A frenum is a piece of tissue in the mouth that extends from the lips and the cheek to the gums. You can probably detect one of your frenums by placing your tongue in the space between your upper front teeth and lip. There are several different frenums in the mouth that attach to the inside of the lip, inside of the cheek and to the bottom of the tongue. Because frenum plays a very minimal role in tongue function and facial expression, a frenectomy procedure is completed without causing any functional problems. Individual needs or problems may dictate when a frenectomy is performed.
For the upper front frenum, a frenectomy is often postponed until the permanent lateral incisors and permanent canines erupt (permanent canines usually erupt between 11 and 13 years of age). This recommendation is based on the fact that when the laterals and canines erupt, they will generally close the early diastema (space) between the permanent central incisors. The procedure may be performed on children as young as 7 or 8 if the frenum is especially large. If the diastema is not closed by a normal eruption of the upper anterior permanent teeth, a frenectomy may be helpful, although orthodontics (braces) may also be necessary.
In certain cases, a frenum can prevent teeth from staying in place after they have been orthodontically moved together. For example, after a patient’s central incisors have been brought together, an excessive frenum can possibly cause the teeth to separate again.
In your lower front teeth, the frenum can actually pull the gum away from the teeth and cause recession. When a denture patient’s lips move, the frenum pulls and loosens the denture, which can be quite upsetting. This surgery is often done to help dentures fit better.
The lingual frenum, which attaches the tongue to the lower arch (tongue-tied), may interfere with speech. Generally, this will become apparent as the child begins to form words and phrases. If a notching of the tongue is noted when the tongue is protruded, it is generally recommended to have the frenum excised when the child starts developing speech patterns. Speech therapy may also be required.
Exceptions to postponing the frenectomy would be evidence on a radiograph of a notching in the bone between the central incisors or evidence of recession on the adjacent teeth. Many times an untreated frenum pull will cause gum recession to occur. If recession has already occurred, a soft tissue (gum) graft may also be necessary.
After the area is anesthetized, the frenum is released with an incision and/or a laser. Resorbable sutures may be placed that will dissolve within one week. The frenectomy site will be sore for 24-48 hours, but medication will help to alleviate any discomfort. Dr. Boden will check the site one week later to ensure proper healing.