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Age that a Child Needs a Frenectomy
©Gerard Koudenburg/

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.


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!

How Teeth Affect the Length and Shape of Your Face

Most people know that teeth help us speak and chew food.  However, an important, often overlooked function of teeth is that they help keep your face as long as it is.

Shorter Face Due to Lost TeethHave you ever noticed how older people sometimes look like their face was compressed together?  Often this is because they have lost teeth, and their jawbones have gradually gotten smaller over time.

If you open your mouth all of the way and then close it, you’ll hit on your teeth.  If you didn’t have any teeth, you would be able to close down much further, which would make your face appear to be shorter.

The picture above shows an elderly man who removed his dentures for the picture.  As you can see, without any teeth to hold his jaw bones apart, the space between the tip of his nose and chin is shorter than you would see in someone with teeth.  Also, you can see that his mouth area appears to be slightly puckered inwards because he doesn’t have any teeth to support the his lips and the area around his mouth.

Here’s a couple more photos to demonstrate this point. Here’s a profile view of an older man missing his teeth:

How Teeth Affect Shape of Face Side View
A Side view showing lower jaw coming forward and space between nose and chin getting smaller | ©Eclypse78/

And here’s a front view of the same man:

How Teeth Affect Shape of Face Front View
A Front view of the same man showing a small VDO | ©Eclypse78/

The technical name for the space between the jawbones when the teeth are touching is called the vertical dimension of occlusion or VDO for short.  If you’re curious about the relative lengths of a face with a normal VDO, look at this image on Google Images.

Ways Your Face Gets Shorter When You Lose the Vertical Dimension of Occlusion

Anything that causes you to lose teeth or tooth structure, can alter your VDO and thus make your face look shorter.  Here’s a list of a handful of things that can cause you to lose some VDO and make your face look shorter:

1- Losing teeth, especially the back teeth that bear a lot of the force when you bite down.

2 – Grinding your teeth. As you grind, you wear away tooth structure and your teeth get shorter, which causes your whole face to get shorter!

3 – Getting cavities. Cavities also eat away tooth structure and can cause your bite to collapse.

4 – Having Your Teeth Drift. This goes hand-in-hand with losing teeth.  Sometimes when you lose teeth, the neighboring teeth will drift into the empty spot (this is why spacers are important in kids!)  As the teeth drift, the top teeth and bottom teeth don’t come together like they used to, which can cause you to have a deeper bite and a shorter face.


As you can see from what I’ve written above, the main causes of losing facial height are due to preventable dental diseases.

By regularly going to your dentist you can treat cavities so that you don’t lose your teeth and you can also get appliances to help you stop grinding your teeth so that you don’t grind them away.

Do you have any questions or comments about this article?  I’d love to hear them in the comments section below – Thanks for reading!

FYI – This was supposed to be yesterday’s article, but my hard drive crashed Thursday night, I got a replacement yesterday at Best Buy and now I’m up and running again!

Braces and Pain

Do Braces Hurt?Recently, I’ve gotten quite a few questions about whether or not braces hurt.  A lot of the questions are from young people who will be getting braces very soon and are getting kind of nervous about whether or not the braces will hurt when they get them put on.

To answer the question of whether or not braces hurt, I’m going to divide it into four sections below:

1 – Do braces hurt when they get put on?
2 – Do braces hurt after they’ve been on for a while?
3 – Do braces hurt after they get tightened?
4 – Do braces hurt when you get them taken off?

Do Braces Hurt When They Are Put On?

When the orthodontist puts your braces on, he or she will usually glue metal brackets to the front of  your teeth and might even put metal bands around some of the back teeth.

After that, your orthodontist will usually put a wire that runs through all of the brackets.  The wire is what gradually applies forces on your teeth that causes them to move.

Having braces put on usually doesn’t hurt at all.

However, a few hours after the appointment, your teeth will most likely begin to hurt a little bit.  The pain isn’t a sharp pain, it’s more like a dull pain.

The best example I can give is to have you press hard on your fingernail.  It may not really hurt, it might just pinch a little.  Now imagine this same pinching feeling going on in your mouth.  This is similar to the feeling that I had when I had my braces on.

Keep in mind that we all experience pain in different ways.  For some people, getting braces may not really hurt at all, and for others it can be rather painful.

Do Braces Hurt After They’ve Been on for a While?

The reason braces hurt when you have them put on is because they are applying force on your teeth that makes your teeth move.  After a few days, the pain usually goes away as your teeth have already begun the process of moving and the tension in the wire has gone down.

After I’d had my braces on for a while, my teeth felt fine.  They felt like they did before I had braces — that is until I went to my first appointment to have them tightened!

Do Braces Hurt When You Have Them Tightened?

After you go in to have your braces adjusted, you will usually experience some more pain, although it probably won’t be as bad as it was when you first had them put on.

When you go in to have your braces tightened, the orthodontist will usually evaluate how your teeth have moved and put in a new wire to keep them moving into the position that will provide you with an ideal, healthy smile.  The new wire will have some tension in it and may cause you some discomfort until your teeth have moved into their new position.  This discomfort generally is most painful in the initial 24 hours after they are tightened but should resolve within two to three days.  After that, your teeth should feel great until you go in for your next appointment.

Do Braces Hurt When You Have Them Taken Off?

Having your braces removed is usually the highlight of the whole experience for many teenagers!  When you have your braces removed, the orthodontist takes out the wire and removes the brackets from your teeth.  I helped one of the orthodontic residents remove a teenager’s braces not too long ago and the brackets just popped right off.  She was nervously wondering if it would be painful to have them removed.  After the appointment she was relieved to realize that it really didn’t hurt at all!

After the brackets are removed, the orthodontist will make sure that all of the glue has been removed that was holding the brackets off and may choose to polish your teeth.

Getting your braces off shouldn’t hurt at all!


Did you have braces or are you getting braces soon?  Share your experiences with everyone using the comment form below.  Also, if you have any questions about braces and pain you can also leave a comment below.

Thanks for reading!

How Spacers Space Maintainers Look In Your Child's Mouth
©Jaimie Duplass/

A few months ago, I wrote an article detailing why it would be necessary for a child to get a space maintainer.  A space maintainer is commonly referred to as simply a spacer.

A Child That Has Lost a Tooth PrematurelyIn the picture to the left, you can see how the lower teeth of a six year old child might appear with a missing baby tooth — the first molar.  Let’s say that this kid didn’t brush his teeth a lot and ended up needing his first molar extracted because of a large cavity that couldn’t be fixed.

If the dentist simply removed that tooth and sent the child home, that kid’s permanent tooth would probably never come in!

Under normal circumstances, all of the teeth in the mouth exert pressure on each other, which holds them in their proper position. When a tooth is lost, the teeth next to the lost tooth will move into the lost space since the lost tooth can no longer exert its pressure on the adjacent teeth. Also, the teeth above the lost tooth will erupt a little more to fill in the space below.

The picture below shows what happens if a space maintainer is not placed after a baby tooth gets extracted.

Tooth Loss - The Space Fills In
When a tooth is lost, the teeth around it are eager to fill in the empty space

Why Teeth Move

Many people wonder why teeth want to move to fill in the gap when a neighboring tooth is extracted.  Here’s an analogy to illustrate why teeth move.

Large CrowdLet’s say there’s a giant crowd of people waiting in line for the chance to read the latest article on Oral Answers.  Now suppose that one person decides he’s sick and tired of waiting and decides to leave.  When he leaves, there is a small opening in the crowd where he used to be excitedly waiting.  Does the crowd leave that space open?  No!  The people that were waiting right next to the space where that guy used to be waiting move to fill it in the empty space that he left behind.

That’s pretty much how it works in the mouth.  When there’s an empty space, teeth move to fill it in.

A Space Maintainer Maintains The Old Space

A space maintainer will conserve the space left by the extracted tooth.  That way, when the permanent tooth starts to grow into the mouth, there will be lots of room for it to fit in perfectly.

Here’s a space maintainer that I made during my pediatric dentistry lab earlier this year.

A Birds Eye View of a Space Maintainer - Spacer
Here is a top view of a band and loop space maintainer.

Here’s another view:

A Dental Space Maintainer - Spacer
A side view of a space maintainer. This is how the space maintainer would look if you were sitting on the inside of your child’s cheek.


If a space maintainer is not used, the jaw may never grow to its full potential and consequently it might not have room for all of the permanent teeth, necessitating the removal of some teeth along with orthodontic treatment (braces).

Do you have any questions or comments about space maintainers (spacers)?  Leave them in the comments below and I’ll get back with you!