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Frenum are the connective tissues that link the lips to the gums and the tongue to the floor of the mouth, playing a crucial role in supporting oral functions. However, when these tissues restrict tongue movement – a condition known as ankyloglossia or tongue-tie – do frenectomies become necessary?

“Frenectomies often receive a bad reputation,” notes Dr. Pankaj P. Singh. Some medical professionals view them as unnecessary, but Dr. Singh, who has performed over 3,000 of these procedures, believes they can be life-changing. Dr. Jenny Kanganis, a general dentist in Bronxville, NY, has witnessed this firsthand. She recalled an 18-year-old patient initially thought to be developmentally delayed, who struggled to speak due to a tongue tie.

Dr. Singh emphasizes the need for proper training in identifying and treating tongue and lip ties, as these topics are not typically covered in dental school. He pointed out that if the frenum is too tight, it can prevent newborns from nursing effectively, making a frenectomy critical for their ability to eat.

Frenulum Abnormalities According to Dr. Fred Solomon, DDS, a general dentist in NYC, frenulum abnormalities often involve a frenum that is too tight, limiting tongue movement. This restriction can lead to problems with sleeping, feeding, and speech. Dr. Singh highlights that a tight maxillary labial frenum can create gaps between teeth and contribute to early childhood cavities and breathing issues. Other types of frenulum restrictions can result in gingival recession and difficulties with dentures.

While organizations like the American Academy of Pediatric Dentistry and the American Association of Oral and Maxillofacial Surgeons have guidelines regarding frenectomies, Dr. Singh believes general dentists should not hesitate to perform them with proper training. He uses the Kotlow classification system to assess the frenum in infants and the tongue range of motion ratio (TRMR) in older patients.

Dr. Singh notes that the most challenging age group for treatment is between six months and four years, and he recommends referring these patients to pediatric dentists if necessary.

Frenectomy Modalities Dr. Singh mentions that laser surgery is now the preferred method for performing frenectomies, although some ENT specialists still use scissors. He explains that a proper release requires several small cuts to create a diamond-shaped wound. While some practitioners advocate for the use of blades, laser methods are popular due to their precision.

Dr. Kanganis emphasizes the importance of recognizing tongue ties, especially in cosmetic dentistry and denture work, where speech patterns can indicate a problem. “It’s crucial to assess whether the frenum feels tight,” she advises, suggesting that symptoms like feeding difficulties and sleep issues be explored.

Dr. Singh also highlights the TRMR as a helpful starting point for evaluations. He has developed a Tongue Restriction Questionnaire to identify common symptoms associated with tongue ties.

In July 2024, the American Academy of Pediatrics published a report in Pediatrics suggesting that frenectomies may be overused and that consulting lactation specialists can often improve feeding positions for better latching. However, Dr. Kanganis counters that frenectomies are frequently underutilized, particularly as more families attempt breastfeeding amidst formula shortages.

Dr. Singh adds that while some pediatricians oppose tongue-tie releases, they often fail to offer effective solutions for feeding challenges. “Dentists with extensive experience know when treatment is warranted,” he states. The experts expressed concerns about the report’s conclusions and the lack of visual references for different types of ties.

Dr. Singh collaborates with a pulmonologist for airway assessments, emphasizing the importance of interdisciplinary cooperation in achieving successful outcomes.

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