PICTURE A
Source: http://www.monadnockorthodontics.com
What is a frenum and how can it obstruct normal oral functions?
A mother of a teenage boy aged 14 recently brought her son for a dental check up, complaining that her son has difficulty in pronouncing certain letters, particularly when reciting the Quran. The dentist attending to the boy remarked that he has a high lingual frenum attachment which may require minor surgery (frenectomy).
Now, what is a frenum? A frenum is a fibrous band that connects two structures in your mouth. Its function is to provide stability of the lips and tongue. When you lift you upper lip, do you notice a thin fibrous band connecting your upper lip to you gum? That is the upper labial frenum, as shown in Picture A.
Another major frenum that can cause abnormality in speech is lingual frenum. When you lift your tongue, you can see a fibrous band running from the floor of your mouth to the tongue. If the band runs all the way to the tip of the tongue (refer Picture B), its high attachment may restrict the tongue movement, causing a person to be tongue-tied.
PICTURE B
Source: http://www.monadnockorthodontics.com/
Tongue tie or ankyloglossia is common in children and can affect feeding, speech and oral hygiene. Severe ankyloglossia in young children can also hamper normal development of bite and orofacial (mouth and face) muscles which can cause various types of teeth and skeletal misalignment later in life.
The normal site for an upper labial frenum to be attached is at the gum above your upper front teeth (incisors). However, if it is attached to the gum between your teeth or even causing your two central incisors to be separated (Picture C), the frenum is considered to be highly attached. High upper labial frenum attachment is one of the causes of gaping between your upper front incisors and can be corrected with orthodontic treatment and frenectomy.
PICTURE C
Source: http://intanberlian87.blogspot.com/p/dentistry.html
High upper labial frenum as also cause gum (gingival) recession as shown in Picture D. Note the receding gum line of the involved tooth compared with the adjacent teeth. This is caused by tension from lip movement pulling the gum away from the tooth, which can form a gum pocket and further cause plaque accumulation and recurrence of periodontal disease.
You must be wondering what a frenectomy is and when and why you might need one? Frenectomy is simply the removal of a frenum. It is indicated when you or your child experience the complications of high frenum attachment as described in the previous paragraphs. It is a simple procedure done under local anaesthesia. First the frenum will be numbed with anaesthetic agent and the fibromuscular attachment will be released. Then the tissue is allowed to heal. When the tissue heals, normal function and mobility will be regained.
PICTURE D
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It is important to note that frenectomy of upper labial frenum causing a gap between the upper front teeth should be delayed until all permanent teeth have erupted as the gap during mixed dentition stage (where there are both milk teeth and permanent teeth in the mouth) could be temporary and will be closed when all permanent teeth erupt. However, it is prudent to consult a dentist or orthodontist so that he or she can provide a more detailed information and treatment options specific to your case.
Dr. Husna Razak (BDS) (KLE VK) is a dental officer working in the Oral and Maxillofacial Surgery Department in Kota Bharu.
References
- Carranza’s Clinical Periodontology, 10th edition
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]