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Child & Adolescent Frenectomy

Did your child have a hard time nursing? Were they, or are they, delayed with speech? Do they gag on food? Do they have sleeping problems or signs of ADHD? Does your child complain of neck and/or head pain often? These are just a few symptoms of children and adolescents who  have restricted tethered oral tissues. Many children “adapt” or were pushed along as failure to thrive of just delayed when they may have a restricted oral tissue. Please review our child assessment form to see if you feel your child may have a tongue tie.

Tongue Tie vs Lip Tie in Older Children

A tongue tie in older children tends to be much more symptomatic than a lip tie. A lip tie is often associated with gapping between the upper teeth, recession due to stress caused by the restriction or can induce decay due to difficulty with cleaning. The tongue tie, on the other hand, is much more often associated with speech, feeding and dental development. The lip tie, contrary to misinformation, is not associated with speech problems.

Dr. Lentfer performs release of tethered oral tissues on not only infants with nursing problems but older children and teens who present with symptoms or were referred from other providers for a release. Using her CO2 laser, Dr. Lentfer is able to perform this procedure quickly without general anesthesia, but with older children, this is behavior dependent. Dr. Lentfer offers sedation with nitrous oxide or general anesthesia for older children.

What is a frenectomy?

A frenectomy, also known as a frenotomy, can refer to any procedure where binding tissue on the body is cut or modified.

Frenectomy procedures are quite common, especially during the infant stage of life.

Most of the time, however, the term refers to an oral procedure meant to resolve a tongue tie or a lip tie.

In your mouth, the “frenum” refers to a piece of soft tissue connected to the lips and gums. If the frenum is too short or too tight, it can interfere with breastfeeding, swallowing, or speech development.

 

Lingual Frenectomy

The lingual frenum connects your tongue to the floor of your mouth. If you touch your tongue to the roof of your mouth, you can probably feel the lingual frenum stretching underneath your tongue.

The length of the lingual frenum varies from person to person. In some cases, people are born with a lingual frenum that’s very short. This shortened frenum restricts the movement of the tongue.

This condition is called ankyloglossia, or “tongue tie.” There is still not enough evidence to support an exact percentage of the population that has a restricted tethered oral tissue, but a lot of studies are findings almost 25% of the population may have a RTOT. Research is also finding it to be more common in males than females.

Though a Tongue tie can interfere with breastfeeding during the infant years, a restricted lingual frenum can have a lot of effects on older children as well. This can include difficulty with speech, eating difficulties, restricted airways, sleeping, dental and jaw growth and development, to name a few.

A quick procedure called a lingual frenectomy can give the tongue a greater range of motion.

 

Maxillary Frenectomy

When a child is older, a labial frenectomy is usually performed to aid development of the erupting dentition to avoid a “diastema,” a gap between the top two front teeth. Dr. Lentfer usually coordinates this with orthodontic providers. Another reason for releasing a labial frenum in an older child is to assist with cleanability of the upper front teeth. A restricted tethered oral tissue of the upper lip can cause pocketing where food and liquids can gather and be difficult to clean.

A maxillary frenectomy can give the upper lip more mobility.

How is the procedure completed on an older child vs an infant?

Younger children, those around 2 to 3 years old and up to 5 or 6 years old, can sometimes have a difficult time cooperating for treatment in the clinical setting. Dr. Lentfer allows parents in the room for this procedure on older children as we do sometimes need help holding your child’s hands to keep them safe.

If a parent opts to not have this completed while their child is awake using the Solea CO2 laser, Dr. Lentfer offers general anesthesia with a release using traditional methods including sutures. For older children and teens, Dr. Lentfer has nitrous oxide available, if the patient wants to use it. Local anesthetic is administered on older children versus the infants who only need topical anesthetic. Sutures are sometimes placed on older children and teens, but this is cooperation dependent.

Signs and Symptoms of Tongue and Lip Ties in Children

 

Speech:

  • Frustration with communication
  • Difficult to understand by parents
  • Difficult to understand by outsiders
  • % Percent of time you understand your child
  • Difficulty speaking fast
  • Difficulty getting words out (groping for words)
  • Trouble with sounds (which?)
  • Speech delay (when?)
  • Stuttering
  • Speech harder to understand in long sentences
  • Speech therapy (how long)
  • Mumbling or speaking softly
  • “Baby Talk”
 

Feeding:

  • Frustration when eating
  • Difficulty transitioning to solid foods
  • Slow eater (Doesn’t finish meals)
  • Grazes on food through out the day
  • Packing food in cheeks like a chipmunk
  • Picky with textures (which?)
  • Choking or gagging on food
  • Spits out food
  • Other:

 

 

Sleep Issues:

  • Sleeps in strange positions
  • Kick and flails around at night
  • Wakes easily or often
  • Wets the bed
  • Wakes up tired and not refreshed
  • Grinds teeth while sleeping
  • Sleeps with mouth open
  • Snores while sleeping (how often)
  • Gasps for air or stops breathing (sleep apnea)
  • Mouth open / mouth breathing during the day
  • Tonsils or adenoids removed previously
  • Ear Tubes previously
  • Reflux
  • Hyperactivity /inattention
  • Constipation