it helps.
Some other sites indicate having the surgery first could cause irreversible scar tissue which would prevent orthodontics from working. So maybe it does just depend on the individual case
Tom,
I just want to say thank-you for responding! My 13-month girl has a prominent maxillary labial frenum, which I just spotted today and learned all about it via your answers to those questions. I will wait till she grows her permanent teeth, per your advice.
Reading this is quite comforting to me as a parent. Many thanks, again!
The dentist insists my 6 year old needs a frenectomy to gain fuller range of motion with his tongue. He has had no speech problems, no trouble eating (or even nursing when he was a baby). When he was a baby his Doctor said that he may need it cut if it cause problems with speech. Well, it has not caused any problems. My son can stick his tongue out, talk and eat just fine, but for some reason this dentist insists he should have it cut. I told the dentist I asked the ENT about this (we were getting my sons tonsils checked) and the ENT did not see a need to have it cut. But the dentist still insists that only a dentist or oral surgeon can make that decision.
I do not want to put my kid through an unneccessary procedure.
What do you think?
Thank you!
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My 18 month old tore her maxillary labial frenum. Do I need to be concerned about a permanent gap in her teeth? The pedi was not concerned but now I'm wondering after seeing this website.
Sorry I did not finish. I am concerned if her big teeth come down and need to be straightened there could be an issue. She sucks her thumb constantly.