Frenums And Frenectomy

Healthy functioning of oral space involves the proper working of dental structure in sync with soft tissues of oral space, facial muscle, and jawbones. One such important part of the dental system is the frenum— a mucous membrane fold containing dense collagenous tissue and elastic fibers- that attach the lip and the cheek to the gingival, the alveolar mucosa, and the underlying periosteum. Mucous membrane folds ensure controlled motion of mobile organs, proper speech, swallowing, and movement of the mouth. Besides its functional role, it plays an important role in making your smile aesthetically brilliant and achieves the desired orthodontic goals without pain and discomfort. There are three types of frena, namely lingual, labial, and buccal. If your frenulum is abnormal, your dentist might recommend modifying or cutting the tissue so that desired functional and aesthetic goal could be restored.

What is Frenectomy?

A frenectomy is a surgical procedure to cut or modify binding tissues of the body. Although this procedure is used commonly to remove abnormal tissues, it is more popular as an oral procedure to remove frenum, including attachment to the underlying bone, to correct lip tie or tongue tie issues. If your frenulum is too short or too tight your dentist might recommend frenectomy to correct swallowing, speech, or aesthetical dysfunction.

Lingual Frenectomy

The tissue connecting the tongue to your mouth is called the lingual frenum. You can feel the lingual frenum underneath your tongue when you stretch your tongue outward. The length of the lingual frenum varies from person to person, but in some cases, people are born with abnormally short frenulum making tongue movement difficult. The condition, called “tongue-tie”, affects newborns’ feeding and speech development. After physical examination, your oral care specialist might recommend lingual frenectomy to improve tongue motion in oral space.

Maxillary Frenectomy

The mucosal membrane connecting the top lip to the gum area just above the front teeth is called the labial frenum. If labial frenum attachments, whether mucosal, gingival, papillary or papilla penetrating, are abnormal it is called lip adhesion. This aberration can affect speech and dental development. Lack of space between lip and teeth could make cleaning difficult, thus increasing the risk of gum disease and other dental issues. If you find the labial frenum of your kid unusually short you should consult your dentist.

Following examination of tissue and dental development, your dentist might recommend maxillary frenectomy to improve mobility of the upper lip, thus solving speech and other dental challenges. In some cases, your orthodontist might recommend frenectomy before the orthodontic procedure if your labial frenum is too short or too tight.

What Are the Steps of Frenectomy Procedure?

Unless the frenum of your kid is abnormally short or tight, he will not face much difficulty in oral functionalities like feeding, speech, and swallowing. If the frenulum is affecting normal oral functions or making you self-conscious while smiling, you should consult your dentist to find a permanent solution. The oral care specialist will detect abnormal frenae by physical examination, which involves applying tension over the frenum to see the abnormality in the movement of the papillary tip. Besides, the frenum could be pathogenic if it is too wide, absence of attached midline gingiva, or shifting of interdental papilla on the extension of the frenum. Whatever is the frenum abnormality, the frenectomy is a simple surgical procedure, involving these steps:

Once all possible diagnosis is done, you will be asked to bring your kid on the scheduled date. You might be told to restrict some kind of food intake as sedative administration might be required to conduct frenectomy with precision.

The procedure starts with normal cleaning and numbing of the area to manage pain. Once the area numbs, your doctor will cut the frenulum using a scalpel, surgical scissors, or laser. Depending on the size and severity, the suture may or may not be required. If laser technique has been used to modify frenum, tissue damage will be minimal with less bleeding, making healing fast and painless. It all takes 15 to 30 minutes to conduct a frenectomy procedure.

You will be free to go home in just a few hours and enjoy the benefits almost immediately, however you will have to take prescribed medications to boost healing and maintain oral hygiene to avoid infections.

Who Needs Frenectomy? 

Most dentists recommend completing orthodontic procedures or aesthetic treatment before frenectomy as not all teeth spacing is caused by frena abnormalities. Your dentist or oral care specialist will recommend frenectomy if:

  • The cause of the midline diastema is the abnormal frenal attachment
  • Gingival recession is caused by close frenal attachment with gingival margin
  • Short or tight frenulum affecting oral hygiene
  • Kid needs frenum removal to allow normal teeth development
  • Frenum aberration affecting orthodontic treatment outcome
  • Infant facing difficulty in feeding due to tongue tie or lip tie
  • Frenum affecting the normal movement of the tongue or lips, thus speech, and swallowing

When Should They Be Done?

Frenectomy procedure is relatively painless and easy and most patients recover without any major complications. Thanks to the development of advanced surgical procedures involving lasers, now frenectomy is almost painless with minimal blood loss. Oral care specialists recommend frenectomy to be done at the earliest as infants and young toddlers heal relatively quickly. Early treatment will allow your child to avoid long-term consequences of abnormal frenum and develop a healthy dental system to lead a healthy life. If you notice the frenal abnormality, you should get in touch with your dentist so that he could examine tooth and jaw displacement and recommend frenectomy if it is going to affect nursing and speech.

If short or tight frenulum makes you self-conscious of your appearance, you can get a frenectomy done by a dental surgeon to make your smile brilliant. Don’t forget to discuss the cost as aesthetics improvisations might not get covered under dental insurance.

 What is the Average Cost of Frenectomy? 

Just like any other treatment, the cost of a frenectomy procedure varies depending on the level of complexity, location of the clinic, whether sedative is required or not, and the number of visits required. You might have to pay a consultation fee to examine the severity of the case and the additional cost involved in healing and aftercare. Frenectomy is a relatively simple and painless procedure and patients recover without the extensive need for aftercare. As far as the cost of frenectomy procedure is concerned on average it costs between $800 and $1500. Thankfully, almost all health insurance companies cover oral frenectomy. So, you should inquire in advance to get the best possible treatment from a licensed practitioner at almost no cost.

Is a Frenectomy Medical or Dental?

Any treatment related to the lingual frenum, the labial frenum, and the buccal frenum comes under the dental procedure. Since oral frenectomy, it is all about improving oral and related functionalities like eating and speech. You will get all possible benefits available under dental insurance.

What are the Risks Involved in Frenectomy Procedure?

Unlike other oral and throat invasive procedures, the frenectomy is the least risky as a minor incision is made to cut or modify the frenum. Although most patients recover easily with pain and infection medications, in some cases with sutures recovery might take longer than average. Complications are rare, but patients might experience:

  • Numbness of tongue
  • Temporary soreness
  • Minor bleeding
  • Blood clotting and bad breath
  • Infection
  • Scar
  • Anesthesia-related temporary uneasiness

Ways to Boost Frenectomy Recovery

Fear of incision is pretty natural and this becomes more intense when it is related to oral and facial parts. With modern surgical technologies, the frenectomy is now almost painless with minimal bleeding. With proper medication aftercare and hygiene, most patients recover easily post oral frenectomy. You can make recovery faster by following these simple steps:

  • Oral cleanliness is most important to prevent infection.
  • Besides standard oral hygiene practices as recommended by your surgeon, you have to avoid certain foods for a few days to avoid infection risk caused by trapped food.
  • Continue taking medicines prescribed by your doctor to heal faster.

In a day or two, you will regain oral functionalities and feel speech or aesthetic improvisation. In just a week or so, your wound will heal properly and you will have better functioning oral space.

Takeaway

Oral frenectomies, whether maxillary or lingual, are simple procedures. In just 30 minutes your doctor will cut or modify the frenum using suitable surgical tools. Frenectomy will remove the nursing challenges of your infant and help your kid develop a perfectly functional dental system for proper swallowing and speech. This painless surgical procedure is highly effective in correcting a lip tie or tongue issue, thus ensuring better oral functionality and healthy life with confidence to smile freely. It is all about the suitability of the treatment, so feel free to discuss all possible expectations including expected outcome, risks involved, and of course the cost and insurance coverage.

An experienced oral care specialist will first examine the dental structure in detail to determine the suitability of frenectomy and recommend the procedure accordingly. If you are concerned about frenal abnormalities affecting your facial appearance, you should discuss all possible pros and cons with your dentist as the only frenectomy might not help much in solving dental spacing and other misalignment issues.

Published by Dr. Daniel Bronsky

Dr. Daniel is an orthodontist at Invis London.

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