Trimming the frenulum under the child’s tongue and lip: why, how and when is it better to do it?

The first person who should pay attention to the bridle is the midwife in the maternity hospital who examines the baby after birth. If she sees that the bridle is too short, she often cuts it herself with scissors. At this time, the mucous membrane of the newborn heals quickly, and soon the baby will be able to breastfeed. If, despite a slightly short bridle, the child can eat, there is no need for immediate trimming, but parents are recommended to pay attention to this and do bridle plastic surgery later. Also, the child is examined by a pediatrician and a visiting nurse, who weigh it, assess the general condition and measure the frenulum, so a recommendation for plastic surgery can be obtained from them as well.

Subsequently, the frenulum of the tongue is responsible for diction, and the frenulum of the lips is responsible for the development of the upper or lower lip, respectively, the position of the front teeth and bite.

What problems can there be with the frenulum of the tongue

Usually, at the age of 5-6, the child’s diction is already developed and aligned. If speech problems persist at this age, in particular, the child does not pronounce some letters (most often r, l, sibilants) or speaks indistinctly, the reason may be the presence of anatomical obstacles. The speech therapist who works with the child must make sure of this: if he discovers that she has an incorrect arch of the palate or a short frenulum of the tongue, he refers her to a pediatric maxillofacial surgeon.

What problems can there be with the frenulum of the lip

At the age of 6-7, another important event occurs: the first change of teeth. The milk upper front teeth fall out and permanent central incisors grow in their place. If at the same time a gap forms between the teeth and they do not fit completely together, this cannot but attract attention, and the child finds himself at a dentist or orthodontist appointment. He determines that the cause is a pronounced frenulum of the upper lip and suggests plastic surgery.

A short frenulum of the upper lip does not allow you to pull back the lip and thoroughly clean the front teeth and gums, which can lead to early caries.

How to understand that a child has a short bridle?

The presence of a short bridle becomes noticeable shortly after the birth of a child. Parents are usually informed about this by an obstetrician, a pediatrician or a visiting nurse. The following signs indicate a short frenulum in a child:

• problems with breastfeeding: the child cannot hold the nipple and suck;
• difficulties with swallowing and breathing;
• diction disorders persist at the age of 5-6 years;
• the presence of a gap between the front teeth;
• forming an incorrect bite;
• problems in the development of the lower jaw.

You can also check whether the frenulum of the tongue is short at home: you should ask the child to touch the palate with his tongue. If she can’t do that, she probably needs bridle surgery.

Why should the bridle be trimmed?

Bridle plastic surgery is necessary for the child to form the correct position of the teeth and for the jaws to develop normally. Also, a timely operation will save her from complications in the future. It is important to understand that a simple incision is not enough to reliably correct the defect of the frenulum — in 30-40% of cases it will lead to relapse (regrowth of the frenulum) and deterioration of the patient’s condition, it is also necessary to eliminate bone compaction and connective tissue.

Is it possible not to trim the bridle?

Sooner or later you will have to trim the bridle. If you don’t cut the frenulum under the tongue or on the lip, then you can live with a speech disorder and diastema for a while (although it’s not comfortable). But orthodontic treatment of the wrong position of the teeth and the diseases caused by it (caries, periodontitis, gum recession, etc.) will cost much more nerves and money.

At what age is it best to cut the frenulum of the lips and tongue of a child

A maxillofacial surgeon will not refuse a child an operation, even if the parents do not bring it. As a rule, plastic surgery of the frenulum of the upper lip and tongue is done in one of the following age periods:

• immediately after birth, if there are vital signs;
• at the age of 5-7 during the replacement of the upper front teeth. When the baby teeth fell out, it’s time to do the plastic braces. Then, at the moment when the lateral incisors cut through, they will move the front incisors, which will close the diastema, and we will get a good result;
• at any age when a child needs treatment from a maxillofacial surgeon. For example, if we are already treating teeth under anesthesia, we can finish the operation with plastic frenum, so as not to return to this issue in the future.

A person may not even know they have a short frenulum until their teenage years, but will eventually need to see a maxillofacial surgeon.

Types of plasty of the frenulum of the tongue and lips

If we are not talking about trimming the frenulum of a newborn in the hospital, sterile scissors alone are not enough for a high-quality result. Depending on where exactly the problem is, the following types of bridle plastic surgery are distinguished:

• pronounced frenulum of the upper lip – if the ligament under the mucous membrane connecting the lip to the jawbone is strong enough, a bony seal is formed, which prevents the permanent incisors from coming together when erupting;
• short frenulum of the tongue – causes speech defects and can lead to the incorrect position of the teeth on the lower jaw;
• a short frenum of the upper lip does not allow the lip to be retracted, so the child cannot fully clean the front teeth. Because of this, early caries occurs on the central incisors;
• short frenulum of the lower lip – leads to underdevelopment of the lower jaw and the formation of alveolar pockets.

Plastic surgery of the frenulum of the lower lip is often performed together with plastic surgery of the vestibule of the oral cavity.

How to correct the shape and size of the frenulum of the tongue and lip of a child

At the Sirius Dent Medical Center, we apply a comprehensive approach to frenum plastic surgery. So, if a pronounced bone ridge has formed under the frenulum in the jawbone, then this seal must be carefully cut out with a special tool. You should also cut out excess connective tissue, collagen fibers and lengthen the space under the lip. There are special surgical techniques for this: you can cut the bridle with a nail or make a transverse incision and stretch it vertically, thereby mechanically lengthening this area.

This operation is not difficult, but requires special attention and thoroughness from the maxillofacial surgeon. In fact, this is microsurgery, so we prefer to perform the operation under general anesthesia for the child, to give the doctor time and the opportunity to work calmly, despite the risk of unexpected movements of the patient. In addition, if we are talking about plastic surgery of the frenulum of the tongue, then there is a much higher risk of bleeding due to the presence of a large number of blood vessels.

Human mucosa can be free or attached to the jawbone. The attached keratinized mucous membrane must have a sufficient volume (at least 5 mm in height), because it is the guarantee that the teeth will be strong and will hold well in the jaw, and the person will not suffer from periodontitis or periodontitis. In recent years, we have seen more and more teenagers with very thin jaws, in which the keratinized mucous membrane is almost transparent and has a height of 2-3 mm, not 5. This leads to underdevelopment of the volume of the cortical bone of the lower jaw – in the frontal area, the roots of the teeth are clearly visible to the naked eye. If a short frenulum on the lower lip is added to that, the situation worsens: gingival pockets and gum recession (gums slip away from the teeth) appear. In such patients, we do not only an incision of the frenulum of the lower lip, but also plastic surgery of the vestibule of the oral cavity, which involves transplanting a fragment of the mucous membrane to the frontal area, sometimes with a connective tissue graft from the palate or maxillary tubercle. Due to this, it is possible not only to correct the position of the frenulum, but also to increase the keratinized layer of the gums, improve the nutrition of the mucous membrane, and subsequently obtain a larger volume of gums and bone tissue. Despite the need to work as neatly and accurately as possible, frenum plastic surgeries are short enough:

• frenulum of the upper lip – 10-15 minutes;
• frenulum of the tongue – 15-20 minutes;
• frenulum of the lower lip and plasty of the vestibule of the oral cavity — 30-40 minutes.

All surgical interventions are non-traumatic, painless and safe for the child.

What to do after trimming the frenulum of the tongue

The first 2-3 days after the operation, slight swelling of the lip may persist, but usually there are no pain sensations (however, if the child complains, you can give him painkillers prescribed by the doctor). Sutures are self-absorbing, so there is no need to remove them. The child can eat everything that he is used to, you just have to be careful that he does not pull back his lip, trying to see the seam, because in this way he can damage it. In general, if the operation is carried out without haste and under sedation, the young patient receives a good result for the rest of his life.