Who Performs a Frenectomy? From Infants to Adults

Frenectomies are performed by several types of healthcare providers, and the one you see depends largely on the patient’s age and the reason for the procedure. For infants with breastfeeding difficulties, pediatric ear-nose-throat doctors (otolaryngologists), pediatric dentists, and sometimes pediatricians or family physicians handle the procedure. For older children and adults, the field opens up to general dentists, periodontists, and oral and maxillofacial surgeons. The overlap between specialties is significant, and which provider you end up with often has more to do with referral patterns in your area than with a strict rule about who is qualified.

The Provider Landscape for Infants

When a newborn or young infant is diagnosed with tongue-tie or lip-tie, the procedure is usually called a frenotomy (a simple snip or release) rather than a full frenectomy (removal of the tissue). In practice, the terms get used loosely. The providers who most often perform these infant releases include otolaryngologists, pediatric dentists, and some general pediatricians or family doctors who have trained in the technique.

A recent survey of practice patterns found some clear differences in how these providers approach the procedure. Otolaryngologists were more likely to see younger infants, typically under two months old, while pediatric dentists more often reported seeing patients whose average age was over twelve months.¹ That pattern makes sense: ENT doctors are embedded in hospital systems and get early referrals from neonatologists and pediatricians, while dentists tend to enter the picture later when the child is already established in outpatient care.

Lactation consultants play a different but closely related role. They don’t perform the procedure themselves, but they are frequently the first professionals to identify a possible tongue-tie in a breastfeeding infant and to recommend evaluation. Their assessments of feeding quality before and after a release often drive the clinical decision about whether to proceed.

How Provider Choice Shapes the Experience

The same survey of pediatric practitioners revealed that your choice of provider doesn’t just determine who holds the instrument. It also affects what instrument they use, whether sedation is involved, and what happens after the procedure. Otolaryngologists were more likely to perform the release with scissors or a scalpel, while dentists were more likely to use a laser. About a third of surgeons reported always using sedation for frenotomy, whereas dentists were more likely to report no upper age limit for performing the procedure while the child is awake.¹

Post-procedure recommendations also diverge. Dentists were more likely than medically trained providers to recommend tongue exercises and to refer patients to physical therapy or bodywork after the release. Whether those exercises genuinely improve outcomes is a separate and debated question, but this difference in philosophy means that two families whose infants get the same basic procedure from different providers may walk away with quite different care plans.

Adults and the Shift Toward Periodontists and Oral Surgeons

The conversation around frenectomies tends to focus on babies, but adults get them too, and for different reasons. A thick or tight labial frenum (the tissue connecting the upper lip to the gum) can pull on the gum tissue between the front teeth, contributing to a gap between the central incisors or to gum recession. A restrictive lingual frenum in an adult can limit tongue mobility enough to affect speech comfort, swallowing, or even sleep.

For adults, the procedure is more commonly performed by periodontists and oral surgeons. A UK-based survey of oral surgeons and oral and maxillofacial surgeons found that a large majority believed a low, hypertrophic frenum can be an important factor in the development of a gap between the upper front teeth. More than half of respondents used a classical surgical technique exclusively, and the vast majority preferred a scalpel over electrosurgery or lasers.² That preference for the scalpel is a notable contrast with the pediatric dental world, where laser use has become widespread.

If the frenectomy is being done alongside orthodontic treatment to close a gap, the timing matters. The same survey found that oral surgeons preferred performing the frenectomy just before the orthodontic closure of the gap, while maxillofacial surgeons were less concerned about timing.² A study of patients aged 13 to 53 who had frenectomies for frenum-related gaps between their incisors found a significant decrease in the distance between teeth one year after surgery, suggesting the procedure can contribute to gap closure even without braces in some cases.³

Laser Versus Scalpel

Whether the provider uses a laser or a scalpel is one of the more practical questions for patients and parents. The short version: laser frenectomy tends to cause less pain and bleeding in the first few days, but by about a month out, the two approaches look similar.

A systematic review and meta-analysis of randomized controlled trials comparing diode laser with scalpel for labial frenectomies found that the laser group had significantly less pain on day one and day seven, markedly less bleeding during surgery, and shorter operating times (roughly seven minutes shorter on average). Swelling was not significantly different between the groups.⁴ The evidence certainty was rated low to very low, though, because most studies were small.

A broader review of diode laser frenectomy studies confirmed the pattern: less pain starting from the first day, faster early healing within the first week or two, better wound appearance at two weeks, but no meaningful difference at the 30-day mark.⁵ The laser seals nerve endings and cauterizes small blood vessels as it cuts, which explains both the reduced pain and the better hemostasis. One observational study found that all patients in the scalpel group had oozing from the surgical site on day one, compared to about a third in the laser group.⁶

For parents of infants, the practical takeaway is that a laser procedure is likely to involve less visible bleeding and less fussiness in the first few days. For adults choosing between the two, the reduced pain and faster early recovery may matter more if you need to eat and talk normally sooner. Neither approach is clearly superior for long-term outcomes.

Why Frenectomy Rates Have Surged

The number of frenectomies performed has climbed steeply over the past two decades, and the reasons behind that trend are worth understanding. In the United States, diagnoses of ankyloglossia (tongue-tie) jumped from roughly 3,900 children in 1997 to nearly 33,000 in 2012, with the steepest increase in the last six years of that period. Frenotomy procedures grew in parallel, from about 1,300 to over 12,400 during the same window.⁷

Canada saw a similar pattern: ankyloglossia rates tripled from about 7 per 1,000 live births in 2002 to nearly 23 per 1,000 by 2014, and frenotomy rates rose alongside them. Researchers have attributed this partly to increased efforts to promote breastfeeding and partly to the absence of standardized diagnostic criteria, which has led to what some describe as “runaway rates” of frenotomy in certain regions.⁸ In other words, more providers are looking for tongue-tie, the tools to identify it are not fully agreed upon, and the result is that far more babies are being diagnosed and treated than a generation ago.

This trend has prompted professional organizations to push for clearer guidelines. An evidence-based clinical practice guideline for managing ankyloglossia in breastfeeding infants issued twelve conditional recommendations, emphasizing that both anatomical and functional assessment should be used together and that frenotomy should be reserved for carefully selected cases where a restrictive frenum is clearly linked to feeding difficulties.⁹

Does It Actually Help Breastfeeding?

This is the question that matters most to the majority of parents considering a frenotomy. The evidence says yes, but with important caveats. A meta-analysis of studies measuring breastfeeding outcomes after frenotomy found that nipple pain dropped substantially within the first one to two weeks and remained improved at one month. Breastfeeding quality, measured by latch scores, also improved within the first week.¹⁰ A separate prospective study found that improvements in breastfeeding self-efficacy and reduced nipple pain persisted at one month after frenotomy, and improvements in reflux symptoms were still significant at six months.¹¹

The caveat comes from a review that pointed out something researchers have struggled to control for: sucking and feeding are inherently soothing to infants. Observed improvements immediately after a frenotomy might partly be a response to the pain of the procedure itself (the infant feeds more vigorously as a self-soothing behavior) rather than a direct result of improved tongue mobility.¹² This doesn’t invalidate the procedure, but it does explain why the research community remains cautious about declaring the evidence definitive. The practical reality is that many families experience meaningful improvement, but not all do, and predicting who will benefit remains imprecise.

Speech Outcomes Are Less Clear-Cut

For older children and adults, tongue-tie release is sometimes pursued to improve speech. The evidence here is muddier than for breastfeeding. A systematic review and meta-analysis found that frenectomy for tongue-tie was associated with an improvement in speech articulation overall, but also found that outcomes worsened with increasing patient age. In other words, younger children saw more benefit than older ones.¹³

But a smaller study that looked specifically at standardized speech articulation scores before and after tongue-tie release found no significant improvement. Average articulation scores barely budged, and intelligibility scores were essentially unchanged. The researchers concluded that ankyloglossia was not consistently associated with the kind of tongue-mobility-related speech errors the procedure is meant to fix.¹⁴ The discrepancy between these findings likely reflects the fact that most speech difficulties in children with tongue-tie are not caused solely by the restriction and that speech therapy may be the more important intervention, with or without surgery.

What Happens After the Procedure

One area where providers genuinely disagree is post-operative management, particularly whether tongue exercises and myofunctional therapy are necessary. A case report and discussion of rehabilitative exercises after lingual frenectomy described how muscle memory for restricted tongue movement persists even after the physical restriction is removed. The tongue has been compensating for years in some patients, and the muscles of the oral cavity have adapted. Post-surgical exercises aim to retrain the tongue, and in the cases described, noticeable improvement in tongue mobility emerged primarily after exercises were started, not immediately after surgery.¹⁵

A systematic review comparing surgical release alone with combined surgical and myofunctional therapy approaches found that surgery alone was mainly associated with anatomical changes and immediate mobility gains, while the combined approach was more frequently linked to broader functional improvements including tongue resting posture, swallowing, and oral coordination.¹⁶ A separate prospective study of children who underwent CO₂ laser lingual frenectomy paired with myofunctional exercises reported that parents saw improvement in speech in about 89% of patients, solid feeding in 83%, and sleep in 83%.¹⁷ Those are parent-reported numbers, not objective measurements, so they should be taken with a grain of salt, but they do suggest the pairing of surgery and exercises is doing something beyond what either does alone.

Complications Are Rare but Real

Frenectomy is generally considered a low-risk procedure, especially in older children and adults. But when it goes wrong, the complications can be serious. A systematic review of major complications after tongue-tie release identified 47 major complications across 34 patients. The most frequent problems included poor feeding after the procedure, hypovolemic shock from bleeding, apnea, acute airway obstruction, and a deep-space infection of the floor of the mouth called Ludwig angina. The procedures in those cases had been performed by dentists, lactation consultants, and otolaryngologists.¹⁸

The fact that lactation consultants appeared on that list of providers is significant. In most jurisdictions, lactation consultants are not licensed to perform surgical procedures, and the occurrence of serious complications after procedures performed by non-surgical providers has been part of the push for clearer scope-of-practice boundaries. For parents weighing the decision, the provider’s training and the clinical setting matter. A procedure done in an environment equipped to manage bleeding or airway issues is safer than one done in a setting without those resources, regardless of the provider’s title.

Costs and Insurance Coverage

The financial side of frenectomies is surprisingly opaque. In the United States, a national analysis found that $45.8 million was billed for infant surgical procedures related to ankyloglossia between 2010 and 2022. The cost per infant rose by a third over that period, and out-of-pocket costs more than doubled, from about $56 to roughly $118.¹⁹ Those figures represent insured patients whose procedures were billed through standard channels. Many frenectomies, especially those done by dentists using lasers, are paid out of pocket entirely and would not show up in medical claims data.

A survey from Southwestern Ontario illustrates the patchwork coverage many families encounter. About 23% of patients had costs covered by the provincial health insurance plan, roughly 19% were covered by private health benefits, but the majority paid between $1 and $800 CAD out of pocket. Patients with multiple oral ties (both tongue and lip) had significantly higher treatment costs.²⁰ The inconsistency in coverage reflects the broader uncertainty about the procedure: insurers are more likely to cover it when it’s ordered by a physician and performed in a medical setting than when it’s done by a dentist in private practice, even if the procedure is identical.

Frenectomy and Airway or Sleep Issues in Adults

An emerging and still-speculative area of interest is whether releasing a tight lingual frenum in adults might improve obstructive sleep apnea by allowing the tongue to sit in a more forward position. A case series of three adult OSA patients who underwent frenotomy found that two of the three showed improvement in tongue-level airway collapse during drug-induced sleep endoscopy, moving from complete to partial collapse at the tongue base. The third patient showed no change.²¹ Three patients is far too few to draw conclusions, but the logic is plausible enough that researchers are investigating it further. For now, frenotomy is not a recognized treatment for sleep apnea, and anyone considering it for that purpose should treat it as experimental at best.

Lower Labial Frenectomy in Adults

Most of the attention goes to tongue-ties and upper lip-ties, but the lower labial frenum (connecting the lower lip to the gum tissue between the bottom front teeth) sometimes needs treatment in adults when it contributes to gum recession or tooth sensitivity. A pilot study of adults who underwent lower labial frenectomy with a diode laser found that all patients in the sample had gum recession and tooth sensitivity before the procedure. Pain and dissatisfaction with the scar were universal through the fourth day, but by 30 days only one patient still reported residual pain.²² This is a small study, but it represents a niche that periodontists manage quietly and that rarely makes it into the mainstream discussion about frenectomies, which tends to revolve around infants and breastfeeding.

How Diagnostic Standards Vary Across Providers

One of the most underappreciated aspects of this topic is that different providers don’t just use different tools; they use different criteria for deciding whether a frenectomy is warranted in the first place. The practice-pattern survey found that fewer than half of providers who were aware of standardized lingual frenulum classification scores actually used them regularly. Instead, most relied heavily on clinical history and feeding evaluations to make their decisions.¹ This means that the same infant could be assessed by two equally qualified providers and receive two different recommendations, not because the science is ambiguous about that particular case, but because there’s no agreed-upon threshold for what constitutes a restriction that warrants surgery. Until diagnostic standardization catches up with the procedure’s popularity, seeking more than one opinion before proceeding is a reasonable strategy for any patient or parent navigating this decision.

1
PubMed. Pediatric frenotomy practice patterns: A survey of pediatric dentists, otolaryngologists and surgeons
2
Wiley Online Library. Labial Frenectomy: Current Clinical Practice Among a Sample of Oral Surgeons and Oral and Maxillofacial Surgeons in the United Kingdom
3
PubMed Central. Evaluation of the distance between the central teeth after frenectomy: a randomized clinical study
4
PubMed. Efficacy of diode laser versus conventional scalpel in labial frenectomy: a systematic review and meta-analysis of randomized controlled trials
5
PubMed Central. Efficacy of diode laser on healing in frenectomy compared to conventional frenectomy with scalpel
6
PubMed Central. Evaluating the Clinical Efficacy of Maxillary Labial Frenectomy Procedure Using Diode Laser (980 nm) and Conventional Scalpel: An Observational Study
7
PubMed Central. Ankyloglossia and Lingual Frenotomy: National Trends in Inpatient Diagnosis and Management in the United States, 1997-2012
8
Paediatrics & Child Health. Changes in the incidence and surgical treatment of ankyloglossia in Canada
9
Pediatric Dentistry. Evidence-Based Clinical Practice Guideline for Assessment and Management of Ankyloglossia in Infants With Breastfeeding Difficulties
10
PubMed Central. Quantitative impact of frenotomy on breastfeeding: a systematic review and meta-analysis
11
PubMed Central. Effect of frenotomy on breastfeeding and reflux: results from the BRIEF prospective longitudinal cohort study
12
PubMed Central. What is tongue-tie and does it interfere with breast-feeding? – a brief review
13
PubMed. Speech Outcomes of Frenectomy for Tongue-Tie Release: A Systematic Review and Meta-Analysis
14
PubMed. The Effect of Tongue-Tie Release on Speech Articulation and Intelligibility
15
PubMed Central. Postoperative Tongue Exercises for Ankyloglossia Following Lingual Frenectomy: A Case Report
16
Exploration of Medicine. Oral functional improvements in lingual hypomobility: a systematic review of surgical, myofunctional, and combined therapies
17
PubMed. Functional Improvements of Speech, Feeding, and Sleep After Lingual Frenectomy Tongue-Tie Release: A Prospective Cohort Study
18
PubMed. Major complications after tongue-tie release: A case report and systematic review
19
PubMed. Plateau in Growth or Losing Influence? Costs and Shifting National Trends of Ankyloglossia Treatment 2010-2022
20
International Journal of Pediatric Otorhinolaryngology. Incidence of oral tie diagnosis and treatment in Southwestern Ontario: A survey study
21
PubMed Central. Does Frenotomy Modify Upper Airway Collapse in OSA Adult Patients? Case Report and Systematic Review
22
SpringerLink. Clinical evaluation of pain perception and surgical wound healing after lower labial frenectomy with diode laser technique: pilot study