The frenulum is a small band of soft tissue connecting a movable part of the mouth to a fixed part. The upper lip frenulum attaches the upper lip to the gum line, located on the midline between the two upper central teeth. While everyone has this tissue, its appearance and length vary widely. A lip tie occurs when the frenulum is unusually thick, short, or tight, restricting the upper lip’s normal range of motion. Understanding the differences between a typical frenulum and a restricted one is the first step toward determining if an issue exists.
Understanding the Normal Upper Lip Frenulum
A normal upper lip frenulum is a fold of mucosal tissue connecting the inner surface of the upper lip to the gum tissue above the front teeth. Its function is to stabilize the lip’s position relative to the teeth and gums while controlling excessive movement. Typically, the frenulum attaches high on the gum line, which allows the upper lip to move freely.
When the upper lip is lifted, a normal frenulum appears thin and flexible, stretching without causing the surrounding gum tissue to blanch or turn white. This flexibility permits the upper lip to evert, or flare outwards, completely. This action is important for oral functions, such as creating a seal during feeding. A frenulum is considered normal if its attachment does not interfere with oral hygiene, is not pulling on the gum tissue, and permits unrestricted lip movement.
Visual Identification of Restricted Lip Ties
Identifying a restricted lip tie involves assessing the frenulum’s thickness, attachment point, and the resulting mobility of the upper lip. A tight frenulum may appear as a prominent, thick, or fan-shaped band of tissue. This tissue sometimes extends very close to or even between the front teeth. The severity of the restriction is often described by where the frenulum inserts into the gum tissue.
When the upper lip is gently lifted, a significant visual cue for restriction is the blanching, or whitening, of the gum tissue at the attachment point. This blanching indicates tension and suggests the tissue is pulling excessively on the gums, limiting upward movement. Further signs of tethering include an inability to fully evert the upper lip to expose the gum line, or a visible crease in the upper lip below the nose when the mouth is open wide.
Functional Issues Associated with Lip Ties
The physical restriction caused by a lip tie impairs the ability of the upper lip to move and seal properly, which is foundational to effective oral function. In infants, this restriction frequently translates into difficulty creating and maintaining a seal during feeding. The baby may struggle to latch deeply onto the breast, resulting in a shallow latch, clicking sounds while nursing, or milk leaking from the sides of the mouth.
An ineffective latch can quickly lead to poor milk transfer, causing the infant to have prolonged feeding sessions, excessive gas from swallowing air, and sometimes slow weight gain or failure to thrive. The mother or caregiver may also experience symptoms, including maternal pain, cracked or bleeding nipples, and sometimes recurrent plugged ducts or mastitis due to incomplete breast drainage.
Beyond infancy, a tight frenulum can lead to other issues as the child grows. The constant pull on the gum tissue can create a noticeable gap, or diastema, between the two upper central incisors. Furthermore, the restricted lip movement can make it difficult to effectively clean the front teeth, potentially increasing the risk of tooth decay and gum disease due to trapped food and poor hygiene.
Professional Diagnosis and Management Options
A comprehensive diagnosis of a lip tie requires more than just a visual inspection of the tissue’s attachment point. Professionals rely on a physical examination combined with an assessment of the functional impact on feeding or other oral activities. Professionals involved in this assessment include pediatricians, lactation consultants, and pediatric dentists.
If a lip tie is suspected, the initial management often includes non-surgical approaches, such as working with a lactation consultant to improve feeding techniques and positioning. In cases where the tie causes significant functional problems, such as feeding difficulties that affect weight gain or cause maternal pain, a surgical intervention may be considered.
The common surgical procedure is a frenotomy or frenectomy, which involves releasing the tight frenulum tissue to restore full mobility to the upper lip. This is typically a quick, in-office procedure that can be performed using sterile scissors or a soft-tissue laser. The goal of the procedure is to eliminate the tethering so the lip can move freely, allowing for improved latching and overall oral function.