A frenectomy is a minor surgical procedure involving the modification or removal of a frenum, a small band of connective tissue in the mouth. These tissues anchor the tongue to the floor of the mouth (lingual frenum) or the upper lip to the gum line (labial frenum). When a frenum is too thick, tight, or short, it restricts movement, a condition often called a “tie.” The specialist who performs the procedure depends primarily on the patient’s age and the clinical issue being resolved.
The Context of the Procedure by Patient Age
The need for a frenectomy varies significantly by age. In infants, the primary concern is resolving difficulties with feeding, such as poor latching during breastfeeding due to a restricted lingual frenum (tongue-tie). The procedure is also performed on the labial frenum (lip-tie), which can similarly impede feeding and may contribute to future dental issues.
In older children and adults, the clinical necessity shifts from feeding to other functional issues, such as improving speech articulation or preparing for orthodontic treatment. A restricted lingual frenum can hinder the tongue’s ability to make certain sounds, leading to speech impediments. A tight labial frenum can pull on the gum tissue, potentially causing gum recession or creating a persistent gap between the front teeth.
The difference in patient size, tissue density, and the need for anesthesia or sedation means that a specialist comfortable with that specific demographic is best suited to perform the surgery. Procedures range from a quick in-office laser treatment for an infant to a more complex surgical revision for an adult. The ultimate goal remains consistent: to improve oral function by releasing the restricting band of tissue.
Specialists Focused on Infant and Pediatric Cases
The earliest and most time-sensitive frenectomy cases, typically performed on newborns and young children, are managed by pediatric dentists and otolaryngologists. Pediatric dentists are highly trained in the oral anatomy and behavior management of infants and young children. Many pediatric dental offices use soft-tissue lasers for frenectomies, which allow for a precise, minimally invasive procedure with little to no bleeding and often faster healing times.
Otolaryngologists (ENT physicians) are also involved, particularly those with specialized training in head and neck surgery and airway issues. The ENT specialist’s focus on the entire upper airway and oral function makes them a qualified provider for diagnosing and treating restricted tongue movement. Both pediatric dentists and ENTs recognize that a restricted frenum can interfere with the complex coordination required for a proper suck and swallow reflex.
A lactation consultant (LC) often serves as the initial identifier of a frenum restriction in a breastfeeding infant, noting symptoms like a poor latch, clicking sound during feeding, or maternal pain. While the lactation consultant is trained to assess oral function and identify the need for a frenectomy, they do not perform the surgical procedure. Their role is to provide a functional assessment and recommend a referral to a trained surgical specialist for the actual treatment.
Dental and Surgical Providers for Older Patients
Frenectomies on older children, adolescents, and adults are handled by a different group of dental and surgical specialists, reflecting the increased complexity of tissue structure and clinical goals. General dentists may perform simple frenectomies, particularly labial releases, in their office on adults where the tissue is thin and the procedure is uncomplicated. These cases often involve using a scalpel or soft-tissue laser under local anesthesia.
For more complex cases, such as those involving thicker tissue that requires sutures or a patient who needs sedation, an oral and maxillofacial surgeon is often the preferred provider. Oral surgeons are trained to manage a full range of oral surgery procedures, including extensive tissue revision (frenuloplasty) or those requiring deeper anesthesia. Their expertise is valuable when the frenum issue is severe or when other oral health concerns are present.
Orthodontists frequently collaborate with surgical providers, as a tight frenum can negatively affect orthodontic treatment. A tight labial frenum, for instance, can prevent the natural closure of a gap between the upper front teeth, known as a midline diastema. The orthodontist often requires a frenectomy before or during treatment to ensure the gap can close and to prevent the frenum from pulling the teeth apart again after the braces are removed. This release also helps to prevent gum recession.