The Importance of the Labial Frenum

When you see your pediatric patients, are you checking their labial frenum? I know many hygienists, including myself, always checked the tongue frenum to check for tongue tied. However, lip ties were never a concern for me. Until now.

Recently, studies have been showing the importance of releasing a lip tie. Not only will a class 4 lip tie prevent a baby from having a proper latch and prevent nursing, it can cause problems as the child gets older.

One problem that can occur is higher decay rates on the anterior teeth. With a lower frenum attachment, the lip creates a “pocket” around the anterior teeth which can trap milk and food. This allows the sugar to sit on the teeth, causing decay to begin around the gingival margin. The strong frenum between the teeth also cause problems with brushing and reaching the toothbrush bristles to the gum line, another reason for increased risk of decay. Another issue that can occur is sleep problems. If the labial frenum is too tight, the upper lip cannot reach the lower and the child is constantly breathing through their mouth. This can lead to sleep apnea in the child. It can help the child orthodontically. Regularly when the lie is released, the infants teeth will move together and have less of a diastema, This can prevent further ortho treatment needed as the child gets older.

I am very passionate about checking for labial frena attachments because it has recently happened to me.

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This is my daughter Georgia. She is almost 2 years old now. Like most two year olds, she’s curious, busy and into everything in my house. However, she was very behind in her speaking and communication, which of course, as a mother, made me very worry. My dad is a dentist in Alberta, Canada and kept asking if her lip and tongue frena’s were tightly attached. Like a daughter would, I brushed it off and we started working with a speech therapist to hopefully help develop her skills. However, he looked at her first dental visit with him and he highly recommended having them released. I waited a few months to complete the treatment because I was nervous!

I scheduled a frenectomy appointment with a pedodontist that uses a diode laser and treats hundreds of lip and tongue ties a month. After a quick consultation, they preformed the surgery with topical anesthetic only. The most important part of the surgery is the post op instructions and lip stretches. While the area is healing, the frenum can reattach, so I stretched her tongue and lip 5 times/day until it healed (about 1 month) to prevent it from reattaching.

Georgia's Class 4 Labial Frenum

Georgia's Class 4 Labial Frenum

 

In my experience, the earlier this is diagnosed, the better:

1.    The earlier the child has the frenum release, the quicker it will start to nurse and eat properly.

2.    The treatment is easier to accomplish on a young baby. Since Georgia was almost 2 when it was completed, she was bigger and stronger and didn’t want to sit for our pediatric dentist during the procedure. She also was a bit aware of what was going on and seemed scared. I'm not going to lie. Since she wasn't happy during the procedure and tried to twist away, it was stressful as a mom! 

3.    The younger the patient, the less likely they will remember the appointment. We are hoping that Georgia doesn’t remember the surgery and will be doing “happy visits” at the pedodontist several times before she actually is a patient for a prophylaxis appointment.

Once a patient is a candidate for surgery, it is extremely important to explain the post op instructions to the patient. For at least 1 month after surgery, the parents or caregivers need to perform lip stretches several times a day to prevent reattachment of the frena. If these stretches are not completed, the tissue will reattach and the surgery will be unsuccessful. If you have any questions on lip stretches, contact your local Oral Myologist.

 

To see different photos between Class 1, 2, 3, and 4 labial frenas, this is a great paper.

Find contact an Oral Myologist, check out the IAOM.


Sources:

The Influence of the Maxillary Frenum on the Development and Pattern of Dental Caries on Anterior Teeth in Breastfeeding Infants: Prevention, Diagnosis, and Treatment

Lawrence A. Kotlow, DDS

DDS, 340 Fuller Road, Albany, NY 12203

J Hum Lact. 26(3):304-308.

http://www.sleep.theclinics.com/article/S1556-407X(14)00025-3/abstract?cc=y= - article-footnote-

 A Novel Treatment of Pediatric Sleep-Disordered Breathing

Joy L. Moeller, BS, RDH, Licia Coceani Paskay, MS, CCC-SLP, Michael L. Gelb, DDS, MS 

Sleep Medicine Clinics 

June 2014Volume 9, Issue 2, Pages 235–243

The influence of the maxillary frenum on the development and pattern of dental caries on anterior teeth in breastfeeding infants: prevention, diagnosis, and treatment.

Eur J Paediatr Dent. 2015 Dec;16(4):262.

Kotlow LA.

Lingual frenectomy: functional evaluation and new therapeutical approach.

Eur J Paediatr Dent. 2012 Jun;13(2):101-6.

Olivi G1, Signore AOlivi MGenovese MD.