A frenulum (or frenum) is a small fold of connective tissue that anchors or restricts the motion of a mobile organ. While frenula exist in various locations, such as the digestive tract and genitals, the most commonly discussed are those within the mouth. These oral structures are often the focus of attention when their limited size or thickness begins to interfere with function. This article focuses on oral frenula, exploring their anatomy, the problems that arise when they are restrictive, and the procedures used to correct them.
The Anatomy and Function of Oral Frenula
The mouth contains two primary types of frenula: the lingual frenulum and the labial frenula. The lingual frenulum is a thin band of tissue connecting the underside of the tongue to the floor of the mouth. This structure is composed of fibrous connective tissues, providing both strength and flexibility to the tongue’s movement. The main function of the lingual frenulum is to stabilize the tongue and prevent excessive backward movement, which is particularly important during swallowing and speaking.
The labial frenula, which include both maxillary (upper) and mandibular (lower) tissues, connect the inside of the lips to the gum tissue. The maxillary labial frenulum, located above the two upper front teeth, is the most frequently discussed of these. These labial frenula help stabilize the position of the lips relative to the teeth and gums. In their normal, unrestricted state, both the lingual and labial frenula are integral to foundational oral functions, allowing for the precise movements necessary for effective feeding and the proper articulation of speech sounds.
Identifying Issues Caused by Tight Frenula
Problems arise when a frenulum is unusually short, thick, or tight, limiting the mobility of the tongue or lips. This restrictive condition under the tongue is known as ankyloglossia, or “tongue-tie,” while a similar restriction of the upper lip is called a lip-tie. These conditions often manifest first in infants through feeding issues.
In newborns, a tight lingual frenulum can prevent the tongue from extending or elevating sufficiently to cup the nipple and maintain a proper seal during breastfeeding. This difficulty with latching often leads to poor milk transfer and poor weight gain, and can result in pain and nipple trauma for the nursing parent. Babies may also make a clicking sound during feeding or swallow excessive air, which can lead to gassiness and fussiness.
As children grow, a restrictive frenulum can cause other functional and developmental issues. Tongue-tie can impede the ability to articulate certain sounds, such as “t,” “d,” “z,” “s,” “th,” “n,” and “l,” possibly requiring speech therapy. The restricted movement also makes it difficult to sweep food debris from the teeth, potentially contributing to poor oral hygiene and an increased risk of tooth decay and gum inflammation.
A tight labial frenulum can also cause dental concerns. The tissue may pull on the gum line, leading to gum recession over time. A prominent labial frenulum is also a common factor contributing to a diastema, a noticeable gap between the two upper front teeth. Furthermore, a tight lip can make it harder for a child to fully clean the gum line near the top front teeth, increasing the risk of early childhood tooth decay in that area.
Treatment Options for Restricted Movement
When a restrictive frenulum causes functional issues that interfere with feeding, speech, or dental health, surgical intervention is often recommended. The two primary procedures are a frenotomy and a frenectomy, with the main difference lying in the extent of the tissue release. A frenotomy is a quick, minimally invasive release where the tight tissue is snipped, typically performed on infants with feeding challenges.
A frenectomy is a more comprehensive procedure that involves the complete removal or modification of the frenulum. This procedure is generally reserved for older children or cases where the frenulum is thicker, has reattached after a previous procedure, or is impacting dental development. While a frenotomy is often done without anesthesia in infants, older children typically receive local anesthesia for the frenectomy.
Both procedures can be performed using traditional surgical instruments like a scalpel or, increasingly, with soft tissue lasers. Laser use is often preferred because it can reduce bleeding, minimize discomfort, and promote faster healing. Recovery from a frenotomy is swift, often within a couple of days, while the frenectomy may require one to two weeks for complete healing.