What is a Frenectomy and Why Would I Need One?

Breathing and Sleep Center - What is a Frenectomy

frenectomy is a minor medical procedure that cuts and reshapes the frenum with a scalpel or laser. There are three types of frenum in your mouth: the upper and lower labial frenum and a lingual frenulum. The labial frenum is the tissue that attaches your gums to your lip between your front teeth. You have three labial frena on both the top and one on the bottom. The lingual frenulum attaches the bottom of your tongue to the “floor” of your mouth. 

If your lingual frenulum is not the right size, it can restrict tongue movement and make it difficult to speak, chew, or do other things that require specific movements. If your labial frenum is too wide or long it may create a space between the front teeth. An extensive lower frenum may cause the gum to recede or pull away from the bottom front teeth. This increases the risk of gum disease or cavities.

HOW THE FRENULUM IS RELATED TO SLEEP APNEA

The tongue is a really important driving force for the development of your upper jaw (known as the maxilla). It is supposed to sit up and forward in the roof of your mouth. This will drive the dentition outward and promote proper development of the jaws, especially during the growing stages of children. 

If the lingual frenulum is too tight, it can restrict the tongue down to the floor of the mouth and prevent it from getting to the roof of the mouth. If the tongue isn’t in the roof of the mouth, it can’t drive the development of the upper and lower jaws. If those jaws are underdeveloped from the restricted tongue, then the airway behind those jaws can become obstructed. This constricted airway means you’re breathing through a coffee straw instead of a garden hose. This increases your risk of Obstructive Sleep Apnea. 

WHY A FRENECTOMY MIGHT BE REQUIRED

A “restricted lingual frenulum” means the tongue cannot move properly. This makes it difficult for infants to nurse or feed. If left untreated, it may impact speech development, cause difficulty with saliva management during eating and speaking, present problems removing stuck food from areas of the mouth, and even increase the risk of cavities. As described above, it can also prevent the growth and development of the jaws and airway.

Having a “restricted lingual frenulum” is often called being “tongue-tied”. Most lingual frenectomies are performed easily within the first few weeks or months of birth but can also be done for adults during certain sleep apnea treatment.

The primary concern for an “extended maxillary labial frenum” (a wide or long labial frenum) is the potential for orthodontic problems. If the labial frenum goes too far down the gum line it may cause a gap between the top front teeth.

Generally, dentists recommend waiting until a child’s permanent teeth grow in before worrying about any potential issues with the labial frenum. In many cases, the gap caused by the labial frenum naturally closes when adult teeth grow in.

Whether your medical or dental insurance will cover the cost of a frenectomy depends largely on what kind of frenectomy is required and the age of the patient.

WHAT TO EXPECT IN A FRENECTOMY

A frenectomy is a fairly common procedure that typically only takes 10 to 15 minutes and can be performed on infants, children and adults. It is most commonly performed on children. The doctor may use a scalpel or laser to make a small cut in the frenum or frenulum. A laser causes less bleeding, minimizes pain afterward, and generally has a faster recovery. 

Just performing the frenectomy might not be enough. Many times myofunctional therapy is required before and after the frenectomy procedure. This is essentially physical therapy for your tongue or lip. Myofunctional therapy ensures proper function for the tongue/lip and can prevent relapse of the restricted frenulum.

The Breathing and Sleep Center has its own myofunctional therapist available that can help achieve the best results and outcomes for their valued patients. 

General anesthesia may be used in very young patients for their comfort. Local anesthesia is usually enough to make older patients comfortable. Recovery takes anywhere from 1 to 3 weeks and most patients only require over-the-counter pain medications such as ibuprofen.

It is important to keep the area clean throughout recovery and follow the doctor’s care instructions. Most doctors recommend rinsing your mouth and brushing your teeth with a soft toothbrush, being careful to avoid irritating the gums or incision area.

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