There are three braces in the mouth: lingual, upper labial and lower labial.
The lingual frenulum is a band of fibrous tissue that attaches the tongue to the floor of the mouth and is what gives mobility to the tongue in order to perform all oro-facial functions (sucking, swallowing, chewing and speaking).
The upper labial frenulum joins the upper lip to the maxillary gum in the midline and gives mobility to the lip. The lower labial frenulum is also located in the buccal midline and joins the lower lip to the gum of the mandible.
Tongue frenulum problems
When the lingual frenulum is too short it decreases the normal movement of the tongue and hinders the action of sticking it out (tongue protrusion). If this alters the proper development of oro-facial functions, it is called ankyloglossia.
In some babies, for example, this pathology causes difficulties in breastfeeding and nutritional problems. It is common for the baby to does not perform the sucking action correctly and does not latch on well to the breast. Damage to the mother’s nipple and pain during breastfeeding may occur. In general, a short frenulum is associated with difficulties in swallowing food.
In older children, it may also result in difficulties in speech, pronunciation of some phonemes such as “t”, “d”, “l”, “n” and “r”. In many cases, speech problems can be overcome with speech therapy.
Another problem is mechanical: the lack of mobility of the tongue causes inability to perform an internal oral self-cleaning, which can have repercussions on the appearance of dental pathologies. It also prevents licking the lips, generating their dryness, and, many times, playing wind instruments.
At the dental level, the tightness of the frenulum can generate recessions in the gums (they go down) and usually generate a separation between the lower central incisors (interincisal diastema), which must be corrected with orthodontics.
Labial frenulum problems
The same happens with labial braces when they are inserted too close to the teeth: they create a pathological space between the central incisors (diastema). A multidisciplinary diagnosis (pediatric dentist, orthodontist, surgeon and speech therapist) is important to determine the best treatment in each case.
The pathological labial frenulum is usually short and thick (hypertrophic), which limits lip mobility and often the correct pronunciation. It often happens that the patient cannot close his mouth naturally (lip seal) and this favors breathing through the mouth instead of through the nose, hindering oro-facial muscle development.
In addition, being more exposed to the outdoors, the labial frenulum is more likely to be traumatized by blows or falls. It can accidentally become severed, irritated or ulcerated, requiring urgent medical attention.
When and how to treat frenulum?
It has been observed that mild forms of ankyloglossia can resolve spontaneously with age. At the Puyuelo Dental Clinic we advise surgical treatment of the frenulum when the patient has difficulty in performing the correct functions, suffers pain, discomfort or tightness due to ankyloglossia.
The optimal time is during the infant’s breastfeeding period or at the beginning of school age (3 years) coinciding with the child’s literacy.
The surgical technique is frenectomy, which consists of cutting some fibers of the frenulum to give more mobility to the tongue or lip. In infants it is performed with a very fine scissors and the baby is encouraged to suckle immediately after the procedure. When children are older, it is advisable to use CO2 laser, a safe and effective technique because it does not cause bleeding, does not require sutures, requires less surgical time, does not cause post-operative infections and does not leave visible scars.
It is important that surgery be accompanied by speech therapy to restore pronunciation as soon as possible. The specialist will recommend daily frenulum stretching exercises to maintain its elasticity.
How long does a dental inlay last?
If the procedure is performed by a dentist specializing in dental restoration and esthetics and coordinated with an expert laboratory technician, the dental veneer provided by dental inlays is very strong, durable and will require no different maintenance than any other tooth.
Daily dental hygiene habits, such as a dental hygiene correct brushing after meals and flossing, as well as regular professional cleanings, are all that is needed to keep dental inlays and onlays in good condition and prevent caries from seeping between the natural tooth material and the bonded ceramic.
