What Is a Frenum?

The mouth has many different types of tissues, from your teeth and tongue to muscles, ligaments and frena (plural for frenum). What is a frenum? It is one of the lesser-known tissues, also called a frenulum. In some cases, a frenectomy may be recommended for children, but is this a wise choice?

Frenum are connective cords found in several places in the body, including under the tongue. They are used to keep body parts from moving too far, tethering them within a safe distance. In the mouth, there are a few different oral frena, including the one under the tongue.

The lingual frenum ties the tongue to the floor of the mouth, and can impact breastfeeding in infants and speech in older children if it is too short or tight. When the lingual frenum restricts the tongue, it is difficult to move the tongue in certain ways and it is at higher risk for a frenulum tear.

Symptoms of Tongue Tie

Those with a short lingual frenum are said to have “tongue tie.” Depending on the type, it may be noticeable in babies if they have trouble “latching” when breastfeeding. Not only can this impact the child and feeding, but it can be painful for the mother while breastfeeding.

Not everyone with tongue tie will have trouble breastfeeding. Some people may not show symptoms until later in childhood or as adults. Symptoms can include impaired speech, orthodontic issues, snoring, dry mouth, sleep apnea, narrow jaw and difficulty swallowing food.

What Is a Frenectomy?

The two frenula in the mouth that are often removed are the lingual and labial frenulum. The lingual is the tongue tie and the labial attaches the lip to the gums. If these are too short, long or large, they can impact oral health and a frenectomy may be recommended.

A frenectomy is an outpatient procedure to “clip” a frenum or frenulum. On the tongue tie, this is usually done if an infant is unable to suckle correctly due to the tight frenum. There are three different types of lingual frenectomies that can be performed, depending on the frenum formation.

For the labial frenum, it is performed if the tissue is impacting the formation of the teeth, usually the top front teeth. Labial frenum can create a gap between the teeth and may impact other dental development. Labial frenectomies may prevent some orthodontic concerns.

Frenectomies are usually performed by a dentist or oral surgeon. The procedure can be completed with the use of a scalpel, scissors, lasers or electrosurgery. It is a quick surgery and minimally invasive for infants, but it can require more recovery time for older children or adults.

Advantages of Clipping Tongue Tie

Most doctors agree that a frenectomy should only be performed if the frenum is causing a problem. Tongue ties can make it hard or impossible for infants to breastfeed, which can be scary for a child’s parents. Clipping a tongue tie that is causing tongue restriction can have the following benefits:

• Improved suckling capabilities for infants
• Alleviate breast pain while feeding for the mother
• Reduce risk of speech problems in older children
• Improve swallowing ability
• Reduce risks of frenulum tears
• May prevent some orthodontic issues
• Reduce risk of snoring and sleep apnea as adults
• Reduce tongue “shocking” sensation

Frenectomies can be beneficial for infants in particular, as they are much less invasive at an early age. Infants who undergo a lingual frenectomy have little to no recovery time and often can begin breastfeeding immediately.

Many children with a tight tongue tie may also have issues with their labial frenulum or lip tie. It is common for both the lip and tongue tie to be clipped at the same time. Lip ties can impact breastfeeding and may interfere with tooth development, usually a gap between the front teeth.

Disadvantages of Clipping Tongue Tie

Frenectomies are a form of oral surgery and all surgeries come with some risks. There is a chance of excessive bleeding or infection, but these complications are rare. For infants, one of the disadvantages of clipping tongue tie is that it does not always fix the breastfeeding issue. Other concerns:

• Some children/adults have speech issues after a lingual frenectomy
• Children and adults may experience some pain and discomfort post-surgery
• Swallowing can be difficult
• Not all insurance covers the procedure, and it may need to be paid “out of pocket”

Clipping tongue and lip frena can have pros and cons, so it is advisable to discuss the advantages and disadvantages of clipping tongue ties and lip ties with your doctor or dentist. Weighing the pros and cons can help determine if it is right for you or your child.

The frena in the mouth have their purposes but, in some cases, removing a frenum can be beneficial, especially for infants. Talk to your dentist to learn more about clipping tongue and lip ties.

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