White Washed Wood

Pediatric Frenectomy

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What is a Frenectomy?

A frenectomy is a simple outpatient surgical procedure involving removing one or both frena from the mouth. A frenectomy is a quick in-office procedure that babies tolerate well and heal quickly.

What is Frenum?

Your baby's frenum or frenulum is a small piece of connective tissue that connects their cheeks, tongue, or lips to their gums. We all have many frena in our bodies, but the frena that typically require frenulectomy are inside the mouth.

Primary frena in the mouth

  • Lingual frenum – This frenum connects the tongue to the floor of the mouth.

  • Labial frena – These frena attach the lips to the gums above the top center front teeth and the bottom center front teeth. There is the top (maxillary) and lower (mandibular) frenum. The one that causes the most problems or often requires treatment is the maxillary (top) labial frenum.

  • Buccal frena – These frena connect the gums to the insides of the cheeks.
     

These frena have a minimal purpose, so removing them does not cause any loss of function.

How to determine if your child needs a frenectomy?

If your child is tongue-tied (ankyloglossia), aka has the lingual frenum more anterior to the tip of their tongue, limiting tongue movement, they may experience symptoms such as:
 

  • Nursing/breastfeeding, your child may have problems latching or drawing milk because the tongue has to move and roll a particular way to get the milk out.

  • Difficulty speaking, your child may have speech problems due to restricted tongue movement.

  • Difficulty sticking tongue out far, making it difficult to eat and swallow.

  • Other challenges your child may face as they get older are problems licking an ice cream cone, licking their lips, kissing, or playing a wind instrument.
     

A thick maxillary labial frenum that extends too far down to or very close to the gum line can cause orthodontic problems and interfere with the proper growth and spacing of the upper middle front teeth. When the labial frenum is close to the gums, there is usually a gap between the two front teeth even after orthodontic treatment, or it can cause the space to reopen after braces.

How The Frenectomy is Performed?

If you or one of your child's healthcare providers determines that your child is having problems due to an elongated frenulum, a frenectomy will be recommended. Dr. Dina will assess the frenum in question to determine whether or not the procedure is necessary.

The two types of frenectomies commonly performed in dentistry are a lingual frenectomy and a maxillary frenectomy. We will perform the procedure with scissors, a scalpel, or a laser. Using a CO2 laser to perform the frenectomy makes the procedure quick with little to no bleeding.

How to prepare for the procedure?

You do not have to do anything to prepare for the frenectomy procedure for your child, but if you want to, you can give your child Tylenol 30-60 minutes before the procedure since it can help to minimize discomfort. You can use ibuprofen for children six months or older, but be sure to check with your pediatrician and follow the dosing instructions on the package. If you have homeopathic remedies that work for you and your family, you can also use those.

Day of the Appointment

Dr. Dina will use topical and/or local (shot) anesthetic to numb your child.

Once your child is numb, Dr. Dina uses the laser to release (cut) the frenum, moving in more posterior to the tongue if it is the lingual frenum or away from the central front teeth for the maxillary labial frenum.

The procedure only lasts 10-15 minutes.

After the Appointment

Your child will have little to no discomfort after the procedure; they probably will not need pain medication. However, if they do, you can give them over-the-counter medicines that you usually give them when they have a headache.

Minimal swelling and discomfort may occur after surgery. In the first 24 hours, to help minimize swelling, apply an ice pack outside your child's lip if the surgery was for the maxillary or mandibular labial frenum. If your child had a lingual frenectomy, use a popsicle or place ice chips under the tongue. For infants, you can freeze off breast milk, break a small piece and apply that to the wound.

Some bleeding or minor oozing following frenectomy surgery is normal; this should be minimal because we use a soft tissue laser. If excessive or heavy bleeding occurs in infants or young children, seek immediate medical care.

Expect to see a patchy white or yellow area in the location of the frenectomy, this part of the healing process.

Aftercare

Your pediatric dentist will go over aftercare instructions based on your child's case but below are some things they may tell you to do:

  • For infants and toddlers, increased skin-to-skin contact such as cuddle time, warm baths, or increased breast time.

  • Wait until the numbness has worn off before eating.

  • Avoid using straws for the first 24-48 hours.

  • Avoid hard/crunchy, acidic, and spicy foods until the wound heals.

  • Drink plenty of liquids.

  • Brush your child's teeth like they typically do starting tonight.

  • Your child can resume regular physical activity the next day after the procedure.

  • Your child may rinse with warm salt water 2x/a day after 24-48 hours.

Additionally, discomfort and discolorations are to be expected after a frenectomy.

Home Exercises or Stretches

You must help your child manipulate the area of the frenectomy to minimize reattachment. The body will attempt to heal by returning to how things were before the frenectomy. Completing the exercises Dr. Dina recommends is the best way to reduce the chance of the body healing unfavorably. Start your child's stretching regimen the evening after the treatment. Wash your hands thoroughly before touching the surgical site.

If your child had a labial frenectomy, Dr. Dina might tell them to lift, lower, and move the lip every few hours to stretch it starting the evening of treatment. For lingual frenectomy, your child can do tongue clicks 30 loud ones 3x a day, tongue circles, or lick their lips in a full circle ten each direction 3x a day.

Healing

Recovery takes approximately two weeks, but a frenectomy's benefits can be immediate.