A frenectomy is a surgical procedure targeting a small band of soft tissue in the mouth called a frenum. This connective tissue membrane helps anchor the tongue and lips, but when it is too tight or short, it can restrict movement and cause functional problems. The procedure involves surgically modifying or removing the restrictive frenum to restore normal oral function. A frenectomy is considered a common procedure, performed on patients ranging from infants to adults.
What is a Frenectomy and Its Variations
The mouth contains several frena, which are folds of mucosal tissue attaching one structure to another. A frenectomy addresses two primary types of frena when they cause oral health or functional issues. The lingual frenum connects the underside of the tongue to the floor of the mouth, while the labial frenum connects the inside of the upper or lower lip to the gum tissue.
A lingual frenectomy corrects ankyloglossia, or “tongue-tie,” where the tether is unusually short or thick. This procedure increases the tongue’s range of motion, which is necessary for proper articulation and swallowing. A labial frenectomy is most often performed on the maxillary frenum, connecting the upper lip to the gum line between the two front teeth.
The procedure performed on the tissue attaching the lower lip to the gums is called a mandibular labial frenectomy. Though less common than the upper lip procedure, it is also performed to address tension and potential gum recession. The goal of any frenectomy is to release the restricting tissue, allowing the corresponding structure to move freely and fully.
Clinical Reasons for Needing a Frenectomy
The necessity of a frenectomy is determined by the functional or aesthetic problems caused by the restricted frenum. For infants, a tight lingual frenum frequently causes breastfeeding difficulties, preventing the tongue from creating proper suction and latch. This restriction can lead to poor weight gain and pain for the nursing parent. In children and adults, a tight lingual frenum can impede the ability to pronounce specific sounds, leading to speech impediments.
For the labial frenum, intervention often relates to dental structure and periodontal health. An overly thick or low-inserting maxillary frenum can create a persistent gap between the two front teeth, known as a diastema, even after orthodontic treatment. Tension from a restrictive labial frenum can also pull on the gum tissue attached to the teeth. This constant pulling causes gingival recession, exposing the tooth root and increasing the risk of sensitivity, decay, and periodontal issues.
In adults, a frenectomy may also be required to ensure the proper fit and stability of a denture. If the frenum is too close to the gum line, the movement of the lip or cheek while speaking and eating can dislodge the prosthetic. For any of these issues, the procedure is considered medically necessary to restore optimal function, oral health, or prosthetic stability.
The Procedure and Post-Operative Care
A frenectomy is typically a quick, outpatient procedure performed under local anesthesia. The traditional method involves using a scalpel to make an incision and then either remove or reposition the restrictive tissue, which usually requires the placement of sutures to close the wound. A common alternative is the use of a soft tissue laser, which has become increasingly popular due to its precision and benefits.
The laser technique often results in less bleeding because the laser cauterizes the tissue as it cuts. This method frequently eliminates the need for stitches and can speed up the overall healing process. Regardless of the technique used, the procedure usually takes only a few minutes to complete, and the patient can return home shortly after.
Post-operative care is crucial for a successful recovery, especially following a lingual frenectomy. To prevent the tissue from reattaching as it heals, specific stretching exercises are usually prescribed. These exercises, involving gently massaging and moving the tongue or lip, must be performed multiple times a day for several weeks.
Pain management is generally achieved with over-the-counter pain relievers such as acetaminophen or ibuprofen, and the discomfort is typically mild and short-lived. Patients are often advised to maintain a soft, cool diet for the first few days to protect the surgical site. Avoiding the use of straws is also recommended, as the suction created can disrupt the healing process or cause bleeding.
Accessing Frenectomy Services through VA Dental
The Department of Veterans Affairs (VA) provides dental care to eligible veterans, but coverage is not universal and depends on specific eligibility criteria. Full, comprehensive dental benefits are typically reserved for veterans with a service-connected dental disability that is rated compensable or for those with a 100% service-connected disability rating. Former Prisoners of War also qualify for any needed dental care.
For a specialized surgical procedure like a frenectomy, coverage hinges on medical necessity and the veteran’s eligibility classification. If a VA dental professional determines the frenectomy is necessary to treat a condition complicating an existing service-connected medical issue, the procedure may be covered. Veterans who do not meet full eligibility requirements may still qualify for a one-time course of care if the procedure is needed to relieve pain or treat a condition that severely complicates their health.
If a veteran is eligible and the VA dental clinic cannot perform the procedure, a referral is initiated for community care. The VA dental provider submits a referral request, which includes detailed documentation and the specific dental procedure code, such as D7963 for a frenectomy. The VA’s community care team then coordinates the authorization and scheduling with an approved external dental specialist. All dental care provided outside of a VA facility must be pre-authorized by the VA to ensure coverage and prevent the veteran from receiving an unexpected bill.