Tags Posts tagged with "Frenectomy"

Frenectomy

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Forces Trying to Move Your Teeth
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Did you know that while you are reading this, there are many different forces acting on your teeth?  I’m guessing that right now your tongue is probably slightly resting on the the back of your lower front teeth and the inside of your lips are resting against your front teeth.  If you took a magic school bus ride into the average person”s mouth, you’d probably find the same thing.

Forces On TeethDid you know that both of these forces along with other forces can affect how your smile looks?  In this article, I will go over some of the forces that act on your teeth and how you can make sure that they don’t negatively affect your smile.

Forces that Constantly Try to Move Your Teeth

As I mentioned above, your lips push your teeth into your mouth while your tongue pushes your teeth out.  They eventually find an equilibrium known as the neutral position.

Normally these forces are good.  For example, these forces help keep your teeth arranged in a symmetrical arch.  These forces can also help push permanent lower front teeth out away from the tongue when the permanent teeth come in behind the baby teeth.

However, if the forces in your own mouth get out of hand, they can push your teeth into abnormal positions.

Tongue Habits

Did you know that the average human swallows more than 2,000 times every day!  If you go ahead and swallow right now, you’ll notice that your tongue pushes against your upper front teeth.  As long as you don’t push excessively on your front teeth, usually everything is fine.

Some people have habits that cause them to hold their tongue between their teeth all the time or to push their tongue out excessively when they swallow.

Lip Habits

The forces that your lips apply to your teeth can become a problem if you develop certain habits.  One such habit is tucking your lower lip behind your upper teeth.  This is especially common in younger children and people who bite their lips when they get nervous.

Frena

The labial frenum has been accused of moving the front two teeth apart after they are perfectly aligned with braces.  For this reason, some people choose to cut away the frenum by getting a frenectomy.

Forces From Your Teeth

Other teeth (or the lack thereof) can move your teeth.  Normally when you bite together, your teeth touch and rest in a certain position.  This position is known as centric occlusion.  Normally, the top teeth oppose the bottom teeth and keep them in check.  However, when you lose a tooth, things get interesting!

When you lose a tooth, the teeth drift to fill the space. The teeth on either side of the lost tooth move, as will the tooth that opposes it. For example, if you lost a lower tooth, the tooth on the upper jaw that normally hits it would start to grow down slightly to fill in the space and the adjacent teeth to the lost tooth would start to lean in towards the empty gap.

Certain habits involving tooth-to-tooth contact, such as clenching or grinding your teeth could also cause movement of your teeth.

Another force that can move your teeth is described in Ten Cate’s Oral Histology textbook.  It talks about the back teeth pushing forward ever so slightly against each other, which causes a gradual forward movement of your teeth as you get older.

Conclusion

As you can see, there are many different forces that are constantly acting on your teeth that could cause them to move.  In addition to these internal forces from your own body, teeth can also move due to external forces such as braces, pipe smoking, or musical instruments.  I will discuss these forces in more detail in a future article.

Do you have any questions, comments, or concerns about tooth movement caused by these forces?  I’d love to hear what you have to say in the comments section below.  Thanks for reading!

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Age that a Child Needs a Frenectomy
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One of the topics that I get emailed about most often is labial frenectomies.  Not long ago, my sister called me asking me whether or not her daughter should get a labial frenectomy.  The dentist had noticed it at one appointment and said that she may have a gap between her front teeth if a frenectomy wasn’t done.

My sister never got back to the dentist.  At the following appointment, the dentist never mentioned that her daughter needed a frenectomy.

Overall, it seems like orthodontists and general dentists are recommending frenectomies more and more often. Is there a sound reason for performing all of these recommended frenectomies?  Should little children get frenectomies to avoid possibly having a gap between their front permanent teeth?  I’ll answer these questions and more in the article below.

At What Age Should a Child Get a Labial Frenectomy?

At What Age Does a Child Need a Labial Frenectomy?

A few months ago, I had a conversation via email with a reader who we’ll call Amy.  Her daughter was only 16 months old and the doctor that she went to recommended that her 16 month old daughter get a labial frenectomy.  Here’s what Amy wrote in one of her emails to me:

Our doctor told us that her gum needed to be cut at some point before her back teeth came in and before the permanent teeth came in to help with the space.  She has not had any problems with it before like pain or trouble talking. To make the story different to me, is that the doctor that did the surgery was a ear, nose and throat doctor. I always had a dentist do the work on me.

I am not sure if this has anything to do with it but we live in a very small town and area. I have talked to many people and they all acted like this was a common thing to do even on toddlers and infants. So I am a little confused with their responses and yours.

I found Amy’s email slightly troubling as I hadn’t ever heard of frenectomies being performed in such young children unless their frenum is so thick that they have trouble eating/speaking or it is causing them pain.

After combing through a few different textbooks, I found a few quotes that I think are worth sharing.  Dr. Pinkham’s book Pediatric Dentistry states the following (I put the important points in bold text – and FYI a diastema is a space between the front teeth):

“Recent trends justify significantly fewer maxillary labial frenectomies.  These procedures should only be performed after it has been shown that the frenum is a causative factor in maintaining a diastema between the maxillary central incisors.  This cannot be determined until after the permanent canines have erupted.  Therefore a maxillary labial frenectomy prior to the age of 11 or 12 is probably not indicated.”

The book Paediatric Dentistry, edited by Richard Welbury echoes Dr. Pinkham’s pediatric dentistry book.  It says, “Parents are often concerned about spacing of the upper incisors, and they can be reassured that it will often reduce as the permanent upper canines erupt…There is some disagreement about the role of frenectomy in the treatment of diastemata, but it is very rarely indicated in the mixed dentition stage and is probably best carried out during active orthodontic treatment.”

Dr. Pinkham’s book states that a frenectomy is probably unnecessary before a child is 11 or 12 years old.  Paediatric Dentistry says that a frenectomy is very rarely done in the mixed dentition (before all of the baby teeth have fallen out – around 11-12 years of age.)

Both of these authoritative books in the field of pediatric dentistry agree that a frenectomy shouldn’t be done, except in rare circumstances, before a child is 11 years old.

Labial Frenectomy After Braces

A labial frenectomy can be done after the gap between the front teeth is closed with braces.  To learn more about this topic, read the article Is a Labial Frenectomy Necessary After Braces?

When Should a Child Get a Frenectomy Before They are 11 Years Old?

There may be some situations where a frenectomy should be performed in a child who is younger than the 11 to 12 years old recommended above.

The book Carranza’s Clinical Periodontology says that “A frenum becomes a problem if the attachment is too close to the marginal gingiva.  Tension on the frenum may pull the gingival margin away from the tooth.  This condition may be conducive to plaque accumulation and inhibit proper toothbrushing.”

The book Pediatric Dentistry also states that if “the frenum attachment exerts a traumatic force on the facial attached gingiva of a permanent tooth (an uncommon situation)” then a frenectomy can also be performed.

Obviously, other valid reasons to perform a labial frenectomy earlier are if the frenum is causing the child pain or making it difficult to speak or eat.

Conclusion

To recap, a child should only get a frenectomy after the permanent canines have come in and after closing the gap between the front two teeth.  This means that a frenectomy should normally only be performed when a child has turned 11 or 12 years old.

A child may need to get a frenectomy earlier if the labial frenum:

  • Makes it difficult for the child to keep their teeth clean
  • Is pulling on the gums causing them to recede
  • Causes the child pain
  • Makes it difficult for the child to eat or speak

Have you had your children get labial frenectomies?  Has your child’s dentist recommended a labial frenectomy before the age of 11?

I’d love to hear about your stories involving frenectomies in the comments section below.  Thanks for reading!

Is a Labial Frenectomy Necessary After Braces?
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A couple of months ago, my sister called to ask my opinion about a frenectomy that the orthodontist had suggested for my nephew.  After discussing it with the orthodontist, my sister decided to postpone the frenectomy for the time being.

Is a Maxillary Labial Frenectomy Necessary?Since then, it seems that I’ve had more than a few questions about the necessity of a maxillary labial frenectomy on the post describing a labial frenectomy.

These questions seem to come from parents who are concerned about whether a surgical procedure is truly necessary to keep their child’s teeth straight after orthodontic treatment.  I don’t blame them for their concern.  I think that an unnecessary surgery is not only a waste of time and resources, but also introduces unnecessary risk to the patient.

In this article, I’ll take a look at at the leading textbooks on orthodontics and pediatric dentistry to see what they say about whether or not a frenectomy is necessary after having braces.  It’s important to note that a frenectomy should not be done during braces treatment as it is believed that the scar tissue formed may prevent the teeth from moving together, thus creating a permanent gap between the two front teeth.

A Labial Frenectomy After Braces – An Orthodontic Perspective

It seems that more and more orthodontists are recommending frenectomies to their patients.  I just turned around and asked my wife if her orthodontist had recommended a frenectomy and she said no.  My orthodontist never recommended a frenectomy either, and I have a large frenum!  Although there is a very small space between my front two teeth, they still touch at the bottom and it’s nothing that would show when people look at me.

One of the leading textbooks in orthodontics, Contemporary Orthodontics by Proffit, addresses the possibility that after the braces come off, teeth may move back to their original position.  He says:

“Another retention problem may be caused by the presence of a large or inferiorly attached labial frenum. A frenectomy after space closure and retention may be necessary in some cases, but it is difficult to determine the potential contribution of the frenum to retention problems from its morphology alone.  Therefore a frenectomy before treatment is contraindicated, and a post-treatment frenectomy should be attempted only if a continued tendency of the diastema to reopen and unresolved bunching of tissue between the teeth show that it is necessary.”

Here he says that a frenectomy should be done only after the space between the front teeth is closed.  He also says that it may be necessary in some cases but that you really can’t tell if the frenum will cause the space to reopen based on its size and shape alone.

In summary, he says that a frenectomy should be done only if the spaces appears to be reopening and you have tissue bunching up between the front teeth (which could cause the space to reopen).

A Labial Frenectomy After Braces – A Pediatrics Perspective

Now that we’ve seen what the orthodontists say about this, let’s turn our attention to the dentists that specialize in treating patients 18 years of age and younger: pediatric dentists.

Dr. Pinkham, in his leading dental pediatrics textbook, Pediatric Dentistry, talks about when and if a frenectomy should be performed.  He says:

“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.”

Just so you know, a diastema is the dental term for a gap between two teeth.

In the above quote, Dr. Pinkham says that a retainer could keep the gap closed after braces in most cases.  He says that a frenectomy should not be done until the diastema reopens after the braces have been removed.  Also, if that is the case, a frenectomy should only be done if the frenum is the suspected cause of the gap reopening.

Conclusion – My Perspective on Labial Frenectomies

As you can see, both Dr. Proffit (the orthodontist) and Dr. Pinkham (the pediatric dentist) both agree that a frenectomy should only be performed after the teeth are moved together with braces and if the frenum is determined to be the cause of the gap. I have to say that I agree with their position on this issue.

It’s important to emphasize again that a frenectomy should not be performed before the space between the front teeth is closed.  Also, a frenectomy should only be performed after it has been determined to be the cause of the space reopening.

If you have any questions about frenectomies, feel free to leave a comment below and I’ll get back to you.

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Videos of Laser Lingual Frenectomies
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A lot of people delay getting things done due to a fear of the unknown.  A few months ago, I wrote about how children might need to get frenectomies.  I think that the whole procedure can be better understood through the use of video.

Lingual Frenum (Courtesy of Enigma51 on Wikimedia Commons)Many people who are tongue-tied don’t want to get a lingual frenectomy because they don’t know if it will hurt, how long it will take, or what will actually happen.

Hopefully the videos below will alleviate those fears. I have embedded three different videos of lingual frenectomies. All of them were performed using laser technology rather than a traditional surgical procedure such as using a high speed drill or using a sharp instrument to cut away the frenal tissue attaching the tongue to the floor of the mouth.

Lingual Frenectomy Videos

This first one shows a young girl getting a lingual frenectomy. The dentist is using an ER:YAG laser to perform the lingual frenectomy procedure. Notice that all the dentist has to do is glide the laser over the tissue and the tissue is mostly cauterized, keeping bleeding to a minimum.

This next video shows the dentist performing a lingual frenectomy with a Periolase Nd:YAG laser.

This final video gives a quick 18-second overview of the whole lingual frenectomy process.

Conclusion

The use of lasers in dentistry has really improved the lingual frenectomy surgical procedure. The laser involves less pain and cauterizes the tissue so that sutures (stitches) aren’t needed.

If you are tongue-tied and you’ve been delaying getting a lingual frenectomy, I hope these videos have helped you.  If you have any questions at all about lingual frenectomies, or if you’ve had one and want to share your story, please do so in the comments section below.

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Frenectomy in Children Necessary?
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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?

Lingual Frenum and Labial Frenum
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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.

To the right, you can see a diagram of the mouth and the major frena that are present.

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 Wikipedia
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:

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.

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.