Frenectomy procedures are any procedures involving cutting or modifying the frenum – soft binding tissue present in the oral cavity/mouth or other parts of the body that have a frenum. Frenectomy procedures are common. While the procedures can take place anywhere in the body where there is a frenum, the term frenectomy is most popular when referring to oral procedures done to correct a lip tie or tongue tie.
The mouth has several frena. Our focus here is on the lingual frenum and buccal frenum
The lingual frenum connects the tongue to the mouth floor. You can feel/see the lingual frenum by lifting your tongue up. The lingual frenum’s size and tightness varies from one individual to another. 3.5 to 5% of people are born with a short lingual frenum to a certain extent. This condition is known as ankyloglossia or tongue-tie. Individuals with this condition suffer from restricted tongue movement.
The lingual frenum has many roles, the most notable being supporting the tongue and limiting tongue movement in different directions. If the lingual frenum is too tight/short, it can interfere with speech development and swallowing. Babies with a short or tight lingual frenum also have problems breastfeeding, resulting in other problems like malnutrition. This creates the need for a procedure to cut or modify the lingual frenum. This procedure is called lingual frenectomy.
The buccal frenum connects the cheeks and lips to the gums (gingiva), alveolar mucosa and underlying periosteum. If the buccal frenum is too close to the gums, it can cause problems like increased plaque formation. Buccal frenum that is too close may also make it hard to brush teeth. Besides closeness, other buccal frenum problems include poor attachment to the gums, poor depth, and high attachment. These problems create the need for a procedure to cut or modify the buccal frenum. This procedure is called buccal frenectomy.
Lingual and Buccal Frenectomy Procedures
Both procedures are similar in nature. The only difference is the frena being worked on. Before any frenectomy procedure is done, the need for the procedure must be established.
The need for lingual and/or buccal frenectomy procedures is first identified by a parent or caregiver. As mentioned above, infants with a tight or short lingual frenum tend to have problems breastfeeding. They may also suffer from speech problems as they grow. These are some of the signs that a caregiver or parent notices and communicates to the pediatrician triggering an examination.
Lingual frenum examinations utilize a special tool known as the Hazelbaker tool. This tool rates the ankyloglossia. Upon examination, a patient can be said to have a tight lingual frenum, less elastic frenum and/or short frenum that is less than one centimetre in length resulting in a V-shaped or clefted tongue tip. Examination also identify tongue motion limits in lift, lateralization, and extension.
Buccal frenum examinations check for tension in the upper lip by moving the lip outwards and upwards. Tension in the lower lip is checked by moving the lip lower and sideways.
Oral frenectomy procedures are fairly straightforward.
Step 1: Treatment begins with an oral examination or consultation with a doctor or pediatrician. During this step, a patient’s history will be taken, and a head and neck exam performed, including a visual exam of the frenum in question and related functions. After evaluation, the patient will be booked for the procedure. On the day the procedure is done, the patient needs to be secured while facing up. If the patient is an infant, he/she may need to be held during the procedure.
Step 2: Patients need to prepare for the procedure. To facilitate this, physicians provide detailed instructions on the procedure. Patients may be asked to avoid water and food a few hours before the procedure, depending on whether an anesthesia will be used or not.
Step 3: Oral frenectomy procedures are usually done at a dental clinic, doctor’s office, or in a hospital. Patients receive instructions on when to arrive for the procedure. On arrival, patients are prepared for surgery, which includes consenting to the procedure. Once the patient is secured in place in the procedure room, a local or general anesthetic is given to numb pain.
Step 4: The frenum in question is sniped/cut using a scalpel, cauterizing equipment, or surgical scissors. The procedure is done with unmatched care. For buccal frenectomy, the frenum located between the gums and cheeks is cut or modified. Lingual frenectomy involves removal or modification of the lingual frenum located underneath the tongue. In severe or more complex cases, the procedure may involve stitching after cutting the frenum (to close the resulting incision).
Important: The process can be done using laser. If that’s the case, the procedure is known as laser frenectomy, which simply means a laser is used for the cutting/modification. Laser frenectomy has many benefits, the most notable being reduced infection risk. Laser frenectomy also reduces blood loss and the time taken to perform the procedure. Lingual and buccal frenectomy procedures take a short time (approximately 15 minutes). The procedures can also take less time.
Step 5: The procedure ends with a reexamination of the treatment site and recording the outcome.
What are the risks, complications, or the side effects of lingual and buccal frenectomy procedures?
Your doctor is supposed to explain the potential risks, complications, or side effects before doing the procedure. They include:
I. Excessive bleeding
II. General risks associated with anesthesia such as dizziness and confusion after the procedure is done.
III. Infection. However, infection risks are lower if the procedure is done using a laser instead of a scalpel or similar cutting instruments.
IV. Nerve damage to the tongue and mouth
VI. Pain. Infants may cry, but for a limited period in most cases.
VII. Reattached frenulum (very rare)
Benefits of lingual and buccal frenectomy procedures
I. Correction of underlying problems. Lingual frenectomy corrects eating and nursing problems in infants. The procedure also improves speech in both children and adults with a short or right lingual frenum. Buccal frenectomy improves oral hygiene.
II. Quick procedure: As mentioned above, the procedures take a few minutes only (15 minutes or less)
III. Quick recovery: Frenectomy procedures don’t cause prolonged discomfort. Patients recover in a few days
How long does it take to see results?
Frenectomy procedures have noticeable results immediately. If the procedure is done using a local anesthetic, patients need to wait for a few hours for the anesthetic effects to wane off before noticing any results.
After frenectomy procedures, children shouldn’t be placed on their bellies as this can increase pressure on their jaws and interfere with healing.
Patients are also supposed to stay for a day (24 hours) without rinsing the mouth. After a day, patients can start rinsing the mouth several times every day using salty water to boost healing.
Lastly, patients need to go for follow-up appointments on a weekly basis to monitor healing and establish whether the procedure resulted in the desired outcome.
Recovery after lingual and buccal frenectomy
1. Frenectomy can result in slight bleeding in the treatment area. While bleeding is normal, it should stop. Any bleeding on the treatment site during recovery should be stopped by gently pressing a sterilized gauge pad on the treatment area till the bleeding stops.
2. Swelling and pain is common during recovery. Patients usually get pain killers to stop the pain and other medication for controlling the swelling and other resulting symptoms.
3. The recovery period is also characterized by little to no activity. However, patients are usually able to resume normal duties in about a week or so.
4. For healing to be fast and easy, patients must keep the treatment areas clean. This may be simple for infants. For adults to meet this recovery requirement, they need to limit food intake for a few days after the procedure is done. Any food clogged in the treatment area increases infection risks.
5. To reduce infection or complication risks, patients may be prescribed oral antibiotics. Taking the prescribed medication and observing other recovery requirements above can fasten healing to less than a week.
6. Patients are advised to eat soft foods only and avoid the treatment area when chewing. Most importantly, patients should maintain a balanced diet and drink a lot of fluids.
7. In regards to oral hygiene, patients should still keep other areas of the mouth clean. The treatment area should be avoided. However, light brushing can be done on the adjacent biting surface/teeth but not the treatment area.
8. Lastly, patients should avoid pulling down the cheek or lip until they heal completely.