Quick transition Treatment of a short frenulum of the tongue
A short frenulum of the tongue (ankyloglossia) is one of the most common minor anomalies in the development of the oral cavity.
The frenulum of the tongue is a fold of the oral mucosa that runs along the midline and connects the floor of the mouth with the lower surface of the tongue.
The function of the tongue frenulum is to fix the tongue to the soft tissues of the oral cavity, preventing tongue retraction (glossoptosis), especially during the neonatal period.
Frenules in the oral cavity
There are three frenulums in the child's mouth. A frenulum in the oral cavity is nothing more than a small strand of mucous membrane. But, despite this, the frenulum in the oral cavity is of great importance in the life of a child; the child’s nutrition, correct pronunciation of sounds, the condition of the mucous membranes, not to mention the child’s bite and facial aesthetics depend on their condition.
Dentists distinguish between the frenulum of the upper and lower lips and the frenulum of the tongue. Each of them has its own location and performs a number of functions. The frenulum of the lower lip connects the body of the lower jaw and the lower lip; normally, the frenulum is woven into the gum of the lower jaw below the level of the central incisors.
The frenulum of the upper jaw is located according to the same principle as the frenulum on the lower lip. This mucous cord also raises many questions and complaints from parents, since it is primarily associated with the formation of an aesthetic defect in the oral cavity - a gap between the teeth. And the last frenulum in the baby’s mouth is the lingual frenulum, which is woven into the tongue and sublingual space.
Why are short bridles dangerous?
Short frenulum in the mouth can cause many unpleasant consequences. The first of them: the baby cannot attach to the breast correctly, so during feeding it expends a lot of effort, but at the same time receives a smaller volume of milk, and it is simply not enough to satiate. This is sometimes the reason for poor weight gain, but quite often mothers and doctors mistakenly look for the cause in a mythical lack of milk, or some disease, although, first of all, it is necessary to look into the oral cavity and assess the condition of the frenulum.
It is very important for parents to know and remember about this problem, because according to statistics, every 14th child has short frenulum in the oral cavity. If you notice this feature in time, then in the future you can avoid many problems and unpleasant consequences - disturbances in nutrition, speech, bite and, accordingly, facial aesthetics.
For the first time, doctors may notice a short frenulum in the baby’s mouth during the first examination, immediately after birth, and if the fact is confirmed, correction is carried out on the spot. This rule applies to a short frenulum of the tongue, but if the frenulum does not interfere with full natural feeding, the frenulum will not be trimmed in the maternity hospital. Symptoms of a short frenulum may appear later - the child may have difficulty pronouncing some sounds, in which case “treatment” will be carried out later, and, as a rule, in tandem with a speech therapist.
Upper lip frenulum
Even with a simple smile you can see the frenulum of the upper lip, but few people pay attention to it. During a routine examination, the doctor assesses its length; in order to assess the size of the frenulum at home, parents just need to move the baby’s upper lip, and it will become noticeable where exactly the frenulum is woven. In the event that the frenulum is woven between the two front incisors 5–8 mm higher, this is a normal option. If the frenulum is woven below this level, these are obvious symptoms of a shortened frenulum, but the final word always remains with the doctor.
A short frenulum on the upper lip can provoke a violation of the aesthetics of a smile when a gap is formed between the central incisors - a trema, a diastema. It is worth remembering that tremors can be physiological; this period is observed during the period of primary occlusion, when the child’s jaws are preparing for the change of primary teeth to permanent ones. In addition, trems can be pathological, which are formed as a result of some pathology. Treatment of this problem is most often carried out in tandem by a surgeon and an orthodontist.
A short frenulum in a child’s mouth can cause malocclusion, which is formed due to the constant tension of the mucous membrane on the upper jaw and bone tissue. As a result, the front incisors move forward. In addition, such pressure on the mucous membrane provokes inflammation of the mucous membrane - gingivitis. There is a loss of gums, as a result of which the necks of the teeth are exposed and the child develops hypersensitivity of the teeth, and all the conditions are created for the formation of cervical caries.
How is the upper lip frenulum corrected?
Treatment of the problem is exclusively surgical, but with one big “BUT”. The frenulum on the upper lip can be corrected only after the eruption of the permanent central incisors, not earlier!!! In some cases, the doctor will recommend adjusting the oral frenulum at the time of the eruption of the permanent lateral incisors - in order to close the gaps between the teeth, such a correction can eliminate orthodontic treatment.
The reason for this ban is very simple. The fact is that during the growth of the jaws, the frenulum on the upper lip can self-correct. That is why there is no point in correcting the frenulum at an earlier age. The correction itself is carried out in a surgical room, under local anesthesia. There are no nerve endings in the mucous cord itself, and therefore the operation is painless; pain relief is necessary when suturing. The operation lasts no more than half an hour and ends with stitches. Thanks to the use of a laser, there is no need for stitches. But there is a certain condition that must be observed after excision of the frenulum: the little one must immediately be attached to the chest.
Frenum of the lower lip
Dentists say that not all babies have a frenulum on the lower lip; it may be completely absent or forked. To study the length of the frenulum, the same technique is used as for studying the frenulum of the upper lip. Normally, the frenulum should be thin and attached in the middle of the body of the jaw. An important condition is that the frenulum of the lower lip must coincide with the center line between the incisors. If these conditions are not met, the bridle is short.
A short oral frenulum interferes with breastfeeding, as the baby cannot properly latch onto the mother's nipple. Fortunately, this situation is quite rare; the most typical manifestation of a short frenulum in the oral cavity is the presence of inflammatory gum diseases in the area of the lower incisors and malocclusion according to the same principle as in the upper jaw.
There are no age restrictions when excision of the mandibular frenulum; usually the mandibular frenulum is diagnosed and corrected at approximately the same time. The principle of the operation is similar to correction on the upper jaw.
Contraindications for surgery
There are practically no contraindications for laser excision of the labial frenulum compared to other operations. The procedure can be performed even on children as young as 6 years old.
Parents should know that laser lip frenuloplasty is the least traumatic and uncomplicated operation that can solve many problems that a child may encounter in adulthood.
Despite this, there are a small number of contraindications, including: - The patient has cancer; — Severe mental and neurological diseases; — Serious defects in the structure of the oral cavity; — Blood diseases; — Infectious diseases in the acute stage; — Advanced caries; - Osteomelit.
As you can see, contraindications are quite serious diseases that are rare. But it should be remembered that a referral for this operation, like any other, can only be given by a qualified dentist after an in-person consultation with the patient.
Tongue frenulum
The most complex and insidious frenulum in a child's mouth. It is this frenulum that is able to regulate the movement of the tongue in the oral cavity. Normally, the frenulum is woven approximately in the middle of the tongue, and its length is approximately 8 mm. If the frenulum is attached almost to the tip of the tongue, this is a direct indication for correction.
After birth, the doctor must examine the baby’s oral cavity, which makes it possible to diagnose the pathology. If the frenulum is short, this can lead to difficulties in feeding, and correction is carried out in the maternity ward.
In some cases, the doctor may not notice a short frenulum, but when feeding, the child may experience symptoms that indirectly indicate pathology.
When feeding, the baby makes “smacking” sounds, often drops the breast and tries to rest - the feeding schedule changes, and the number of feedings increases. Babies may be capricious at the breast or even refuse, as a result the child does not gain weight well. Mothers often complain that babies bite their breasts because they cannot get their tongue between the gums and the mother’s nipple.
A short frenulum in the oral cavity can be diagnosed throughout life. In order to make sure once and for all that everything is in order in the child’s mouth, it is necessary to carry out a series of tests. Parents can also do this, although the doctor will most correctly conduct the tests.
The child should be asked to open his mouth and reach his tongue to the roof of his mouth. If the baby performs this operation without any difficulties, there is nothing to fear. But, if the child experiences unpleasant or painful sensations, or the baby is not able to reach the sky, this is an indication for a quick visit to the dentist. Parents should remember that such a test is informative only for children two to three years old.
Only a dentist or speech therapist can confirm shortening of the frenulum of the tongue in children of school and preschool age. Usually, an examination is prompted by a speech disorder in a child, when the child cannot pronounce a certain set of sounds - “r”, “sh”, “sch”, “zh”, “ch”, etc.
How is a short tongue frenulum corrected?
There are features of plastic surgery depending on the age of the child. In the case of correction of the frenulum in newborns, which occurs in the maternity ward and with the obligatory presence of the mother, the frenulum is cut using special scissors or a laser, the latter is preferred. There are no nerve fibers in the frenulum itself, but there are many blood vessels. When using a laser, all blood capillaries are closed - there is no bleeding, and there is no need for stitches. A prerequisite is the presence of the mother during the procedure, since immediately after excision of the frenulum, the baby must be attached to the breast. It is at this time that the frenulum returns to normal and possible bleeding stops.
In the case of correction of the tongue frenulum in older children, both surgical and speech therapy treatment can be used. Everything will depend on its length and the age of the child, and on the consequences that this pathology provoked. Parents must clearly remember that the final verdict rests with the dentist, and not with the speech therapist, who can sometimes give false hopes for stretching the oral frenulum using various exercises.
It is the dentist who can assess the damage and clearly predict whether speech therapy treatment is suitable in each specific case. Quite often, dentists advise using complex treatment: surgical dissection of the oral frenulum and the use of speech therapy exercises - this combination gives excellent results.
Clinic Constant. Information for parents of young patients.
How is bridle trimming done?
Trimming the frenulum in babies is quick and completely painless, taking only a couple of minutes. In adolescent and adult patients, the operation may take 20-30 minutes. Carrying out laser surgery in a dental clinic by the hands of professionals guarantees the absence of complications and painlessness.
Expert opinion
Dzhutova Aida Vladimirovna Implant surgeon Work experience 10+
“The ability to use painkillers during frenulum trimming depends on the condition of the frenulum, the patient’s age and sensitivity. In children, the film is very thin, so the procedure takes only a few seconds, but in adult patients, anesthesia may be required, since the frenulum becomes denser, and the operation can cause unpleasant and even painful sensations.”
Stages of the operation:
- injection of anesthetic,
- dissection of the frenulum using a laser device, surgical instruments,
- sutures, which usually dissolve on their own 4-5 days after surgery.
At Smile-at-Once, a laser may be used to trim the frenulum. In this case, no anesthesia is required; the laser beam simultaneously carries out antiseptic treatment and stops blood vessels, which prevents bleeding and injury to the mucous membrane.
Additional treatments
After the operation, speech therapy treatment is required to help the child speak and move his tongue again - this will solve all pre-existing speech problems.
If shortened labial mucosa has caused aesthetic problems with the shape of the gums, flap plastic surgery may additionally be performed. Its goal is to form a new gingival contour by cutting and displacing the mucosa.
Speech therapy exercises
Speech therapists offer a wide range of exercises that are aimed at stretching the frenulum of the tongue. All exercises are carried out in a playful way, which only increases the baby’s interest in the exercises.
- The first and quite common exercise is the “horse”. To do this, the baby needs to make clicking movements, imitating the sound of a horse.
- For small children, you can offer the “kitten” exercise - give the baby a saucer and ask him to lick it. Instead of a saucer, the child can be offered any other object, for example, a spoon.
- For older children, you can use more conscious games, for example, ask the child to imagine that the oral cavity is a room in which the ceiling needs to be painted, the tongue is used as a paint roller, and the ceiling is the sky.
Stretching the frenulum can occur not only with exercises that are aimed at stretching the frenulum in length; exercises that are aimed at stretching the frenulum to the side give excellent results. For example, ask the child to count the teeth in the mouth, or “paint” the inside of the cheeks with paint.
The basis of all exercises, one way or another, is stretching the frenulum in the literal sense of the word.
The number of exercises will depend on the clinical picture, the length of the frenulum in the cavity and, of course, on the age of the child. Volunteer professor Bessonov Sergey Nikolaevich CONSTANTA Clinic through the eyes of a child! Anesthesia for operations in children Treatment of children with the support of the Charitable Foundation
Diagnostic methods
How can a tongue tie be diagnosed in infants? Parents can easily recognize this defect on their own. The baby’s tongue is tightly attached to the lower jaw, its movements are limited (mobility directly depends on the severity of the anomaly), the child is not able to stick his tongue out of his mouth. By lifting the baby's tongue, you can see the connective tissue thread that attaches the tongue to the oral cavity.
This diagnosis can be easily recognized during breastfeeding. For such babies, the feeding process takes a longer time, since the baby is not able to grasp the nipple normally. Therefore, the sucking process is difficult and intermittent. Because of this, these babies gain weight slowly and become restless before feeding.
In older children, such a pathology as a short frenulum is expressed by a violation of word formation and a lisp - it is difficult for them to pronounce the sounds sh, shch, h, zh, r.
