A frenectomy is a minor oral surgery that removes or releases a frenum, one of the small bands of tissue that connect your lips, cheeks, or tongue to your gums and the floor of your mouth. The procedure takes only minutes and is one of the most common soft-tissue surgeries in dentistry. It’s done when a frenum is too tight, too thick, or attached in a position that causes problems with breastfeeding, speech, tooth spacing, or gum health.
What Is a Frenum?
A frenum (also called a frenulum) is a rope-like band of tissue, usually the same color as your gums, made primarily of dense connective tissue packed with collagen. You have several of them in your mouth, but the three most prominent are the lingual frenum under your tongue (visible if you lift your tongue toward the roof of your mouth), the labial frenum above your two upper front teeth (connecting your upper lip to the gum), and a smaller labial frenum below your two lower front teeth.
These bands normally help stabilize lip and tongue movement. Problems arise when a frenum is unusually short, thick, or anchored too close to the teeth or the tip of the tongue, restricting normal function.
Why a Frenectomy Is Recommended
The reasons for the procedure differ by age group, but they generally fall into three categories: feeding difficulties in infants, speech issues in children, and dental or gum problems in older children and adults.
Infants and Breastfeeding
A tight lingual frenum, commonly called tongue-tie (ankyloglossia), can make it difficult for a baby to latch during breastfeeding. Symptoms typically show up as painful nursing for the mother and poor milk transfer for the infant. However, tongue-tie alone doesn’t always require surgery. The American Academy of Pediatric Dentistry recommends evaluating other potential causes of feeding difficulty, including nasal obstruction, airway issues, reflux, and craniofacial anomalies, before performing a frenectomy on a newborn. A 2024 study in Pediatrics found that tongue-tie did not significantly affect breastfeeding rates at six months or infant weight gain, suggesting the decision should be made carefully and on a case-by-case basis.
Speech in Children
A restricted lingual frenum can limit tongue movement enough to affect how a child pronounces certain sounds. A systematic review and meta-analysis covering 10 studies, with an average patient age of about four years, found that frenectomy was associated with a meaningful improvement in speech articulation. The data also suggested that catching the issue earlier in childhood may lead to better outcomes, though that finding wasn’t conclusive after adjusting for other factors. Speech therapy is often used alongside surgery.
Tooth Spacing and Gum Problems
In older children, teenagers, and adults, a labial frenum that attaches too close to the gum line between the upper front teeth is the most common cause of a diastema, the persistent gap between those teeth. Beyond cosmetics, a high frenum attachment can pull on the gum tissue every time the lip moves, leading to gum recession, deeper periodontal pockets, loss of the triangular gum tissue between teeth, and increased plaque buildup because the area becomes harder to clean.
When a frenectomy is done for orthodontic reasons, the American Academy of Pediatric Dentistry recommends waiting until the permanent canines have erupted and performing it either after orthodontic closure of the gap or during orthodontic treatment. Most diastemas in baby teeth and mixed dentitions close naturally with growth, so early surgery is rarely needed.
How the Procedure Works
A frenectomy is performed in a dental or oral surgery office, typically under local anesthesia (a numbing injection near the treatment site). For very young infants, the tissue is thin enough that topical numbing gel alone is sometimes sufficient. The procedure itself is quick, often completed in under 15 minutes.
There are two main approaches:
- Scalpel (traditional): The frenum is cut and removed with a surgical blade, and the wound is closed with a few small stitches.
- Laser: A dental laser vaporizes the tissue. This approach produces significantly less bleeding during the procedure because the laser seals blood vessels and tissue proteins as it works. It also eliminates the need for sutures in most cases and tends to cause less post-operative pain, likely because the surgical site is smaller and there’s less tissue trauma.
At three months after surgery, healing outcomes are comparable regardless of which method is used. Laser-treated wounds can look different early on because the body forms a protein layer over the surface rather than a traditional scab, and initial healing may appear slightly slower. But the final result is the same.
Recovery and Aftercare
Most people experience minimal discomfort after a frenectomy. Bleeding is typically negligible, especially with laser procedures. Over-the-counter pain relievers like acetaminophen are usually enough to manage any soreness. A follow-up visit about one week after surgery is standard, and satisfactory wound healing is typically visible by that point.
For lingual frenectomies, post-operative tongue exercises are a critical part of recovery. They help maintain the new range of motion and prevent the tissue from reattaching as it heals. A typical exercise routine includes sticking the tongue out as far as possible, trying to touch the nose with the tongue tip, making circular motions with the tongue extended, and opening and closing the mouth while holding the tongue tip against different spots on the palate. Patients are generally advised to do these exercises in front of a mirror about 15 times per session, three times a day, for up to three months.
Risks and Complications
Frenectomy is a low-risk procedure, but complications can occur. The most common concern is tissue reattachment, where the frenum grows back partially during healing, which is why the stretching exercises matter so much after a lingual release.
In rare cases, particularly with lower lip frenectomies in patients who have had prior orthodontic treatment, the surgery can expose part of a tooth root if the underlying bone is thin. This is called bone dehiscence, and it’s more of a risk when incision lines aren’t planned carefully around previously moved teeth. Infection is possible with any oral surgery but uncommon with proper aftercare.
Cost and Insurance
A frenectomy is billed as a dental procedure. Fee schedules list the procedure in the range of roughly $500 to $560 before insurance, though actual out-of-pocket costs vary widely depending on your location, the provider, and whether a laser is used. Many dental insurance plans cover frenectomies when they’re deemed medically necessary, such as for documented feeding difficulties or as part of orthodontic treatment. Some families also have success billing through medical insurance when the procedure is tied to a diagnosed condition like ankyloglossia. Checking with both your dental and medical insurance before scheduling is worth the effort.