WHAT IS A FRENUM?

A band of tissue located in and around teeth, gum and under tongue.
The two major frenums are the :
1- labial frenum- located in the upper arch connecting the gingiva to the inner part of the lip
2- lingual frenum-located under the base of the tongue connecting to the floor of the mouth
There are also five minor frenums located in the oral cavity.

CLINICAL IMPLICATIONS IF THE FRENUM IS RESTRICTED

If the labial frenum is restricted then there is a diastema (gap) between the upper anterior incisors. If left untreated while the dentition is developing- orthodontic treatment will be needed to corrected the malocclusion. If however, the frenum is not treated yet orthodontic treatment is done  then the diastema will eventually return regardless of orthodontic treatment.

If the lingual frenum is restricted then a host of problems ensue

1- Mouth Breather -There is a tendency for the tongue to settle at the bottom of the lower arch at rest instead of resting at the roof of the mouth (palate)-

2-Speech Interference – may have limited success with speech therapy

3-Trouble Eating and Swallowing- there will be a tendency for more decayed teeth

4-Malpostion of the Anterior Dentition-lower anterior teeth tilt inward , instead of normally tilting out . This increases crowding resulting in need for orthodontic treatment

5- Mandibular Underdevelopment- the lingual frenum limits the growth and development of the mandible

6- Poor Tongue Posture- generally indicative of airway interference. Main cause is the tongue not resting on the roof of the mouth but may also be due to enlarged tonsils and/or adenoids

7-Tongue Thrust-Tendency – the tongue thrusts forward during breathing and speech. This causes an anterior open bite, forward tilted anterior teeth in both arches and a speech impediment. Limited success of orthodontic treatment if not corrected

WHO TREATS A FRENECTOMY ?

ENT, oral surgeon, periodontist and  pediatric dentist all treat frenectomies. Ideally it should be done with a soft tissue laser which minimizes tissue trauma. It is then a bloodless procedure not requiring sutures to heal.

Exercises before and after dental frenectomy are very important to a successful outcome-less than 30% re-attachment. They should ideally be done a minimum of two weeks prior to surgery.  Generally 30%-60% of the frenum is expected to re-attach.

The major benefits include
1-thins out frenum
2-increases range of motion
3-pushes back nerve and blood vessels

It is important to remember that there is normally a 30-60% re-attachment once the surgical site has healed. The exercises are extremely important to prevent the need for re-treatment in the future

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