A frænum is a band of fibrous tissue that links the lips to the gums or the tongue to the gums.
Upper Jaw Frænum.
A ‘high’ or prominent upper frænum in children, although a common finding, is often a concern, especially when associated with a diastema (a space between 2 teeth such as the upper central incisors). Treatment is necessary only when the frænum exerts a traumatic force on the gum or it causes a diastema to remain open after eruption of the permanent canines / ’eye’ teeth.
In an older child, if a frænum is present and the tissue immediately behind the central incisors on the roof of the mouth side of the teeth blanches when the upper lip is pulled, removal of the frænum is indicated.
Early treatment is also indicated to prevent subsequent inflammation, recession of the gum around the spaced teeth, pocket formation within the gums and the possible loss of the bone supporting the teeth and/or teeth themselves.
Tongue Tie / Ankyloglossia.
A Tongue Tie / Ankyloglossia is characterised by a short, thick fibrous band linking the tongue to the gum just behind the lower central incisors. It limits the movement of the tongue.
The significance and management of ankyloglossia are controversial. Studies have shown a difference in treatment recommendations between Speech Therapists, Pædiatricians, Ear, Nose & Throat Surgeons and Oral & Maxillofacial Surgeons. Most professionals, however, will agree that there are certain indications for frænectomy.
A tongue tie can limit tongue movement and create swallowing problems. A frænectomy for functional problems should be considered on an individual basis.
A tongue tie can lead to problems with breastfeeding, speech, how teeth bite together and potential gum disease and gum recession problems. The frænectomy will only be done if evaluation shows that function will be improved by surgery.
If you are to have your frænum removed, you can expect the following. This list is not exhaustive but it is predictive.
The most pertinent warnings have been included here.
Pain. As it is a surgical procedure, there will be soreness after the frænum has been removed. This can last for several days. Painkillers such as Ibuprofen or Paracetamol are very effective. Obviously, the painkiller you use is dependent on your medical history & the ease with which the frænectomy was carried out.
Swelling. There will be swelling afterwards. This can last several days. Avoidance in the first few hours post-op of exercise or hot foods / drinks will decrease the degree of swelling that can develop.
Stitches. The frænectomy site will be closed with stitches. These are dissolvable and ‘fall out’ within 10 – 14 days.
Limited Mouth Opening. Often the chewing muscles and the jaw joints are sore after the procedure so that mouth opening can be limited for the next few days.
Conscious Use of Tongue. Don’t automatically assume that once the tongue tie has been released, you’ll be automatically able to stick your tongue out. You will have been used to the tongue being limited in its movements for a number of years so to fully use the ‘released’ tongue, a conscious effort will have to be made to use it.
Floor of the Mouth Complications. This may have an effect on the salivary ducts in the region of the floor of the mouth in that the stitches may restrict the outward flow of saliva and this can lead to ballooning up of the floor of the mouth. If this is the case, get back in contact with the OMFS department / Oral Surgeon post-haste.
Repetition of Frænectomy. Sometimes, the degree of tongue movement is not as great as expected and may mean that the frænectomy needs to be done again.
Closure of Spaced Teeth. Having an upper frænectomy will not necessarily by itself, produce the closure of the space. It is often an adjunct to the Orthodontic closing of the space.
Exposed, Raw Areas. If the upper frænum has been removed, there may be initially, an area in the midline where the gums can not be approximated; this produces a raw area that can take awhile to heal.
Gum Recession. When the upper frænum is removed, it is possible that the gums around the upper central incisors may recede.
Level of ‘Lip Line’. Once the frænum has been removed, the upper lip is freed and can ‘ride up’ higher displaying more teeth and gums (that is, showing a higher lip line).