Frenulum's: What are they and why should we worry about it?

The frenulum is a webbing of tissue in the mouth.  The lower frenulum is under the tongue and connects it to the muscles of the floor of the mouth.  The upper frenulum is tissue connecting the upper gum and lip.  Most of the time both frenulums do not cause any problems.  There is some controversy over whether the lower frenulum can cause speech problems and breastfeeding (latching) problems.  Ankyloglossia is the technical term for a tongue webbing that is restrictive.  The upper frenulum  can be thick and make your infant or young child's teeth look gapped in the middle.  The good news is that it generally recedes with the onset of adult teeth, around age 6 to 8 years of age in most children.  In the last few years there has been a push in some circles to be more aggressive in treating or removing part of the frenulum.
What are signs that the frenulum is causing a problem?  There is no specific standard test to determine this; however there are some clinical criteria.  If the webbed tissue under the tongue extends too far, it limits the movement of the tongue in the horizontal and vertical planes.  This can cause difficulty latching and can be painful to the nursing mother’s breast.  If your child's tongue cannot move up into the middle of the mouth or forward to at least the gums, removal of some of the tissue may be helpful. Some baby’s tongues will appear a bit misshapen at the tip - often referred to as a heart or clover shape.
 If you are concerned about your child's frenulum, please discuss this with one of your trusted providers at Pediatric Associates.  There are dentists and oral surgeons charging cash for laser surgery to remove the tissue.  This is almost never indicated in the medical literature and is more invasive and painful than a standard frenotomy or frenulectomy.  If we deem that the frenulum is indeed causing problems for your child we can do a simple procedure in the office (or for newborns in the hospital before discharge) where we trim the fine elastic webbing that is causing difficulty for your child.  This is best done in the first one to two months of age.  For older children we recommend seeing an ear, nose, and throat doctor.
Speaking of breastfeeding, did you know that one of our long-time nurses Elise is now a certified lactation counselor?  She is available at our Crestview Hills office generally on Mondays, Tuesdays and Wednesdays.  This is a new service to try to help you and your baby have the best experience possible at one convenient location. The advantage is to be able to work hand in hand with our providers which enhance communication and makes follow up appointments easy!

Charlie Cavallo MD
Posted: 4/9/2019 6:06:17 AM | with 0 comments