What does the frenulum of the upper lip look like? Types of operations on the frenulum of the upper lip

The problem of oral frenulum occurs quite often. According to statistics, their frequency is approximately 10 percent of children. If not diagnosed in a timely manner, they can cause a lot of difficulties for the child in the future. And the consequences are very serious.

After all, bridles can make adjustments not only to appearance, changing the aesthetics of the face and smile for the worse, but also significantly affect speech functions and the ability to eat normally. Therefore, it is very important to promptly notice this disorder in a child and seek medical help.

There are three frenulums in the oral cavity, each of these frenulums is a small cord. Despite their small size, they can have a big impact on a baby’s daily life.

With their help, to a large extent, the child is nourished, the oral mucosa is maintained in normal condition, and most sounds are correctly and clearly pronounced. To a certain extent, frenulums can affect the degree of bite. And, of course, the appearance of the baby’s face also depends to a large extent on the condition of the frenulum.

Specifically, bridles are:

upper lip. It performs a connecting function between the upper lip and the gum located on the upper jaw. Its weaving occurs above the front incisors located in the dentition;
lower lip. Its attachment occurs similarly to the upper lip, the principle is the same, but on the lower jaw;
language. In its structure and functions, this bridle is more complex than other bridles. This is what parents most often have questions about. But not because problems with it occur more often, but only because parents mistakenly believe that it is the only frenulum of its kind in the child’s mouth. The frenulum connects the tongue and the sublingual area.

Why are they dangerous?

When the lip moves, the frenulum entails the gum, which moves away from the incisors of the front teeth, thereby causing their increased sensitivity. As a result, the roots are exposed and periodontal disease occurs. Such manifestations occur, mostly in older people.

As for such a disorder in children, the problem is much more serious. Since they are developing a permanent bite and at this time the short frenulum forces the front teeth to move forward, this is more noticeable if there is little meta in the dentition. It should be noted that the consequences of such bites are difficult to correct. In addition, all this will require time and financial costs.

A short frenulum of the upper lip in a newborn child can cause not only serious problems, but also pose a certain danger. With this pathology, the child has difficulty grasping the mother’s nipple, which causes him anxiety, and he quickly experiences fatigue. As a result, he receives less milk than he could have received. Due to fatigue during feeding and incomplete saturation, the baby gains little weight.

The problem also exists in the fact that the reason for such behavior of the child, his physical condition, the mother, and often doctors, see something else - a lack of milk. But it would seem that it would be easier to look into a child’s mouth. Therefore, you need to be aware of this and try to respond more carefully to every change in the child’s behavior.

There are every opportunity to determine the short frenulum in the maternity hospital. It is quite possible that doctors will immediately perform surgical intervention to eliminate frenulum disorders. If at that time it does not interfere with the child’s ability to suckle normally, the correction will be postponed until a later date. Although this may initially affect the child’s pronunciation of individual sounds - he will not be able to pronounce them. In this case, the attending physician will jointly correct the frenulum with a speech therapist.

How to determine

How to recognize any frenulum deviations? What consequences can this pathology have for a child? - such questions are often asked to mothers at a doctor’s appointment.

Identifying a short frenulum in a baby is not difficult even for a non-specialist; it can be seen immediately.

Parents just need to lift the baby’s lip a little and they will be able to see where the frenulum is woven. Compare with the level of the incisor neck. In a normal state, the bridle should be woven slightly above this level - approximately half a centimeter. If the reading is lower, this may directly indicate a short frenulum.

But the final diagnosis, of course, must be made by a doctor. If a pathology is detected, you should contact a medical facility. The consequences of a short frenulum can be found in the list below:

sucking function is impaired. In most cases, the baby is not able to properly attach to the mother's nipple - to clasp it well and completely;
changes external data, the face takes on a not entirely aesthetic appearance;
Tremas are formed, diastemas are gaps located between the front teeth. The latter can be provoked by physiological reasons, for example, this is observed at the stage of development of baby teeth. During this period, the child’s body prepares the jaws for the natural process of replacing teeth with permanent ones. But there are gaps that are caused by pathological reasons - one of which is a short frenulum. In this case, both surgical and orthodontic treatment are recommended;
be a provoking factor in the manifestation of bite pathology. This occurs as a result of the constant tension of the frenulum causing the incisors to protrude forward. A similar disorder usually occurs in children who already have permanent incisors. The pathology is treated, as in the previous case, with the help of a surgeon and an orthodontist;
due to the pressure that is constantly exerted on the mucous membrane of the upper jaw, preconditions are created for the development of inflammatory processes and dental diseases - gingivitis and periodontitis. As a result of the gums exposing the necks of the teeth, they acquire increased sensitivity, which opens the way for caries.

When to prune

At what age should a short frenulum be corrected? Is the operation difficult? – such questions often arise from mothers who are faced with this problem. Indeed, it can only be solved surgically. True, there are also difficulties here. It is not always possible to carry out such an operation; certain conditions are required for this.

Trimming the frenulum of the upper lip in children is recommended only when the child’s permanent teeth, or rather the front incisors, begin to emerge. Sometimes such a correction is allowed after the canines or incisors located on the side have erupted. An operation performed during this period will avoid orthodontic treatment. This becomes possible because at the moment of eruption of other teeth it provides the necessary pressure and diastema, three capable of closing themselves.

In the case where the frenulum is treated after the canines and incisors have erupted, it is necessary to use a mechanical clamp of the incisors. Special ties are used for this procedure. They should be placed on the teeth for a short period of time. According to experts, with an integrated approach, the result will be positive.

All these restriction measures are related to the fact that as the jaw grows, the frenulum also changes. An exception to this rule can only be made in the maternity hospital, as mentioned above, when the frenulum really poses a threat to the normal development of the child, he cannot attach well to the mother’s breast. In other cases, you should adhere to the rules of limitation in order to avoid many negative consequences.

Torn frenulum

It often happens when a child, injuring the upper lip, causes damage to the frenulum - it ruptures. In such a situation, you should immediately seek help from a doctor. Not only to treat the wound, but also to avoid complications when the frenulum heals on its own.

After all, without proper surgical treatment, there is no guarantee that the frenulum will heal correctly and not asymmetrically. In addition, a rough scar will appear, which will limit the mobility of the lip. And this, in turn, will lead to speech impediment. After such an injury, the child will need to be taught exercises that will promote the mobility of the organ responsible for articulation and allow the frenulum to be slightly lengthened.

How the adjustment is carried out

Trimming the frenulum of the upper lip is done in a medical facility. Local anesthesia is used for pain relief, and the doctor may even talk to the child during the operation. The duration of the operation, as a rule, during the normal course of the process is about thirty minutes.

There are three options for frenuloplasty:

dissection. This technique is used when the frenulum of the upper lip is narrow and does not connect to the edge of the alveolar process. The specialist, using experienced manipulations, cuts it across, making barely visible longitudinal seams;
excision. Here, on the contrary, a wide frenulum is visible. The surgeon needs to make an incision that will affect the crest of the tense frenulum and excise the interdental papilla, as well as the tissue located between the roots of the spread incisors;
frenuloplasty. This is the name of the method in which the place of attachment of the bridle is changed.

Such operations are almost always carried out with four incisors fully cut. This corresponds to a seven to eight year old child.

During the rehabilitation period, you need to follow some recommendations:

eat ice cream more often, especially for the first time in the early days;
maintain general hygiene, monitor the condition of the mucous membranes;
The diet should not contain solid and rough food.

After the correction, sutures will be placed; they are made of a special material that can dissolve on its own. A distinctive feature of this operation is that recovery requires only a few hours.

If the operation was performed on a baby, you can immediately feel the result - the baby will begin to pronounce individual sounds more clearly and apply himself correctly to the mother’s breast.

It should be noted that in recent years, performing operations with sutures has increasingly become a thing of the past, as the usual scalpel is being replaced by a laser one. The recovery period is also shortened, so this technique is primarily indicated for infants for whom breastfeeding is important.

The use of modern methods allows you to avoid even minor complications, such as swelling. During the rehabilitation period, the baby only needs to strictly follow the doctor’s recommendations and exercises for training the frenulum. And everything will work out as if nothing had happened.

Every child and adult has a frenulum of the upper lip in the oral cavity, which serves as an additional attachment of the lip to the jaw bone. It is a vertical fold of the mucous membrane and has the following structure:

Mucous type: easily extensible;
Fibrous type: dense, slightly extensible;
Muco-fibrous type: medium density and extensibility.

Attachment height:

Low: transition into the tissue of the gingival papilla;
Medium: located in the middle of the attached gum;
High: located in the area of the transitional fold of the upper lip.

The correct location is considered to be one in which the lower edge of the frenulum connection is 5-8 mm from the neck of the teeth in the center of the alveolar process of the upper incisors. If it is attached below this distance or extends beyond the front incisors, then it is considered shortened. Anomalies of its development are among the factors predisposing to dental diseases.

Consequences of a short frenulum

In newborn babies, short frenulums of the upper lips can interfere with sucking function, preventing them from correctly and completely taking the nipple from the mother's breast. In this case, after examination by a neonatologist, it is trimmed in the maternity hospital. However, if the baby gains weight well during feeding, frenulum correction is not performed.

In preschool age, its low attachment has little effect on the mobility of the lips and the growth of the facial skeleton. But when, after the eruption of the central incisors, the frenulum is tightly woven into the gingival papilla between them, this leads to the formation of a gap, which, without treatment, will only widen with age.

Also, the presence of a short frenulum of the upper lip can lead to the following dental, orthodontic and speech therapy problems:

Pushing forward of the upper central incisors and, as a result, malocclusion, deformation of the dentition;
Changes in the configuration of the upper lip, protrusion, which does not allow completely covering the upper teeth;
Excessive tension of the mucous membrane of the gums, and as a result of its recession, exposure of the roots of the teeth, inflammatory diseases in the area of the anterior incisors: gingivitis, periodontitis.
Impaired pronunciation of labialized sounds, unclear diction.

When is the upper lip frenulum trimmed?

With the growth and development of the child's jaws, the frenulum is able to change its place of attachment and stretch significantly without external intervention. Therefore, a short and thick frenulum of the upper lip during the period of primary occlusion is considered a normal variant. But when, even after the eruption of the permanent incisors, it remains short and low-attached, a periodontist or speech therapist may recommend trimming it.

In children, the operation is performed no earlier than 6-8 years of age, after complete eruption of all 4 front incisors on the upper and lower gums. Cutting the frenulum earlier may lead to the development of an overbite.

The main indications for its plastic surgery are as follows:

Diastema;
Preparation for orthodontic treatment;
Periodontal diseases or the threat of their occurrence;
Preparation for removable prosthetics;
Violation of diction and pronunciation.

How to trim the frenulum of the upper lip

This is a simple but very effective surgical operation that allows you to solve and prevent a number of problems. Quite often, not only children, but also adults need it. It is performed on an outpatient basis, under local anesthesia, using the classical method using a scalpel or an alternative method using a medical diode laser. The main advantages of laser plastic surgery are bloodless, painless, and highly antiseptic.

Dissection (frenotomy) is indicated for a narrow frenulum of the upper lip that is not attached to the edge of the alveolar process. It is dissected in the transverse direction, after which sutures are applied in the longitudinal direction. Removal of sutures after surgery is not required, as surgeons use self-absorbing suture material catgut.

Sometimes a child may rupture the frenulum of the upper lip as a result of a fall; in this case, you should immediately contact a surgeon at a dental clinic to resolve the issue of its future fate.

Excision (frenectomy) is indicated for a wide frenulum of the upper lip. The surgeon cuts the tense frenulum along the ridge, then excises the interdental papilla and tissue in the space between the roots of the central teeth. Frenuloplasty is indicated to move the site of attachment of the frenulum.

Postoperative period

After the operation, there is a slight discomfort due to the novelty of the sensations; fresh wounds may ache a little at first, but the patient quickly returns to normal. To minimize discomfort and consolidate the results obtained, the following rules should be followed:

Refrain from eating solid and hot foods for 2-3 days;
Strictly observe oral hygiene;
Be sure to see the surgeon the next day or the day after the plastic surgery;
To strengthen the chewing and facial muscles, a week after surgery, regularly perform special myogymnastic exercises.

There are also ones that can also cause problems in children.

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A beautiful smile and clear pronunciation of sounds depend on the position and length of the frenulum in the oral cavity. Abnormalities of the folds between the gums and lips are common: the cord is too short, wide or narrow, making communication difficult and causing numerous oral health problems. In childhood, the frenulum is cut or its congenital position is changed - this is a simple operation with a minimal period of tissue restoration.

Why cut a child's frenulum? Its too small size causes difficulties with sucking in infants, and in older children - problems with the location of the permanent incisors and pronunciation of sounds. A small anomaly can serve as the beginning of the development of early caries, the appearance of gingivitis, and exposure of the necks of teeth. For this reason, plastic surgery of the upper lip frenulum is prescribed in infancy or preschool age.

When is trimming the frenulum of the upper or lower lip indicated?

Is it necessary to correct the frenulum of the upper (lower) lip in a child? If conservative therapy is ineffective, the doctor prescribes surgery. If you refuse it, diseases of the gums and teeth may occur, an uncomfortable bite may form for the baby, and speech defects may appear. Plastic surgery of the frenulum on the upper lip is prescribed for the following problems:

the fold is too thick or short;
inability to breastfeed;
periodontitis;
formation of a gap between teeth (diastema);
presence of speech defects;
preparation for orthodontic treatment.

Trimming the lower frenulum in children is carried out if it is too wide, short, incorrectly placed, or there are two folds instead of one. The defect can lead to caries of baby teeth, the formation of gum pockets, and inflammation (we recommend reading:). In babies, this area of the mouth sometimes hurts, causing discomfort. Most often, the frenulum of the lower lip is trimmed with a laser. In adults, surgery is indicated for certain diseases of the oral cavity and before installing dentures, if there is a risk that the fold will cause the structure to collapse.

It happens that parents missed a developmental anomaly, and adult patients turn to a specialist for correction. Plastic surgery of the upper labial frenulum is performed at any age - the operation is performed quickly, under local anesthesia and is easily tolerated by the person.

Reasons for the formation of a short or too long frenulum

This article talks about typical ways to solve your issues, but each case is unique! If you want to find out from me how to solve your particular problem, ask your question. It's fast and free!

The frenulum of the upper lip is a soft and elastic fold that can be found when the lip is pulled back (located vertically, coming from the gum). The bridle at the bottom is located similarly. Normally, it is almost invisible, located in the middle of the dentition 5-8 mm above (below) the neck of the teeth. When properly sized, this fold does not cause problems with articulation, eating, or imperfections in the facial area around the mouth. Photos will allow you to independently identify the presence of pathology and contact a dentist.

In general, the causes of fold development anomalies are not fully understood. In almost 50% of cases, a short, deformed or wide frenulum is inherited from one of the parents (we recommend reading:). Other cases are associated with harmful effects on the fetus in the 1st trimester of pregnancy:

severe toxicosis;
taking antibiotics;
viral diseases;
the effect of varnish, paint and other chemicals.

Optimal age for the procedure

The best time to excise the frenulum on the lower lip and above is infancy. In a 2.5-6 month old baby, this area of the mucous membrane does not yet have formed nerve endings and a strong blood supply.

The operation is carried out quickly - it is convenient for the doctor and painless for the little one. If time is lost, plastic surgery of the frenulum of the lower lip is performed at 7-9 years, and the upper lip at 6-8 years, when the formation and eruption of permanent incisors occurs.

The main reason why upper lip correction is performed is to prevent periodontal disease. Deformations are the basis for the development of gingivitis, periodontitis, increased sensitivity of the enamel; food debris collects in the gum pockets, provoking the proliferation of pathogenic microbes. This can lead to rapid tooth loss.

Types of frenuloplasty

The fold can be modified in two ways: it is partially removed or it is cut open for suturing and subsequent fusion in the correct position. Its rupture can occur spontaneously when falling or chewing hard food, which is quite painful. Therefore, it is better to consult a doctor in time to diagnose and identify the need for surgical intervention. The method of eliminating the problem is chosen depending on the severity of the pathology. Before surgery, the patient undergoes a general urine and blood test, a coagulogram and fluorography.

Laser plastic surgery

Recently, plastic surgery of the upper lip frenulum using a laser has become increasingly popular. The procedure takes 3-5 minutes, and the child will not be hurt because an anesthetic gel is used. A laser device is directed onto the tissue, generating a powerful light beam. The mucous membrane “dissolves”, and the edges of the wound are sterilized and sealed using the device. The videos will help you learn more about the laser excision method and get ready for the procedure. The laser frenuloplasty method has many advantages:

absence of sounds that frighten the baby;
no need for stitches;
short rehabilitation period;
minimal inflammation;
bloodlessness;
eliminating the possibility of infection.

With laser surgery, there is virtually no chance of experiencing pain or getting a post-operative scar. This method is most often used to perform plastic surgery of the lower lip frenulum. In some cases, doctors are inclined to carry out intervention using traditional methods, since the laser beam is not able to cope with anomalies.

Frenuloplasty methods

One of the proven methods of upper and lower lip plastic surgery is frenuloplasty. It is indicated when the fold is narrow and does not reach the alveoli. The procedure is performed under local anesthesia using surgical instruments. There are 2 ways to do it:

The specialist moves the fold between the lip and gum to the desired location, and sutures are applied using catgut. During this operation, a bed must be formed, since simply stitching the tissues together will weaken the tension, but will not solve the main problem. Most often, plastic surgery of the upper lip frenulum is used before the installation of orthopedic structures or brace systems.

Frenectomy

Removal of the frenulum is indicated if it is too wide. Large amounts of plaque constantly accumulate on the teeth, which can lead to serious dental diseases. An incision is made along the ridge of the mucosa, after which the surgeon removes the interdental papilla and the tissue that is located at the roots of the incisors in the center. Often, plastic surgery of the upper lip frenulum using the frenectomy method is performed when a child accidentally damages the oral cavity due to a fall. Then stitches are applied or the fold is completely excised.

These small mucous strands can affect the clarity of speech, the aesthetics of a smile; in infants, the frenulum of the oral cavity can affect the quality of attachment to the breast, or the ability to suck a bottle. It is for this reason that parents should pay attention to these anatomical formations.

If the frenulum(s) of the oral cavity are short, the baby will not be able to eat properly, attach to the breast, and therefore will get tired faster, remaining hungry. There can be no talk of any increase in the child’s weight or height. Parents should remember and be aware of this problem and be able to notice alarming symptoms. According to statistics, a large percentage of short frenulums are registered in children, on average every 14 children. If the problem is diagnosed in time, it is possible to avoid those complications that can cause short frenulum.

Oral anatomy

There are three frenulums in the child’s mouth, and not alone, as many parents believe. After all, more " famous» frenulum of the tongue, which is attached to the underside of the tongue and sublingual space. The frenulum of the tongue is rightfully considered the most insidious, but at the same time practically the most important.

In addition to the frenulum of the tongue, in the baby’s mouth there are also frenulums of the upper and lower lips, which are also assigned certain functions. The frenulum on the upper lip should be woven into the upper lip and into the mucous membrane of the gums, just above the level of the front incisors. The frenulum on the lower lip is woven in the same way as the upper lip.

As a rule, a short frenulum in the mouth can be diagnosed in the parent department; this is more true for a short frenulum of the tongue. As for the rest of the frenulum of the oral cavity, diagnosis mainly occurs in the dentist's chair at a random appointment. There are cases when a tongue frenulum is not immediately diagnosed, and the frenulum in no way interferes with the feeding of the baby. But subsequently, the child may pronounce incorrectly defined sounds, and then the question of a short frenulum of the tongue comes up again, which, as a rule, is diagnosed at an appointment with a speech therapist.

Upper lip frenulum

When diagnosing a short frenulum, there are usually no difficulties, even for parents. To do this, you just need to carefully pull back the upper lip at rest and see at what level the mucous cord is attached. Normally, attachment should occur 5–8 mm from the neck of the child’s incisors. If the frenulum is attached lower or its attachment is not visible at all, then we can talk about a short frenulum.

What are the dangers of having a short frenulum?

In a newborn baby, a short frenulum on the upper lip can affect breastfeeding; the baby simply cannot position the upper lip correctly and correctly grasp the mother's breast. Only in this case can the frenulum of the upper lip be corrected in the maternity hospital. Fortunately, this happens quite rarely.
At an older age, a short frenulum in the oral cavity can affect the aesthetics of a smile, since a gap is formed between the child’s front teeth - a diastema (trema). Typically, children are embarrassed by such diastemas, especially teenagers, and try to smile or talk less.

Such gaps between teeth are considered dental defects that require orthodontic treatment, sometimes in combination with surgery. But it is worth remembering that an aesthetic defect is not the only problem that can be caused by a short frenulum of the upper lip; the most serious complication is problems with bite, namely the protrusion of the front incisors forward.

The protrusion of the front incisors occurs as a result of pressure. The fact is that when talking or eating, the lips are involved, and the frenulum connects the lip and the alveolar process and pulls it along with it, while mechanically acting on the jaw in the area of the incisors, promoting their advancement forward. The solution to this problem is orthodontic, and requires a fairly large investment of time and money. In fairness, it is worth noting that such a scenario can only develop in children with permanent incisors; if the baby still has a milk bite, then there is no need to worry.

Excessive tension of the gum mucosa can provoke inflammatory diseases in the area of the front incisors - gingivitis, periodontitis. As a result, the child may develop increased tooth sensitivity. Speech defects may also be characteristic of a short frenulum; the toddler cannot correctly pronounce some sounds that the baby uses his lips to pronounce, for example, “o”, “u”, etc.

In addition, inflammatory diseases in the gum area can provoke caries in the neck area of the teeth. Due to the low attachment of the frenulum, a large amount of plaque accumulates in the incisor area, and it is quite difficult to remove.

How does the correction happen?

Correction can be done exclusively surgically, but it is worth remembering some features. Correction of the frenulum on the upper lip is indicated only after or during the eruption of the permanent incisors! Usually this is 6 - 8 years old; until this age, parents should not worry.

It is not recommended to perform the operation before this period, with the only exception in the maternity hospital. Otherwise, such actions may result in bite pathology. A shortened and thick frenulum of the upper lip in a primary occlusion is not a pathology, but a variant of the norm; as the jaws grow, the frenulum can self-correct, i.e. stretch out and change its place of attachment.

It is for these reasons that the most optimal time for correction is the time when all the permanent incisors on the upper jaw have erupted, and active eruption of the canines begins, or when the anterior permanent incisors are erupting, and when the lateral incisors are actively erupting. The fact is that when the frenulum is corrected at this time, the erupting teeth will move the teeth towards each other and the gap between the teeth will close on their own, and there will be no need for orthodontic treatment.

If it was not possible to correct the frenulum in time, it is necessary to use orthodontic treatment, when the doctor places a “brace” on the front teeth, which will bring the incisors together.

Surgical treatment

Dentists can use 3 types of surgical treatment:

Frenotomy - dissection;
Frenectomy - excision;
Frenuloplasty – relocation of the frenulum attachment site.

Children can cut the frenulum on their own, and cases of such injuries are quite common. For example, if you fall or chew toys too hard, the frenulum may rupture, which is accompanied by bleeding and hematoma. In case of injury, you must immediately consult a dentist to decide the future fate of the injured frenulum. Frenectomy allows you to solve this problem, and even with trauma to the oral cavity, ruptures of the frenulum, as a rule, do not occur.

The operations themselves are performed in a surgical clinic, using local anesthesia, and the procedure usually does not take more than 30 minutes. After cutting the frenulum, the doctor places sutures made of a special biomaterial that dissolves on its own, which avoids the unpleasant procedure of removing them. The recovery period after the procedure is not long and takes from several hours to several days. And as soon as the swelling subsides after the operation, parents note that the child begins to pronounce sounds more clearly, or grasps the mother’s breast more freely.

The operation can be performed using various instruments - surgical scissors or a scalpel, or using a laser. Using the latter technique is the most acceptable, as it avoids stitches and significantly reduces the baby’s recovery time. Most often, the frenulum is corrected in young children using a scalpel, the amount of time spent is reduced, and immediate attachment to the chest is a prerequisite.

Frenum on the lower lip

There may be no frenulum of the lower lip or it may be forked. In order to diagnose a frenulum on the lower lip, it is necessary to retract the lower lip. At the same time, the frenulum itself becomes noticeable, which runs from the middle of the alveolar process of the lower jaw, intertwining below the area of the lower incisors, and attaching to the lower lip.

Under normal conditions, the frenulum should be thin and almost invisible, in addition, it should be flush with the center line. If the baby's frenulum is thick, short and attached at the base of the lower incisors, the frenulum is short.

Why is a short frenulum of the lower lip dangerous?

By analogy with the frenulum on the upper jaw, the sucking function of a toddler may suffer. When sucking, the short frenulum pulls the lower lip along with it, thereby breaking the vacuum that is formed during sucking. The baby needs more effort, the baby quickly gets tired, remaining hungry and abandoning the breast. In this case, frenuloplasty can be performed in the maternity ward.

A short frenulum can also cause malocclusion, inflammatory and carious diseases in the area of the lower front incisors. The formation of spaces between the lower anterior incisors is quite rare, but can still be diagnosed if the frenulum is woven into the area of the gingival papilla between the anterior incisors of the lower jaw.

Treatment

The operation can be performed on children of different ages, but most often these are children with fully erupted permanent incisors. No less often, the frenulum can be cut already in adulthood, when it comes to prosthetics of the lower jaw.

The operation itself is carried out in a clinic, using local anesthesia, and 2 operations can be used to correct the frenulum - frenotomy, frenectomy.

Tongue frenulum

It is this frenulum that can influence the movement of the tongue; most often it limits these movements. The tongue is the most important organ in the oral cavity, which is involved in many functions - speech formation, nutrition, breastfeeding and much more.

Normally, the mucous cord is woven from the inside of the tongue approximately in the middle, and connects to the sublingual space. The normal length of the frenulum is about 8 mm. If a toddler’s frenulum is attached almost to the tip of the tongue, then this is a clear indication for correction.

This classic sign of a short frenulum of the tongue is not always found; there are other symptoms that can be used to diagnose its shortening. Doctors usually use a simple test that parents can use too. When the baby’s mouth is open, you need to ask her to touch the very roof of her mouth, and if the baby reaches without difficulty, everything is normal. But if a child experiences a painful reaction, or the child simply cannot perform this operation, this is a reason to contact a doctor.

The only drawback of this test is the age restrictions for children; such a test can only be performed on children over 3 years old. If the baby is younger, then he can simply refuse to carry out such manipulation. There is also a set of tests for younger children; doctors usually ask or provoke the child to show his tongue. And at the same time, the doctor evaluates how much the baby’s tongue can come out of the mouth.

Why is a short oral frenulum dangerous?

Every mother should pay attention to feeding the baby, monitor his reaction, pay attention to the sounds the baby makes, and weight gain. With a short frenulum of the tongue, the baby simply cannot properly place his tongue under the mother’s nipple, it turns out that the baby cannot grasp the breast correctly, and “clicking” sounds may occur during feeding.

In addition to inadequate breastfeeding and problems for the mother, the baby spends more effort to get enough, the baby’s sucking activity gradually decreases, and the feeding time itself increases, during which the baby takes a short break. The baby tries to compensate for the greater amount of effort by clenching his jaws, and often when feeding, babies bite their mother's breast.

Often such children set their own feeding schedule, since full saturation occurs over a longer period of time; usually babies eat approximately every two hours. Weight gain is at the lower limit of normal, or even lags behind.

The frenulum may not be diagnosed in infancy, and can be detected during the period when the baby begins to actively talk. Babies with a short frenulum of the tongue cannot correctly pronounce quite a lot of sounds, namely those sounds in which the tongue should touch the palate or upper incisors - “r”, “sh”, “sch”, “ch”, “ry”, etc. Diagnosis of the frenulum often occurs at an appointment with a speech therapist, from where parents receive a referral to a dentist.

Treatment

Treatment can take place in two ways - surgical or speech therapy; often a combination of these two methods occurs. Parents should remember that the choice of treatment method lies entirely on the shoulders of the dentist, and not the speech therapist.

Surgical correction of the frenulum

The frenulum can be corrected in the maternity hospital; the operation is carried out in the obligatory presence of the mother, and after the operation the baby must be immediately applied to the breast. There are no nerve endings in the frenulum itself, but there are blood vessels; there are none in the place where the dissection occurs, therefore, there is no pain or bleeding. Babies can simply get scared, and applying to the breast is more of a calming maneuver.

In young children, correction is most often carried out using a laser, which eliminates the need for stitches and reduces recovery time.

In older children, namely school children, it is performed under local anesthesia. In this case, the doctor cuts the frenulum and applies sutures using a classic set of instruments. It is more advisable to use a laser scalpel. When using it, the time of the operation itself is reduced, and there is no need for sutures.

After rehabilitation, the baby must follow a special gentle diet and perform the exercises recommended by the dentist or speech therapist. These exercises are aimed at training the frenulum. If the frenulum is not very shortened, then it is possible to solve the problem without surgery, but only if the child is less than 5 years old.

Speech therapy exercises

Exercises can be different, and the choice will depend on the age of the child. For the little ones, you can offer play exercises where the baby’s tongue will be used, for example, the “kitten” exercise - the baby is asked to lick a saucer like a kitten.

You can use the exercise " horse", ask the baby to click like a horse, while the tongue rises to the sky, tension and stretching of the frenulum occurs, which trains it.

At the appointment, the speech therapist can massage the frenulum using special tools or with the help of hands. It is worth remembering that the child gets tired quite quickly, and unpleasant sensations, even pain, may occur. That is why the load must be increased gradually, and it is precisely this fact that is associated with the fact that speech therapy treatment does not give quick results, and in most cases it is impossible to do without surgical intervention. And when diagnosing a short frenulum, it is necessary to obtain

Despite the fact that most “non-dentist” doctors, mothers and fathers for some reason do not consider pediatric dentistry to be something difficult (in their opinion, the main difficulty is keeping the child in the chair), there are a number of issues on which there is no clear opinion still doesn't exist. One of these issues is plastic surgery of the frenulum of the upper lip. Why is it needed, how and when is it done - read below.

For what?
Any medical intervention must be justified. It must also pursue some goals. Therefore, the pediatrician’s words “Your child has a short frenulum of the upper lip” are not an indication for emergency plastic surgery. In this case, it is better to seek advice from a good dental surgeon who knows how to work with children.
And the indications for plastic surgery of the upper lip frenulum are as follows:
1. The presence of a gap (diastema) between the central incisors. The frenulum of the upper lip, intertwined with the interdental papilla and forming a thick cord, does not allow the incisors to converge towards the center. Moreover, due to constant low load, the diastema will increase, and the teeth themselves will move forward and away from the center.
In such a situation, the interdental papilla is constantly exposed to injury - this can lead to periodontitis and, as a consequence, tooth loss.
2. In preparation for orthodontic treatment. As mentioned above, all kinds of soft tissue cords in the oral cavity, including the frenulum of the upper lip and tongue, create small loads on the dentition and significantly affect the bite. Therefore, if your child needs to have his bite corrected, you need to pay attention to the frenulum of the upper lip.
3. For periodontal diseases and the threat of their occurrence. In this case, the frenulum of the upper lip “pulls” the mucous membrane from the teeth. Gum recession occurs - a very unpleasant thing that will require long-term and expensive treatment.
4. In preparation for removable prosthetics. When the lips move (for example, while talking or eating), a short frenulum of the tongue can cause the denture to fall off. Naturally, we are talking about who uses removable dentures.
5. Very, very rarely A severely shortened frenulum of the upper lip can cause impaired sound production and speech therapy problems. This is also an indication for plastic surgery of the upper lip frenulum.

When?
This is where one of the main disagreements arises. Sometimes very young children aged 0 to 2 years are brought to us with a request to “cut” the frenulum of the upper lip. To the question: “Why?” we get a natural answer: “The pediatrician said...”

Remember once and for all: UPPER LIP Frenuloplasty is NOT PERFORMED ON INFANTS! There are no indications, but there are quite a lot of dangers.
The optimal age for plastic surgery of the upper lip frenulum is from 5-6 years. At this time, an active change in the bite occurs - milk teeth fall out, permanent teeth erupt. So, the ideal option is the time when the central incisors have erupted (at least by a third), but the lateral incisors have not yet erupted. In this case, the erupting lateral incisors will, as it were, “push” the central incisors towards the center (nothing will interfere with their movement) - and everything will fall into place. Sometimes on their own, and sometimes with a little orthodontic help.

How?
No special preparation is required for upper lip frenuloplasty. I don’t quite understand why some doctors send children for tests and fluorography - this operation is very low-traumatic. In my opinion, as well as the opinion of the children themselves, removing baby teeth is much more unpleasant. We don’t send tests to everyone who comes to get rid of a tooth.
My only wish is that the child should be well-fed. A hungry person tolerates everything worse, hunger is additional stress, and a hungry person’s blood clots worse. So feed your baby before you go to the dentist.

One of the main conditions for the operation is that the child must sit quietly in a chair for at least 10-15 minutes. How to achieve this, .
The operation is performed under local anesthesia and takes about a quarter of an hour. It is absolutely painless and does not cause any discomfort (the child sits with his mouth slightly open and can even talk). Sutures are placed on the surgical wound, which do not need to be removed later - absorbable suture materials are used.

The postoperative period is also very calm. Of course, when the anesthetic wears off, the operation site may hurt a little, but this is the maximum.
The entire regime at this time comes down to three simple rules:
1. Careful oral hygiene
2. For 1-2 days, avoid rough and hot foods. It seems to me that you can live without chips, nuts, apples and carrots for two days.
3. Postoperative examination. Usually carried out the next day or every other day.

If all these conditions are met, then the baby will not have any problems. The operation goes almost unnoticed for both him and his parents, and the result obtained allows him to prevent many dental problems in the future.

Below is an example of such work. This time I will not show all stages of the operation (due to criticism from some readers for being “bloody”), but will demonstrate only the initial version, postoperative examination and long-term results after 6 months.

Girl Katya, 7 years old. Initial situation:

As you can see, the frenulum of the upper lip is woven into the interdental papilla. Because of this, the 11th tooth grows slightly to the side; one should expect that the same problem will arise with the 21st tooth. Therefore, together with the orthodontist, it was decided to perform plastic surgery of the upper lip frenulum.

Two days after plastic surgery of the upper lip frenulum:

The white strips are absorbable suture material. The postoperative wound gives an idea of the traumatic nature of this operation.

After this, Katya continues orthodontic treatment. The result of our collaboration after 6 months:

I wish I could teach Katya how to brush her teeth)))... A small diastema still remains, but this is a solvable problem.

As always, I look forward to your questions in the comments.
Good health!