Frenectomy

What is a frenectomy?

The folds of tissue that join together the lips, tongues, and cheeks are known as frenum, a frenectomy is a dental procedure that involves the removal of one or more of these folds. There are several types of frenectomy that can be carried out; a lingual frenectomy – an operation on the tongue, labial frenectomy – surgery on the lips, or a frenectomy that removes the tissue between two teeth.

What is the procedure used for?

Frenectomies can help with numerous medical problems affecting the mouth in adults and children. As the tongue develops, larger frenums can affect speech – a condition referred to as ankyloglossia, by holding the tongue in place too securely, instead of allowing it to move freely to form words and sounds. Over-sized frenums can also make it difficult to eat, particularly in infants, due to the tongue not becoming correctly co-ordinated with the chewing motion. In older children, it may become obvious that the tissue is far too rigid, either because the folds under the tongue get stuck between the teeth, or because they can’t stick their tongue out to any great degree. A lingual frenectomy is used to free the tongue and allow speech to properly develop, if the frenum is not removed, it could also cause problems with periodontitis.

A labial frenectomy is to help with larger frenums that are attached between the front two teeth on the upper jaw, this condition is usually noticeable after the adult teeth have grown in, but in some cases it is visible even before the baby teeth have started to appear. Labial frenum are particularly troublesome for orthodontists, causing gaps to form between the teeth that can return even after treatment, a frenectomy should be performed to prevent a relapse after braces have been used.

The tissue in the mouth tend to cause less problems as we age, most larger frenums should be removed before adulthood. However, older people who want to be fitted for dentures may need to have the folds reduced if they prevent the dental appliance from sitting securely in the mouth. This is typically a problem which affects the skin at the front of the mouth on both jaws.

How is the procedure performed?

A frenectomy is actually a fairly simple procedure, the surgeon will use a scalpel to cut the frenum away and then stitch the wound carefully to close it up. Some clinics may use a laser to cut through the tissue, this cauterises the edges of the incision as it works, eliminating the need for sutures and allowing for a faster healing period.

If this procedure is being performed on an older patient, a local anaesthetic will generally be used. However, younger children may need to be completely anaesthetised to prevent them moving during the surgery. A frenectomy should take no longer than about fifteen minutes to complete, depending on the experience of the surgeon and barring no complications.

What happens after?

It usually only takes a few weeks for an operation like this to heal completely, during that time it’s important to maintain a decent oral hygiene routine, to prevent infection. Be careful as you brush, if you have sutures holding the wound together you don’t want to rupture them. Patients who have dissolvable stitches don’t need to worry as much, but a delicate technique is still the best way to deal with aftercare. Even if you do have dissolvable stitches, you will still be required to return to the surgery for a follow-up appointment, so your surgeon can make sure everything is healing normally and check for signs of infection.

The surgery isn’t too invasive, so there shouldn’t be too much pain, but if you or your child is experiencing discomfort afterwards, you should try an over-the-counter anti-inflammatory such as Ibuprofen; it can help with the pain and also reduce any inflammation. If you notice a severe amount of pain, head back to the clinic to consult with a medical professional. Ripped sutures or early symptoms of infection could warrant a trip to the emergency dentist, the Pearl Dental Clinic runs a twenty-four hour surgery for patients that require immediate assistance, give them a call if your problem is out of office hours. Having said that, most frenectomies will heal without any trouble, especially if the patient cleans the area carefully.

How risky is a frenectomy?

In some cases, the tissue can re-bond to its original position after the operation, this requires a repeat surgery to try and solve the problem. Lingual frenectomies are more likely to fail than labial frenectomies; this is because the tongue will not have developed the necessary muscles to move around and so it will just return to its original position.

Bleeding is another problem that can occur after a frenectomy, more so with the lingual variety than the labial, due to the larger blood vessels that travel through the tongue. In general, the tongue is more difficult area to deal with because it is much larger and more complicated than other parts of the mouth. However, it should be noted that excessive and prolonged bleeding are not commonplace following a frenectomy.

Another risk is bruising of the nerves in the jaw. This is seen more frequently in older patients who need to make room for dentures. Damaging the nerves that supply sensation to the chin and lower lip can lead to numbness that lasts several months, however, the function and movement of the jaw are not affected.

If you have undergone a frenectomy and you are concerned about heavy bleeding or on-going numbness, contact your dentist to discuss your symptoms, it may just be that you are taking slightly longer to heal than the average patient or you could need further treatment.