What Happens During a Pediatric Frenectomy (and Why It’s So Quick)

What Happens During a Pediatric Frenectomy (and Why It’s So Quick)

If you’re a new parent, you probably spend a lot of time analyzing your baby’s every move. Are they latching correctly? Is that sound normal? Why is feeding taking so long? If you’ve been struggling with breastfeeding or noticed your child having difficulty with speech or eating, you might have heard the terms “tongue-tie” or “lip-tie.”

These common conditions can cause significant stress for families, but there is a straightforward solution: a procedure called a frenectomy. It sounds like a serious medical term—and hearing it can be intimidating—but the reality is much less scary. A pediatric frenectomy is a routine, fast, and often life-changing procedure that can resolve feeding and speech issues almost immediately.

This guide will walk you through exactly what happens during the procedure, why it’s necessary for some children, and how Evergreen Pediatric Dentistry ensures the process is smooth and comfortable for your little one.

Understanding the Anatomy: What is a Frenulum?

Before diving into the procedure itself, it helps to understand the anatomy involved. Everyone has frenula (the plural of frenulum) in their mouth. A frenulum is a small fold of connective tissue that restricts the movement of a mobile organ in the body.

In the mouth, these bands of tissue attach the lips to the gums and the tongue to the floor of the mouth. Their purpose is to provide stability to these structures. However, sometimes this tissue is too short, too thick, or attached too tightly, which restricts necessary movement. When this happens, it affects how the mouth functions, leading to the issues commonly known as tongue-ties or lip-ties.

It is important to note that having a frenulum is normal. It only becomes a “tie” or a medical concern when it hinders function.

Types of Frenula That May Require a Frenectomy

While there are several frenula in the oral cavity, there are two specific types that pediatric dentists focus on most frequently:

The Lingual Frenulum (Tongue-Tie)

This is the band of tissue connecting the underside of the tongue to the floor of the mouth. You can see it if you lift your tongue up.

• The Issue: When this tissue is too tight or short (Ankyloglossia), it holds the tongue down, preventing it from lifting, extending, or moving side-to-side.
• The Impact: For infants, the tongue needs to elevate and cup the breast or bottle nipple to create a vacuum for milk extraction. If the tongue is tied down, the baby compensates by chewing or using their gums, causing pain for the nursing parent and inefficient feeding for the baby. In older children, a restricted tongue can affect speech articulation (particularly sounds like t, d, z, s, th, n, and l) and the ability to clear food from the teeth.

The Labial Frenulum (Lip-Tie)

This tissue connects the upper lip to the gum tissue just above the two front teeth.

• The Issue: A tight labial frenulum keeps the upper lip tethered to the gum line, preventing it from flanging outward.
• The Impact: In infants, a good latch requires the lips to flare out (like a fish). A lip-tie forces the lip to curl inward, breaking the seal and causing the baby to swallow air (aerophagia), leading to gas and colic. In older children, a severe lip-tie can cause a gap (diastema) between the two front permanent teeth or make it difficult to brush the gum line effectively, increasing the risk of cavities.

What Exactly is a Frenectomy?

A frenectomy is the surgical release of these restrictive tissues. The goal is not to remove the frenulum entirely but to release the tension so the lip or tongue can move freely.

Historically, this was done with scissors or a scalpel. While those methods are still used in some settings, modern pediatric dental practices often utilize laser technology. Laser frenectomies are the preferred method for many practitioners because they are incredibly precise. The laser energy vaporizes the tissue rather than cutting it, which instantly cauterizes the wound. This means there is minimal bleeding and a significantly reduced risk of infection compared to traditional surgical methods.

Why Would a Child Need a Frenectomy?

The decision to proceed with a frenectomy is usually based on function rather than just appearance. Just because a tie is visible doesn’t mean it needs to be corrected. However, when the restriction impacts daily life, intervention is recommended.

Infant Feeding Challenges

This is the most common reason for the procedure. Symptoms that suggest a revision might be necessary include:

• For the Mother: Cracked, bleeding, or flattened nipples; severe pain during nursing; mastitis or plugged ducts; low milk supply due to incomplete drainage.
• For the Baby: Poor weight gain (failure to thrive); clicking noises while feeding; dripping milk; prolonged feeding sessions; symptoms of reflux, colic, or excessive gas; inability to hold a pacifier.

Speech and Development

As children grow, untreated ties can lead to new challenges.

• Speech Delays: Difficulty articulating sounds that require the tongue to touch the roof of the mouth.
• Solid Foods: Difficulty managing solid textures. The tongue is responsible for moving food around the mouth to be chewed and swallowed. A restricted tongue may lead to gagging or choking hazards.

Dental Health and Sleep

Long-term, untreated ties can influence the shape of the dental arch (causing crowding) and are even linked to mouth breathing and sleep apnea, as the tongue’s resting posture affects airway development.

Preparing Your Child for the Procedure

If you have consulted with a lactation consultant, pediatrician, or speech therapist and determined that a frenectomy is the right step, the next phase is preparation. At Evergreen Pediatric Dentistry, the team prioritizes parental education and comfort.

For infants, preparation is minimal. It is often recommended to feed the baby shortly before the appointment so they are not hangry, but not so full that they might spit up if they cry.

For older children, preparation involves simple, honest communication. You might explain that the dentist is going to “help their tongue wiggle better.” Avoid using words like “cut,” “pain,” or “shot.” Instead, focus on the laser being a “special light” and the doctor helping them eat or speak more easily.

On the day of the appointment, bring comfort items. A favorite blanket or stuffed animal can help an older child feel secure. For babies, having a pacifier or a bottle ready for immediately after the procedure is helpful.

Step-by-Step: What Happens During the Procedure?

One of the most surprising aspects of a pediatric frenectomy is how quickly it is over. The actual laser release often takes less than a minute. However, the appointment involves several steps to ensure safety and precision.

The Examination

Even if you have a referral, the dentist will perform a thorough examination. They will assess the mouth’s anatomy and, crucially, its function. For babies, they may place a gloved finger in the mouth to test suction strength and tongue elevation. For older kids, they may ask them to stick out their tongue or move it side to side.

Stabilization and Safety

Safety is paramount. For infants, the baby is typically swaddled comfortably to prevent sudden movements. Protective eyewear is placed on the child (and anyone else in the room) to shield eyes from the laser light. Parents are often allowed to stay in the room to comfort the child, though protocols vary by clinic.

Numbing

While the procedure is very quick, patient comfort is a priority. A topical anesthetic gel (numbing jelly) is applied to the frenulum. This works quickly to numb the surface tissue. In some cases, a small amount of local anesthetic might be used for older children with thicker tissue, but often the topical gel is sufficient for the laser procedure.

The Release

This is the main event, and it is incredibly fast. The dentist uses a specialized soft-tissue laser to release the frenulum.

• Precision: The laser removes the tissue layer by layer.
• Cauterization: As it releases the tissue, it seals the nerve endings and blood vessels. This is why there is very little bleeding and why the pain is manageable.
• Duration: The actual release takes about 10 to 15 seconds per site.

Immediate Results

Once the tissue is released, the dentist checks the range of motion immediately to ensure the restriction is gone. If a baby was tongue-tied, the parent is often encouraged to breastfeed or bottle-feed immediately in a private recovery room. Many mothers report an instant improvement in latch and a reduction in pain.

Why Is It So Quick?

Parents are often stunned when the dentist says, “We’re all done,” just moments after starting. The speed is due to the efficiency of the laser technology and the small nature of the surgical site. The frenulum is a thin band of tissue. Unlike complex dental surgeries involving bone or deep roots, this is a soft-tissue procedure. The laser acts as both the cutting instrument and the bandage (by sealing the wound), eliminating the need for sutures in most infant cases.

The Recovery Phase: What to Expect

While the procedure is fast, the healing process requires diligence from parents to ensure the best results.

Immediate Aftermath

It is normal for a baby to cry during the procedure—mostly because their mouth is being held open and they are being swaddled, which can be frustrating. However, because the laser seals nerve endings, the acute pain diminishes rapidly. Most babies calm down as soon as they are held and fed.

The Healing Patch

A small diamond-shaped wound will be visible under the tongue or lip. It will initially look white or yellow—this is not infection; it is a “wet scab” and a sign of healing. It usually heals completely within two weeks.

Pain Management

Discomfort is usually mild. For infants, skin-to-skin contact and frequent feeding are the best pain relievers. If necessary, your pediatric dentist at Evergreen Pediatric Dentistry may recommend an age-appropriate dose of Tylenol.

The Importance of Stretches

This is the most critical part of aftercare. The mouth heals very quickly, and moist tissues like to stick back together. If the wound edges heal together, the tie can reattach, rendering the procedure ineffective.
To prevent this, parents must perform “stretches” or “active wound management” several times a day for a few weeks. This involves:

1. Washing hands thoroughly.
2. Lifting the lip or tongue to reveal the diamond-shaped wound.
3. Gently rubbing or stretching the area to keep the raw surfaces apart.

The team at Evergreen Pediatric Dentistry will demonstrate these exercises before you leave the office. While it can be emotionally difficult to stretch a wound in your child’s mouth, remember that it is not causing them immense pain, and it is crucial for preventing a second surgery.

When to Call the Dentist

Complications are rare, but it helps to know what to look for. You should contact your provider if you notice:

• Uncontrolled bleeding (more than a tiny spot).
• Refusal to feed for more than a few hours.
• Fever.
• Signs of infection (redness spreading around the site, though the white patch itself is normal).

A Small Procedure with Big Benefits

Navigating medical decisions for your child can be overwhelming. However, understanding the frenectomy treatment process demystifies the experience. It is a quick, safe, and highly effective way to improve your child’s ability to eat, speak, and thrive.

If you suspect your child has a tongue or lip tie, or if you are struggling with breastfeeding pain, don’t wait it out. A consultation can provide answers. The compassionate team at Evergreen Pediatric Dentistry is experienced in diagnosing and treating oral restrictions with the latest technology and a gentle touch.

Evergreen Pediatric & Airway Dentistry
Dr. Susan Kim
12910 Totem Lake Blvd NE #103
Kirkland, WA 98034
(425) 814-3196
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evergreenkidsdentist.com