We are often asked to see young children when there are concerns about the upper labial fraenum (this is the fleshy bit of skin between the upper lip and between the upper front teeth) causing a gap (diastema) between the upper front deciduous (baby) teeth. In fact, surgery is rarely indicated in these situations. The best way to think about this labial fraenum and the gap between the front teeth is that it is an effect and not the cause of the gap between the front teeth. The gap will usually close without any intervention when the upper permanent eye teeth erupt. By in large, an upper labial fraenectomy (removal of the fleshy bits of skin between the upper lip and the upper front teeth) should only be performed when there are specific indications. In the vast majority of times as your child grows the frenum becomes less prominent. There is debate as to what role the fraenum plays when there is a gap between the front teeth, as it is natural to have some spacing in baby teeth. We would not recommend performing an upper lip frenectomy until the adult canine teeth have erupted at age 11 or 12, as most often the gap will spontaneously close. Furthermore, if there is a gap when the permanent canines (eye) teeth erupt, a labial fraenectomy will not cause the space to close and it can only be closed with orthodontics. Generally speaking spacing between the adult front teeth is a genetic phenomenon and if there is no family history, it is unlikely to occur in your child's teeth. Only very rarely will a low lying fraenum cause pain, difficulty eating and speaking, or gum problems. However, a child may need to get a fraenectomy earlier if the labial fraenum:
- Makes it difficult for the child to keep their teeth clean
- Is pulling on the gums causing them to recede
- Causes the child pain
- Makes it difficult for the child to eat or speak
This is a photograph of a normal position for a labial fraenum during orthodontic treatment and following the eruption of the upper canines.
A lingual frenectomy (tongue tie) is more commonly performed, but once again only for specific reasons. A very pronounced tongue tie may cause feeding problems in babies, and may on occasions interfere with speech in the older child. When there is a significant tongue tie, this procedure can be performed at any age.