- What are frenulum?
- What are the abnormalities in the structure of the frenulum?
- When to cut the frenulum?
- What is the correction of the frenulum? Types of treatments
- What are the contraindications for the treatment?
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VERIFIED CONTENTAuthor: Krzysztof Bialazite
The frenulum is a fold of the oral mucosa that connects its structures. In the oral cavity, there is a frenulum of the upper and lower lips, as well as the frenulum of the tongue. The size of the frenulum is small, but their abnormalities can disrupt the anatomy and functioning of the entire oral cavity. Find out the functions of the frenulum, when and why the frenulum should be cut and how the procedure of cutting the frenulum is carried out.
What are frenulum?
The frenulumis a structure made of connective tissue. The frenulum is a thin fold of the mucosa that supports and connects the structures of the oral cavity. Inside the oral cavity, there are three most important frenulum:
- the upper lip frenulum that connects the upper lip with the gum above the upper incisors,
- the lower lip frenulum that connects the lower lip with the gum below the lower incisors,
- the frenulum of the tongue, which connects the base of the tongue to the floor of the mouth.
Each of these frenulum can be viewed in the mirror after the lips are properly exposed or the tongue is raised. Properly constructed frenulum should support the elements of the oral cavity in the right position. At the same time, the frenulum must be long enough to maintain sufficient mobility of the lips and tongue.
Each frenulum should be properly positioned, with the correct dimensions and consistency. Incorrect variants of the structure of the frenulum may have significant dental, orthodontic and speech therapy consequences.
What are the abnormalities in the structure of the frenulum?
Frenulum defects are usually formed in the early stages of human life. Some disorders have significant consequences already in infancy - in such cases they should be corrected as soon as possible. In other cases, defects of the frenulum may show up at a later stage. Some frenulum requires correction only in adulthood.
The most common abnormalities in the structure of the frenulum include:
- shortening the frenulum - too short a frenulum blocks the proper mobility of the oral cavity. Shortening the frenulum causes constant "pulling" of the surrounding tissues. Too shortThe labial frenulum can expose the gums and develop periodontitis. In turn, the shortened lingual frenulum in an infant causes feeding problems and impaired speech development. The shortened frenulum also increases the susceptibility to caries and periodontitis.
- frenulum hypertrophy - that is, its excessive thickening, caused by the growth of connective tissue within the frenulum. An overgrown frenulum may result in incorrect positioning of the gums, as well as difficulty in maintaining hygiene. The hypertrophy of the frenulum can also be corrected for aesthetic reasons.
- incorrect attachment of the frenulum - most often concerns the labial frenulum. A correct frenulum should stick around the gums. Moving the frenulum attachment towards the surface of the teeth disturbs the anatomy of the dental arches. Too distant attachment of the frenulum may result in diastema, i.e. a break between the incisors.
Read also: The effects of poor oral hygiene. How to take care of your teeth?
When to cut the frenulum?
The decision regarding the correction of the frenulum depends on many factors. The type of defect and its clinical consequences, the patient's age and the risk of complications should be taken into account. The final decision may require consultation of several specialists (dentist, orthodontist, oral surgeon, speech therapist). The general rules for correction are separate for each type of frenulum.
In the upper lip frenulum, the most common abnormality isexcessive shortening or incorrect attachment , pulling the upper gum towards the lip. As a consequence, the upper incisors move apart and form diastema, i.e. a break between ones. In such a situation, the decision to undercut the frenulum depends mainly on the patient's age. Diastema in a child who still has deciduous teeth is a normal phenomenon because it provides space for the eruption of permanent teeth in the future. If the diastema persists after the permanent teeth replacement, the lack of undercutting the frenulum may contribute to the aggravation of malocclusion.
Another indication for the correction of the upper lip frenulum isexcessive pulling of the gums upwards, resulting in the exposed necks of the teeth . This complication increases the risk of periodontitis and, consequently, the development of periodontitis. A symptom of an increased risk of such complications is the so-called pulling syndrome. If the surface of the gingiva turns white when the lip is pulled forward, it means that prophylactic undercutting of the frenulum is advisable. The reason for the correction of the upper lip frenulum may also be due to aesthetic reasons. People usually decide to undergo such a procedurehaving the so-called gum type of smile and an overgrown frenulum, which may be a cosmetic defect.
The lower lip frenulum should be trimmed in situations analogous to the upper lip frenulum. The most common indications for their correction are:
- exposing the necks of the teeth in the lower dental arch,
- risk of developing periodontitis,
- malocclusion.
Shortening the lower lip frenulum may be associated with an abnormal structure of the mouth vestibule. As in the case of the upper lip frenulum, its undercutting is performed after the eruption of permanent teeth in older children and adults. The correction of the labial frenulum is often carried out as an introduction to further stages of treatment (installation of an orthodontic appliance, prosthetic procedures).
The indications for undercutting the frenulum of the tongue are different than in the case of the labial frenulum. The abnormalities of the frenulum of the tongue usually show up very early in a child's life. The shortened frenulum of the tongue may interfere with the suckling reflex and make feeding difficult. In this case, the correction of the frenulum should not be delayed - the procedure should be performed in infancy.
Lack of correction of the frenulum of the tongue may have many consequences in the further development of the child. The disturbed mobility of the tongue results in the difficulty of pronouncing some sounds, it can cause drooling, lisping, and also malocclusion. The abnormal structure of the frenulum of the tongue is sometimes recognized in the speech therapist's office with a significant delay, as a cause of speech development disorders.
Read also: What do malocclusions lead to?
What is the correction of the frenulum? Types of treatments
Correction of the frenulum in the oral cavity is most often performed with a minor surgical procedure. Depending on the anatomical conditions, one of the following procedures is performed:
- frenulotomy, i.e. cutting the frenulum;
- frenulectomy, i.e. complete excision of the frenulum;
- frenuloplasty, i.e. the correction of the shape and position of the frenulum.
The doctor who performs the surgery decides about the type of surgery performed. The course of each type of labial frenulum correction is similar. These are minor surgical procedures, usually lasting several minutes. At the beginning of the procedure, local anesthesia is administered, most often in the form of a gel or spray. Sometimes it is necessary to give an injection of anesthesia in the area of the gums. Then the frenulum, depending on the needs, is cut, shifted or completely removed.
A surgical scalpel, laser or electric knife are used to undercut the frenulum. Usetraditional surgical knife may require suturing at the incision site. In procedures with the use of a laser or electric knife, bleeding practically does not occur, so often suturing is not necessary.
The correction of the labial frenulum is performed on an outpatient basis - the patient may return home on the same day. It may take several days for the wound to heal after surgery. During this period, it is recommended to take a sparing lifestyle, eat semi-liquid foods and use painkillers if necessary. If the stitches have been installed after the procedure, they are removed after a few days.
The procedure of undercutting the frenulum of the tongue is most often performed in infancy. The frenulum is then the thinnest and most delicate, so the painfulness of the procedure is minimal. After the procedure, there may be slight bleeding which will stop on its own within a few minutes. Your baby can be fed normally soon after the procedure.
Improvement exercises are an important element of the recommendations after the correction of the frenulum. Even a few minutes a day ensures adequate mobility and flexibility of the individual structures of the oral cavity. It is recommended to start exercising after the surgical wound has healed. For detailed instructions, please contact your doctor or speech therapist.
Read also: What are the causes of the formation of superslides?
What are the contraindications for the treatment?
Trimming the frenulum is a minimally invasive surgical procedure, therefore there are relatively few contraindications to its performance. The only permanent limitation in the possibility of correcting the frenulum are the states of reduced blood coagulation. Both diseases that reduce blood clotting (e.g. hemophilia) and taking blood thinners may result in excessive bleeding during the procedure.
The remaining contraindications to the correction of the frenulum are temporary. You should refrain from surgery during the period of infection or exacerbation of chronic diseases. In the event of inflammation in the oral cavity, the treatment should be postponed for a few days.
About the author
Krzysztof BialaziteA medical student at Collegium Medicum in Krakow, slowly entering the world of constant challenges of the doctor's work. She is particularly interested in gynecology and obstetrics, paediatrics and lifestyle medicine. A lover of foreign languages, travel and mountain hiking.