The frenum is a piece of tissue which connects to the mouth in two places- the base of the tongue and beneath the upper lip. 

A frenectomy is a surgical procedure that consists of releasing the frenum under the tongue and/or upper lip to allow for better range of motion. Infants may be born with a combination of conditions called tongue-tie (ankyloglossia) and /or a lip-tie causing restrictions in movement that can cause difficulty with breast feeding, and in some instances, other health problems like dental decay or spacing, speech and airway difficulties, and digestive issues. These issues can generally be corrected by this simple procedure. The surgery is a common dental procedure performed on both children and adults. At Dentistry 4 Kids, we perform this procedure with a with a soft tissue laser. The laser method induces much less bleeding, reduces the need for stitches, minimizes post-operative discomfort and promotes a faster recovery time. 

The frenum that connects the inside of the upper lip to the gums above the front teeth, when very thick or tight, may interfere with latching in breastfeeding infants, can prevent teeth from erupting, create a need for orthodontics or prevent a person from fully smiling. A tight frenum between the tongue and the floor of the mouth, commonly referred to as a “tongue tie,” may also cause difficulty in breast and bottle feeding and can cause speech issues or pain.

Symptoms you may notice while nursing include:

• Difficulty latching or staying on latch
• Excessive gas or burps
• Gagging and choking
• Milk dribbles
• Reflux/colic
• Excessive spitting up
• An arched back due to discomfort
• Falling asleep at the breast
• Long feeding times or continual feeding
• Lip calluses or blisters
• Swallowing air
• Chomping on the nipple
• Comes off latch
• Can only feed during letdown
• Tucking of the upper lip
• Fussing/fighting at the breast
• Acts tense while nursing
• Sensitive gag reflex
• “Lazy Eater”
• Difficulty holding a pacifier
• Clicking sound while feeding 

Laser frenectomies are extraordinarily precise and quick. There is no need for general anesthesia. Your baby will only have minimal discomfort or swelling, and the laser treatment sterilizes the treatment area, reducing the chance of infection. In addition to the benefits of this laser procedure, once the release of the tongue tie is complete, your baby will be more able to latch on to the breast and feed more efficiently. This will improve the baby’s health and the wellbeing of the mother. 

In routine frenectomies, this is a relatively simple procedure done right at your Pediatric Dentist’s office. Your baby will be swaddled (you are welcome to bring a blanket from home), and a topical anesthetic is applied to the area. The dentist then uses a precise laser to release the tightened tissue. This soft-tissue laser is used to focus a beam on the tissue to be removed, the treatment simply removes the specifically targeted tissue. This method causes minimal discomfort and very little bleeding. The whole procedure takes less than 10 minutes and in most instances the baby is able to latch immediately when he or she is returned to you. Your baby may experience some slight swelling for a day or so following the treatment. The dentist will provide advice on how to care for the baby’s mouth and if any exercises or post-surgical care is needed to ensure that the frenum does not reattach again. 

A laser Frenectomy generally heals quickly and with little or no pain. Your doctor may recommend a mild pain reliever such as Tylenol for infants and younger children after the procedure and instruct the use of coconut oil or vitamin E to facilitate healing. There will be post-surgical exercises to be done weeks following the procedure, to ensure correct healing of the area and prevent reattachment. 

Breastfeeding immediately after the procedure is fine as breast milk contains amazing healing properties and the simple act of breastfeeding will reassure and soothe the baby.
It is possible that latching will be a struggle at first since we are using a small amount of topical anesthetic to complete the procedure. The numbness will wear off about 30-45 minutes after the procedure. Do not be alarmed if latching is difficult at first.
Posterior tongue-ties may require a few weeks of practice before seeing the benefits of the frenectomy. We recommend being thorough with the prescribed post treatment exercises and to work with a lactation consultant to increase the chances of success.