A frenum is a vertical band of soft tissue in the mouth. The most common frenums are located between the upper lip and top teeth and between the tongue and the gum tissue behind the lower incisors. If the tissue is too tight or too thick it can cause a multitude of problems such as: poor latch when breast feeding, inadequate tongue movement during swallowing and speech, gum recession and/ or asymmetrical gum levels. In these cases, a frenectomy can be performed with a diode laser to remove this soft tissue attachment.
Benefits of Laser Frenectomy
The benefits of laser frenectomy compared to traditional surgical techniques have been shown in literature to include:
- Reduced bleeding during surgery with consequent shorter operating time and rapid post-operative control of bleeding, thus eliminating the need for sutures.
- Improved post-operative comfort and healing.
Post-op instructions after Laser Frenectomy
- Avoid sharp, spicy, and acidic foods/ liquids for the first 48 hours.
- Post op discomfort will likely be mild and can be managed with Tylenol or Motrin following the instructions on the back of the bottle. A stronger medication may be prescribed if the doctor feels it will be needed. Do not hesitate to call the doctor if you have any questions regarding medications.
- A “white soft scab” will appear for the first 7-10 days while the frenectomy site is healing. This is not an infection and is simply a covering over the healing soft tissue.
- Lasers are antibacterial so infection is very unlikely.
- For the first 48 hours, cold beverages, ice cream, or popsicles can be applied gently to the surgical site to help minimize swelling.
- Brush your teeth normally but be careful not to disrupt the soft tissue while it is healing. Avoid mouthwashes and rinses for the first 24 hours. These may “sting when used. You may use a warm salt water rinse after 24 hours.
- It is important to move and exercise your tongue almost immediately after treatment
The purpose of post-op exercises
Post-operative exercises following tongue-tie surgery are not intended to increase muscle-strength or to improve speech, but to:
- Develop new muscle movements, particularly those involving tongue-tip elevation and protrusion, inside and outside of the mouth.
- Increase kinesthetic awareness of the full range of movements the tongue and lips can perform. In this context, kinesthetic awareness refers to knowing where a part of the mouth is, what it is doing, and what it feels like.
- Encourage tongue movements related to cleaning the oral cavity, including sweeping the insides of the cheeks, fronts, and backs of the teeth, and licking right around both lips.
Will the exercises improve speech?
The exercises will not improve speech. If you want to improve speech, you have to work on speech.
The exercises must be individualized
Discuss these suggested exercises with YOUR child’s speech-language pathologist / speech and language therapist before commencing them as they may not be suitable for your child. The SLP/SLP will modify them according to your child’s age and requirements.
Encourage oral play
Encourage oral play generally, and do a selection of the following exercises, in any order, in 3-t0-5-minute bursts, once or twice daily for 3-4 weeks post-operatively. Have a flashlight and hand-mirror handy. Make it fun.
Exercises
- Stretch your tongue up towards your nose, then down towards your chin. Repeat.
- You can vary the exercise above and make it more interesting by putting a dab of food in various positions above the top lip, to be retrieved with the tongue tip (You could call this game ‘Elephant Tongue’ and read books about elephants (e.g., ‘Babar’) to stimulate your child’s interest in playing the ‘tongue games’ spontaneously at other times – not just when you are there.
- Open your mouth widely. Touch your big front teeth with your tongue with your mouth still open. Can you FEEL how tough your teeth are?
- Look in the mirror. Still with your mouth open wide, say dar-dar-dar, now say nar-nar- nar, now say tar-tar. Look in the mirror to see what your tongue is doing. Can you FEEL where it is?
- Lick your whole top lip from one side to the other. Now go back the other way.
- Lick your whole bottom lip from one side to the other. Go back the other way.
- See how many times you can lick your lips right around.
- Poke your tongue out as far as it will go.
- Shut your mouth and poke it into your left cheek to make a lump.
- Do the same on the other side.
- Now see if you can make your top lip fat without opening your mouth.
- Can you go in-out-in-out-in-out with your tongue? (demonstrate)
- Put your tongue behind your teeth and shut your mouth. Can you find your big top teeth with your tongue while your mouth is still shut? FEEL how tough your teeth are.
- Play your own version of copycats, Simon Says or Follow the Leader incorporating the preceding movements.
