What Is a Frenectomy?
A frenectomy is the removal or modification of a frenum. Everyone has several frenums in their mouth. The two most commonly treated are the lingual frenum, which connects the tongue to the floor of the mouth, and the labial frenum, which connects the upper lip to the gum tissue above the front teeth.
When a frenum is abnormally tight, thick, or short, it can restrict normal movement. In infants, a tight lingual frenum (tongue-tie, or ankyloglossia) can make breastfeeding difficult. In older children and adults, it can affect speech, oral hygiene, or the position of the teeth. A frenectomy resolves these issues by releasing the restriction.
Lingual Frenectomy vs. Labial Frenectomy
A lingual frenectomy addresses the tissue under the tongue. This is the procedure performed for tongue-tie. Tongue-tie occurs when the lingual frenum is too short or extends too far toward the tip of the tongue, limiting its range of motion.
A labial frenectomy addresses the tissue connecting the upper lip to the gum above the front teeth. A thick or low-attaching labial frenum can pull on the gum tissue, contribute to a gap between the front teeth (diastema), or interfere with orthodontic treatment. In infants, a tight upper lip tie can also affect the ability to latch during breastfeeding.
When Is a Frenectomy Needed?
A frenectomy is recommended when a restrictive frenum causes functional problems. Not every short frenum needs treatment. The decision depends on whether the restriction is causing real difficulties.
In Infants
Tongue-tie affects an estimated 4% to 11% of newborns. Not all tongue-tied infants have feeding problems. A frenectomy is typically recommended only after evaluation by a lactation consultant or pediatric specialist confirms that the restriction is contributing to feeding difficulties.
- Difficulty latching or staying latched during breastfeeding
- Poor weight gain related to feeding challenges
- Clicking sounds or excessive air intake during feeding
- Maternal nipple pain or damage that does not improve with lactation support
- A visible tight band of tissue under the tongue that limits tongue elevation
In Children and Adults
- Speech difficulties, particularly with sounds that require the tongue to touch the roof of the mouth (L, R, T, D, N, S, Z)
- Difficulty moving the tongue side to side or lifting it to the upper teeth
- A gap between the upper front teeth caused by a thick labial frenum that an orthodontist wants to close
- Gum recession on the lower front teeth caused by a tight frenum pulling on the tissue
- Discomfort or difficulty with oral hygiene due to a restrictive frenum
- Before or during orthodontic treatment when a frenum is preventing tooth movement
Frenectomy Procedure: Laser vs. Surgical
A frenectomy can be performed using a traditional surgical approach or a dental laser. Both methods are effective, and the choice depends on the patient's age, the provider's training, and the specific clinical situation.
Laser Frenectomy
A laser frenectomy uses a focused beam of light energy to release the frenum. The laser vaporizes the tissue precisely, sealing blood vessels as it works. This means less bleeding, often no need for stitches, and reduced post-procedure swelling.
For infants, a laser frenectomy is very quick, typically taking 1 to 2 minutes. A topical numbing gel is usually sufficient. For older children and adults, local anesthetic is used. The procedure takes 10 to 15 minutes including preparation.
Traditional Surgical Frenectomy
A surgical frenectomy uses a scalpel or surgical scissors to cut and remove the frenum. The area is numbed with local anesthetic, the tissue is excised, and the wound is closed with dissolvable stitches.
This approach is common when a larger section of tissue needs to be removed, such as a thick labial frenum in an adult. It may also be preferred when the frenum is especially fibrous or when the procedure is combined with other oral surgery.
Frenotomy vs. Frenectomy
You may hear the terms frenotomy and frenectomy used interchangeably. Technically, a frenotomy is a simple snip or incision of the frenum to release it, while a frenectomy involves removing the frenum tissue entirely. In infants, a frenotomy (quick release) is most common. In adults, a full frenectomy with tissue removal is more typical to prevent reattachment.
Frenectomy Recovery and Aftercare
Recovery from a frenectomy is generally quick, but it varies by age and procedure type.
Infant Recovery
Infants typically feed immediately or within an hour after the procedure. The wound under the tongue heals rapidly in newborns, usually within 1 to 2 weeks. Parents are often instructed to perform gentle stretching exercises several times a day to prevent the tissue from reattaching during healing. A white or yellowish patch at the wound site is normal and is a sign of healing, not infection.
Child and Adult Recovery
Older children and adults can expect mild soreness for 2 to 5 days. Over-the-counter pain relievers are usually sufficient. Soft foods are recommended for the first few days. Most patients return to normal activities within 1 to 2 days.
If stitches were placed, they typically dissolve within 1 to 2 weeks. Full healing of the surgical site takes about 2 weeks. Your provider may recommend tongue exercises or speech therapy exercises to help retrain movement patterns, especially if the restriction was present for years.
When to Contact Your Provider
Call your provider if you notice heavy bleeding that does not stop with gentle pressure, signs of infection such as increasing redness, swelling, or fever, or if an infant refuses to feed for more than a few hours after the procedure.
Frenectomy Cost
A frenectomy typically costs between $250 and $1,200. The wide range reflects differences in technique, provider type, patient age, and geographic location.
What Affects the Price
- Technique: Laser frenectomy may cost slightly more than a traditional surgical approach due to equipment costs.
- Patient age: Infant procedures are often shorter and less involved, which may lower the fee. Adult procedures requiring more tissue removal or stitches may cost more.
- Provider type: Pediatric dentists, oral surgeons, periodontists, and ENT physicians all perform frenectomies. Fees vary by specialty and practice.
- Anesthesia: Topical numbing for infants adds minimal cost. Local anesthesia for children and adults is typically included. Sedation, if used, adds $150 to $500.
- Geographic location: Costs vary by region and local market rates.
Insurance Coverage
Many dental insurance plans cover frenectomy when it is deemed medically necessary. Medical insurance may also cover the procedure, particularly for infants with documented feeding difficulties. Some families find that medical insurance provides better coverage than dental insurance for infant tongue-tie release. Check with your insurance provider before scheduling. Costs vary by location, provider, and case complexity.
Which Specialist Performs a Frenectomy?
Several types of dental and medical specialists perform frenectomies. For infants, pediatric dentists and ENT (ear, nose, and throat) physicians are common choices. For older children and adults, oral surgeons and periodontists typically handle the procedure, especially when it involves a thicker labial frenum or is part of a larger treatment plan.
If your child has been diagnosed with tongue-tie, start with an evaluation by a pediatric dentist or lactation consultant who can assess whether a frenectomy is appropriate. For adults, a general dentist can provide a referral to an oral surgeon or periodontist.
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