A frenectomy is the surgical alteration of a frenum which is a fold of tissue which restricts movement. In the mouth this is generally a small portion of tissue related to the upper lip, the tongue, or the lower lip.
Usually one end of the frenum is connected to a muscular part of the body, like the tongue or lip, and the other to a relatively static part such as the floor of the mouth in the case of the tongue, or to the gums in the case of the upper lip.
Too much restriction of movement of the tongue, for example, is not necessarily a good thing since it can interfere with normal function and this is why a frenectomy may be required.
There are three types, that vary on the location of the problem in the mouth:
- Sometimes the frenum associated with the upper lip, which is in the midline, tends to cause or exacerbate spacing between the upper two front teeth (central incisors) and this may be considered unpleasing to the eye. Such a marked frenum extending well down into the gum can also be a barrier to an orthodontist being able to close up a mid-line gap between the front teeth and so a ‘maxillary’ frenectomy would be indicated.
- There is sometimes a similar situation in the lower jaw where an extensive frenum can be associated with separation of the incisor teeth or can cause the gum to pull away (recede) from the neck of one or more lower front teeth. This would invite food debris to lodge and gum disease to follow, so is again an indication for a frenectomy.
- The third most common type of undesirable frenum in the mouth is that which connects the underside of the tongue to the floor of the mouth. If this is extensive, running almost up to the tip of the tongue, it can seriously restrict it’s movement, causing speech difficulties and adversely affecting oral hygiene. This condition is termed ankyloglossia, or more commonly being “tongue-tied”. The condition is usually noticed in the young child when difficulty feeding or learning to speak become apparent. A ‘lingual’ frenectomy is required here.
The surgery is a straightforward and a quite common dental procedure performed both on children and sometimes adults. A child might receive speech therapy first before resorting to the procedure although it is not a major operation by any means.
Adults who have no natural teeth remaining and require full dentures may need a frenectomy in one or more locations if a marked frenum is tending to unseat a denture. This is more common in the lower jaw where the amount of bony ridge to hold a denture is much less than in the upper jaw.
The frenectomy procedure
A frenectomy may be done with a scalpel or a laser. The latter causes less bleeding, reduces the need for stitches, and minimizes post-operative discomfort (and has a faster recovery), but it does require that the patient be very still throughout.
If the patient is young this may necessitate a general anesthetic. In the older patient local anesthesia is quite sufficient. The procedure only takes about 15 minutes and stitches are placed if it’s done in the traditional way. The cost is usually relatively low compared to other dental surgery.
After the operation, it’s essential to keep the area clean with gentle salt water mouth rinses for best recovery. If at all possible, the patient should carry out careful tooth brushing with a fairly soft brush, to remove plaque on the teeth without irritating the gums. Stitches may dissolve by themselves in time or may need to be removed by the dentist. It can take one to three weeks to achieve complete healing, so care is needed when eating, and very hard foods should be avoided.
Pain can be controlled with over-the-counter pain killers such as ibuprofen or other NSAIDs (non-steroidal anti-inflammatory drugs), and doesn’t usually last for more than one or two days.
There is always some blood loss when surgery is carried out, but a frenectomy is a minor procedure and doesn’t constitute a serious risk of complications in the healthy patient.
A frenectomy involving the underside of the tongue is most liable to cause a fair amount of bleeding since there lots of blood vessels in the area, but this is not usually a problem. Use of a laser will reduce bleeding significantly but it’s not always an option. There is a slight risk of damage to the facial nerve that provides for sensation in the chin and lip, and consequent numbness. The feeling usually returns within a few months, however, if this should happen.
A frenectomy is generally successful in achieving the desired result although just occasionally it might have to be done again. The freedom of movement of an otherwise “tied” tongue, or the closing of an ugly gap between front teeth is well worth the slight discomfort!