A frenum is a muscular attachment between two tissues in the body, existing to connect the two parts. There are two kinds of frenum in the mouth, the labial frenum and the lingual frenum.
A labial frenum connects the inside of the upper lip to the center of the gums between the two upper front teeth. When this frenum is very large or restrictive, its presence can create a large gap between the two upper front. We refer to this as ‘lip tie’.
If the labial frenum is not causing pain or affecting the child’s eating and nutrition, pediatric dentists will usually advise patients to wait for the growth of the child’s two permanent upper front teeth before considering the treatment for a labial frenum. More often than not, a child with a large labial frenum will experience a fall or accident that will naturally tear this frenum. While it will cause bleeding and some discomfort, a fall that tears the frenum will typically not cause any permanent damage.
For children that make it through their early childhood without tearing the frenum, the gap between the upper front teeth is often lessened or eliminated during the growth of permanent teeth. If the gap between the front teeth does not close, braces are used to correct the gap. A labial frenectomy may be performed if the braces are unable to correct the large gaps caused by labial frenum.
In some cases where the presence of labial frenum can cause pain to the upper lip and gums in younger children, or when it is causing problems with nursing or feeding, a labial frenectomy is performed.
The second kind of frenum is called lingual frenum. It is a muscular tissue that connects the bottom center of the tongue to the floor of the mouth. Lingual frenum that extends all the way to the tip of the tongue can sometimes restrict the patient from eating and speaking properly. This condition is also called ‘tongue tie’. An infant that is tongue-tied will have a hard time nursing and often the mother will experience pain and discomfort as the child struggles to feed.
A lingual frenectomy is often performed when the presence of the lingual frenum prevents the child from eating and speaking properly. In infants, the pain is very minimal and the baby can nurse immediately afterward.